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Following a number of deaths due to this phenomenon, KAZEEM BIRIOWO examines how antimicrobial resistance has become an increasing concern in Nigeria, and how the Nigerian government, working with global health organisations, can reduce the scourge.
Antimicrobial resistance (AMR) is a global health threat that has been described as a “silent tsunami” by the World Health Organisation (WHO).
AMR is when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines used to treat them. This makes infections harder to treat and increases the risk of disease spread, severe illness, disability, and death.
AMR is a natural process, but human activity, such as the misuse and overuse of antimicrobials, accelerates its emergence and spread. Microorganisms that develop resistance to antimicrobials are sometimes called “superbugs”.
AMR affects all countries, but Africa is likely to bear the heaviest burden.
The burden of AMR is felt disproportionately in low- and middle-income countries, including Nigeria, where the healthcare system is already overburdened.
AMR represents a global challenge as 4.95 million people who died in 2019 suffered from drug-resistant infections. AMR directly caused 1.27 million of those deaths and one in five of those deaths occurred among children under five years old.
In the GBD region of Western Sub-Saharan Africa, Nigeria has the seventh highest age-standardised mortality across 19 countries
Deadly effects of AMR
There are several victims of AMR in Nigeria, some of whom are no longer alive. Those who Nigerian Tribune spoke with were comfortable with just their surnames being used.
Mrs Adebayo, a 35-year-old mother of two, knows firsthand the devastating effects of AMR. Her seven-year-old son, Tunde, was diagnosed with pneumonia and was treated with antibiotics.
However, the antibiotics proved ineffective and Tunde’s condition worsened. He was eventually diagnosed with a multidrug-resistant form of pneumonia which required more expensive antibiotics.
“We were devastated when we found out that the antibiotics were not working,” Mrs Adebayo said.
“We had to sell our belongings to afford the more expensive antibiotics. It was a very difficult time for us.”
Similarly, Mr Okoro, a 42-year-old businessman, also has a personal experience with AMR. His 65-year-old mother was diagnosed with a urinary tract infection and was treated with antibiotics.
However, the antibiotics were ineffective, and her condition worsened. She eventually died from complications related to the infection.
“The death of my mother was a devastating blow to our family,” Mr Okoro said.
“We were not aware of the risks associated with AMR and we did not know how to prevent it. We hope that our story can serve as a warning to others and encourage them to take action to prevent AMR.”
Miss Chukwu, a 28-year-old nurse, has seen the devastating effects of AMR almost on a daily basis. She works in a hospital in Lagos, where she has seen many patients die from infections that were resistant to antibiotics.
“It is heartbreaking to see patients die from infections that could have been treated with antibiotics,” Miss Chukwu said. “We need to do more to prevent AMR and ensure that antibiotics are used responsibly.”
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Causes and consequences of AMR in Nigeria
According to the WHO, the causes of AMR in Nigeria are multifaceted and interconnected. Some of the key causes include misuse and overuse of antibiotics which are major drivers of AMR.
In Nigeria, antibiotics are often prescribed inappropriately and patients often demand antibiotics for viral infections, which do not respond to antibiotics.
Also lack of National Antibiotic Guidelines in Nigeria contributes to the misuse of antibiotics. Healthcare professionals often rely on personal experience and judgment when prescribing antibiotics rather than following evidence-based guidelines.
General awareness and understanding of AMR in Nigeria is poor. Many healthcare professionals and the general public are not aware of the risks associated with AMR which contributes to the misuse and overuse of antibiotics.
Inadequate infection control measures in Nigerian hospitals contribute to the spread of microbes, including resistant strains. Poor hygiene practices, inadequate use of personal protective equipment and lack of sterilisation of medical equipment are common in many Nigerian hospitals.
The consequences of AMR in Nigeria are severe and far-reaching. Some of the key consequences include, increased morbidity and mortality. AMR poses a risk of increased morbidity and mortality, particularly in low- and middle-income countries like Nigeria.
The economic burden of AMR is also substantial as a study published in the Journal of Pharmaceutical Policy and Practice estimated that the economic burden of AMR in Nigeria could be as high as $1.3 billion annually.
According to the study, “AMR reduces the effectiveness of antibiotics, making it challenging to treat infections. This can lead to prolonged hospital stays, increased healthcare costs, and increased mortality.
“AMR increases the risk of infections, particularly in vulnerable populations such as the elderly, young children, and people with compromised immune systems.”
State of AMR in Nigeria
Nigeria, with a population of over 200 million people, is faced with the burden of poverty and poor environmental conditions, such as lack of potable water and sanitation, and inadequate infection control. These factors are crucial in the spread of microbes, including resistant strains.
