Zim among highly burdened AMR African countries with National Action Plans

By Kuda Pembere

With Zimbabwe drafting its second National Action Plan to reduce Antimicrobial Resistance (AMR), it is among some African countries that is still battling high AMR, a study says.

Compared to European countries with AMR national action plans, despite a display of commitment to ameliorate AMR issues, African countries are still struggling with the high burden.

A study published in The Lancet titled ‘The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis’, noted that implementation of these policies was the major reason why some African countries with NAPs are still burdened with high AMR.

Fitting the researchers’ estimates on why some countries have higher fatal burden related to AMR issues is Zimbabwe which reportedly has poor health care and safe water and sanitation.

“These estimates also show that quality and access to health care and safe water and sanitation are correlated with AMR mortality, with a higher fatal burden found in lower resource settings. Our cross-country analyses within this region can help local governments to leverage domestic and global funding to create stewardship policies that target the leading pathogen–drug combinations.

“We observe that with limited access to safe water and sanitation there is increasing mortality attributable to AMR and that AMR burden is driven primarily by the high infectious disease burden in the region,” said the study.

The study noted that there are some countries like Zimbabwe implementing the NAP but still burdened by AMR. In Zimbabwe in 2019, there were 3,900 deaths attributable to AMR and 15,800 deaths associated with AMR.

“As resources permit, NAPs can be helpful in mobilising cohesive national responses to the AMR burden. In our assessment of AMR in the WHO European region, development of NAPs was associated with decreases in AMR burden. NAPs are expensive, however, and often require a diverse host of invested parties to create, finance, and evaluate them.

“This might help explain why only 23 countries in the region had approved, financed, and implemented NAPs for AMR at the time of this analysis. An important challenge is ineffective implementation.

“Notwithstanding the limitations of the crude classification of NAP status used in these analyses, the ineffective implementation of NAPs in some countries is demonstrated by the variable progress regarding the development, implementation, or financing of NAPs that has been made in 2019 by countries in the region.

“The lack of a clear pattern between weaker NAP implementation and higher AMR burden in this analysis is unlike that seen in the European region and further complicates this comparison.

“We note that many countries with financed and implemented NAPs were in some instances also among the highest-burden countries in the region (eg, Mozambique, Eritrea, and Zimbabwe),” read the study.

The study found that while the threat of AMR is substantial across the globe, its burden is disproportionately high in low-income and middle-income countries (LMICs).

“Many LMICs, including those in sub-Saharan Africa, lack access to crucial, more effective antibiotics, which might contribute to increased AMR burden,” noted the study.

Researchers found that in 2019 there were 3.83 AMR related deaths.

“We estimated 3·83 million deaths in 2019 involving infection in the WHO African region. 1·86 million (1·53–2·27) of those deaths were caused by both susceptible and resistant bacteria.

“Of these, 1·05 million deaths (829 000–1 316 000) were associated with AMR and 250 000 deaths (192 000–325 000) were attributable to AMR.

“The WHO African region has the largest fatal and non-fatal burden of AMR compared with any other WHO region Infection-related mortality rates are highest in the WHO African region (348·3 [288·2–425·1] per 100 000), while the fraction of deaths associated with resistance (27% [25–29]) and attributable to resistance (7% [6–8]) are the lowest.

“Despite the relatively low prevalence of resistance in the region, the sheer number of infections yields high AMR mortality,” said the research.

Some four pathogens were responsible for more than 100 000 AMR associated deaths.

“Four pathogens were each responsible for more than 100 000 deaths associated with AMR in the WHO African region in 2019: Streptococcus pneumoniae (195 000 deaths [95% UI 159 000–239 000]), Klebsiella pneumoniae (184 000 deaths [142 000–236 000]), Escherichia coli (147 000 deaths [112 000–189 000]), and Staphylococcus aureus (136 000 deaths [109 000–172 000].

“These four pathogens were each estimated to be directly attributable to more than 25 000 deaths in 2019: K pneumoniae (50 000 deaths [33 000–71 000]), followed by S pneumoniae (39 000 deaths [25 000–54 000]), E coli (37 000 deaths [27 000–50 000]), and S aureus (30 000 deaths [19 000–43 000]).

“Two other pathogens were responsible for more than 40 000 deaths associated with AMR in 2019: Acinetobacter baumannii (48 000 deaths [31 000–71 000]) and Mycobacterium tuberculosis (42 000 deaths [27 000–64 000]). In total, these six pathogens were responsible for 752 000 deaths associated with (or 72% of all associated deaths) and 188 000 deaths attributable to (or 75% of all attributable deaths) AMR in the region in 2019,” said the study.




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