Alarm over rising deaths due to antimicrobial resistance

Bacterial infections that could not be cured by antibiotics because of resistance to drugs killed more people than HIV/Aids and malaria did in 2019, a new global study has found.

The study was conducted in 204 countries, including Kenya. Principal researchers were from the Kenya Medical Research Institute (Kemri)—Wellcome Trust Research Programme and the Centre for Global Health Research, Kemri, Kisumu.

They found that more than 1.2 million deaths in 2019 were directly linked to treatable antibiotic-resistant bacterial infections and an overall 4.95 million people had related deaths. This was compared with 860,000 HIV/Aids deaths and 640,000 malaria deaths in the same year. 

“If all drug-resistant infections were replaced by no infection, 4·95 million deaths could have been prevented in 2019, whereas if all drug-resistant infections were replaced by drug-susceptible infections, 1·27 million deaths could have been prevented,” said the researchers.

This phenomenon is called antimicrobial resistance (AMR) and is touted by scientists as a ‘silent pandemic.’

Simple infections

Dr Evelyn Wesangula, who is in charge of the AMR programme at the Health ministry, explains that AMR occurs when microorganisms are no longer able to be suppressed or killed by antimicrobial agents.

“What this means is that simple infections cannot be treated by the commonly available antimicrobial agents, resulting in increased length of stay in hospitals as some of the microorganisms that cause infections are resistant to antibiotics.

“This means patients develop multidrug resistance to antibiotics and require antibiotics of a higher class to treat that infection, which is most likely to be very expensive, thus increasing the cost of care and if nothing happens, we end up losing the patient.” she told Saturday Nation.

Children, and people living in Sub-Saharan Africa were the hardest hit. In every five children, one died from antimicrobial resistant complications.

“Our analysis showed that AMR all-age death rates were highest in some low- and middle-income countries, making AMR not only a major health problem globally but a particularly serious problem for some of the poorest countries in the world,” revealed the study.

Tim Jinks, head of Intervention, Infectious Disease at Wellcome Trust who commissioned the research, believes it is time African leadership stepped forward and give African solutions to AMR.

“Countries are not prioritising the implementation of their national action plans and now the GRAM report should serve as a call to action. By last year, 39 countries had developed their plans, but few have implemented them,” Mr Jinks said.

The researchers compared the leading causes of death in 2019, with AMR coming third after Ischaemic heart diseases and stroke. “The list was intended to inform research and development priorities related to new antibiotics and put the most emphasis on pathogens with multidrug resistance that cause severe and often deadly infections in healthcare and nursing home settings,” their report said.

According to the Centers for Disease Control and Prevention (CDC Kenya), AMR is one of the most significant global public health problems and is rising in many countries due to over-use of antibiotics, widespread availability of counterfeit or substandard medicines and poor infection prevention and control measures.

 From the findings, the country is already experiencing increasing levels of antimicrobial resistance due to a lack of systematic surveillance and so the exact burden of AMR in Kenya is unknown.

Limited diagnostic capability

“The GRAM report estimates are much higher in Sub-Saharan Africa but the report does not breakdown the data per country because of limited diagnostic capability and surveillance in the region,” Mr Raphael Chanda who is a senior policy advisor at ReAct Africa told Nation.

Dr Wesangula explains that when prescriptions are done poorly or patients use the prescriptions poorly, it gives the microorganisms an opportunity to become stronger and develop resistance. She explains the burden in low, middle income countries such as Kenya.

 “When the lab results come out and you have 70 per cent resistance, it is very worrying and leaves us with little or no option to discard that drug and pick up another drug yet looking at the population and availability of this drugs we are not as privileged as countries in the west that has access to cheap and affordable medical care.”

In 2016, when British economist Jim O’Neill was tasked by former UK Prime Minister David Cameron to chair a review on Antimicrobial resistance, the report indicated that the estimated global death resulting from AMR at the time was 700, 000.

“The magnitude of the problem is now accepted. We estimate that by 2050, 10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug-resistant infections if we do not find proactive solutions now to slow down the rise of drug resistance,” said the O’Neill report.

Adding: “AMR also has a very real economic cost, which will continue to grow if resistance is not tackled. The cost in terms of lost global production between now and 2050 would be an enormous 100 trillion USD if we do not take action.”