According to the Institute for Health Metrics and Evaluation (IHME), University of Washington, Nigeria had an estimated 627,000 deaths attributable to AMR in 2019, which is the highest number of deaths in Africa.
The IHME also estimated that the mortality rate due to AMR in Nigeria was 335.6 deaths per 100,000 population in 2019.
Urgent need to tackle AMR
Dr John Oladapo, a consultant microbiologist at the Lagos University Teaching Hospital (LUTH), emphasized the urgent need to address the growing burden of AMR in Nigeria.
“AMR is a ticking time bomb in Nigeria,” Dr Oladapo said. “We need to take immediate action to address the root causes of AMR, including the misuse and overuse of antibiotics, poor infection control practices, and lack of awareness about AMR.”
Dr Adebiwale Akintayo, a public health expert at the University of Ibadan, emphasized the need for a multifaceted approach to address AMR in Nigeria.
“We need to adopt a comprehensive approach to address AMR in Nigeria,” Dr Akintayo said.
“This includes improving infection control practices, promoting responsible use of antibiotics, and enhancing awareness and understanding of AMR among healthcare professionals and the general public.”
Dr Eyitope Ogunbodede, a professor of microbiology at the Obafemi Awolowo University (OAU), emphasized the need for research and development of new antibiotics to address the growing problem of AMR.
“We need to invest in research and development of new antibiotics to address the growing problem of AMR.
“We also need to improve our surveillance systems to monitor the spread of AMR and develop effective strategies to prevent it,” he said.
FG’s action plan
Recently, the Federal Government launched the National Action Plan on Antimicrobial Resistance (AMR NAP-2.0).
The Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, said the launch of AMR NAP-2.0 came at a time when the global community, through platforms like the 2024 United Nations General Assembly (UNGA), had committed to renewed and urgent action against AMR.
He said in 2017, Nigeria made significant strides by launching its first National Action Plan on AMR, adding “We recognised that a multisectoral, one health approach-integrating human, animal, and environmental health-was essential in confronting AMR.”
The minister also disclosed that the Federal Government is committed to integrating genomic technologies into all aspects of the work, noting that a plan has been laid out to build capacity for genomic sequencing and surveillance, as well as improving response to emerging infections and advancing vaccine development.
The Director General of the Nigeria Centre for Disease Control and Prevention (NCDC), Dr Jide Idris, said the second AMR National Action Plan is a comprehensive five-year strategy designed to combat antimicrobial resistance in Nigeria, adding that the NCDC leads the Antimicrobial Resistance Coordination Committee (AMRCC) to drive the implementation of the plan’s priority actions.
Co- chair of the national AMR Technical Working Group, Professor Kabiru Junaid, said it will cost a total of $77.6 million to implement all the strategic objectives of the AMR National Action Plan.
The Minister of Agriculture and Food Security, Sen. Abubakar Kyari, said his ministry is committed to the implementation of the activities of the action plan.
The Minister of Environment, Mallam Balarabe Abbas Lawal, speaking through the Director, Department of Pollution Control and Environmental Health, Bahijjahtu Abubakar, said effective implementation of the plan will improve the country’s strategies in addressing AMR and strengthening surveillance in the environment sector, livestock and healthcare settings, while promoting sustainable standard practices that ensures food security, protection of the environment and human health.
WHO’s role in supporting AMR efforts
WHO has been a key technical partner in developing AMR NAP-2.0, providing guidance on global best practices and supporting the Federal Government in aligning its strategies with the Global Action Plan on AMR.
To improve the national efforts to control the impact of AMR, the ministry launched the AMR NAP 2.0, which is a revision of the national action plan on AMR adopted in 2017.
With the expiration of the AMR NAP-1.0 (2017-2022), an assessment of its implementation revealed key gaps and challenges, with only a 44 percent completion rate.
The assessment highlighted weak involvement from sectors such as environment, plant, food, aquaculture, agriculture, and relevant human health sectors in the implementation of priority activities. Additionally, NAP-1.0 was not costed and lacked specific milestones and targets.
In response, the Government of Nigeria, through the Federal Ministry of Health and NCDC, requested WHO’s support in developing NAP-2.0 (2024-2028) and providing strategic guidance for the AMR Coordination Committee to develop the plan based on the AMR Global Action Plan, WHO manual for NAP Development, WHO implementation handbook for NAPs on AMR, and the People-cantered approach to addressing antimicrobial resistance in human health.
This story is produced for the Media-EIS Fellowship Programme, a collaborative partnership among the Nigeria Centre for Disease Control and Prevention(NCDC), the USAID-funded Breakthrough ACTION Nigeria and the African Field Epidemiology Network(AFENET)
