2018 Cholera Drug Resistance Burden Linked To Poor Waste Management

IMPROPER disposal and management of waste in Zimbabwe has given rise to Antimicrobial drug resistance (AMR) especially for diarrhoeal diseases as people end up continuously taking antibiotics to manage recurring diseases, Director Epidemiology and Disease Control in the Ministry of Health and Child Care (MoHCC), Dr Portia Manangazira has said.

By Michael Gwarisa

The revelations also follows a recent study by local epidemiologists which concluded that the Cholera epidemic of 2018 which ravaged Zimbabwe, had high incidences of drug resistance which made it difficult to contain the disease using the usual antibiotics.

During the 2018 Cholera outbreak, it was gathered that the Cholera bacteria (Vibrio Cholerae) strain was resistant to Ciprofoxacin and Ceftriaxone, both first line Cholera antibiotics and government had to import the second and third line drugs including Azithromycine.

Speaking during a Zoom Media Workshop on Antimicrobial resistance (AMR) in Africa, Dr Manangazira said the Cholera outbreak of 2018 was characterized by high cases of drug resistance and there was severity because of the resistance to the commonly used antibiotics and more resources had to deployed to treat the patients.

As a country, we do have challenges of antimicrobial resistance, we have seen the Cholera and Typhoid resistance as well. During the COVID-19, we also realized that some of the issues of antimicrobial resistance still come to haunt us in terms of complicating cases.

“We have experienced quite a number of cholera outbreaks and of note is the last outbreak where the resistance really was characterized and backed by evidence. We saw complications among the Cholera cases that would normally just improve on adequate re-hydration and the resistance was characterized in terms of Ciprofoxacin among other common antibiotics,” said Dr Manangazira

She added that government had to advocate for the adoption and use of a Cholera vaccine.

“In 2018, the Cholera patients would stay longer in Cholera isolation centers and the cost of antibiotics under such circumstances rise exponentially once you go past the first line drugs. In some instances, third line antibiotics had to be used including Azitrhomicyne.There is an agent need to preserve the remaining antibiotics so they continue being effective against pathogens.”

Meanwhile, EMA Microbiologist, Tracey Mubambi said AMR was leading to serious negative health outcomes in both human being and animals and there was need for adopting an AMR centric approach to waste management.

“The impact of poor waste management leads to pollution of surface and underground water and this leads to recurrence in disease such as cholera, Typhoid and dysentery and when this has happened, people are exposed to many antibiotic treatment and the more antibiotic treatment that they have, the greater the risk of developing drug resistance.

[pullquote]”A case in point will be cholera outbreak of 2018. You would see that the environment has really a part to play when it comes to antimicrobial resistance[/pullquote].

“The major drivers of waste in Zimbabwe are the high population densities, if we are to look at statistics, you would see that in 2002, 40 percent of the population was living in urban areas as compared to 22 percent in 1982. You can imagine where we are right now if 40 percent was living in urban areas in 2002, in 2020 I bet we are now at 80 to 90 percent of the population in the urban areas. This is leading to sprouting of illegal settlements as people try to look for accommodation and places to stay as they come to urban areas.”

According to the EMA, as estimated 1.6 million tonnes of waste are generated in Zimbabwe annually and the figure is expected to surpass 5 million tonnes per year by 2030 if no action is taken.

In Zimbabwe, the EMA, a statutory body established under section 9 of the Environmental Management Act, Chapter 2027 of 2002, is the one that is mandated to regulate the collection, disposal, treatment and recycling of waste. There are waste management laws that govern the transportation, treatment, storage and disposal of all types of waste.

The other drivers according to Mubambi are the changes in consumption partners and the issue of non-provision of bins, the inconsistency and non-collection of bins by local authorities and people’s general attitude against waste management.

We need to look at residual antibiotic in the environment. The conventional water treatment plants that we have are really not designed to manage AMR. You find that the water will be treated but still the antibiotics will be ale to pass through and is later consumed.”

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