How Ghana contributes to the growth of global antimicrobial resistance

Crisis is looming over the efforts of the human race to combat infections caused by pathologic microorganisms—bacteria, viruses, fungi and parasites. This was the central message contained in a recent and first-ever World Health Organisation (WHO) global surveillance report on the growth of antimicrobial resistance (AMR) in the world.
AMR refers to the ability of a microorganism to withstand the killing or growth-limiting effect of an “antimicrobial drug that was originally effective for treatment of infections caused by it.” According to the report, the proportions of antibiotic (antimicrobial agents against bacteria) resistance in bacteria that cause common infections (e.g. urinary tract infections, pneumonia, bloodstream infections) is high and it is commonplace in all regions of the world.
There are a lot of reasons for Ghana to be also concerned with this global blight which by all standards may not be a far cry from global warming. Ghana suffered a scare of this phenomenon in early 2012. It can be recalled that the Korle Bu children’s emergency ward once had to be closed down owing to the outbreak of bacterial infection known as Methicillin-Resistant Staphylococcus Aureus (MRSA).
The impact of AMR can be devastating as infections caused by resistant microorganisms often fail to respond to standard treatment, resulting in prolonged illness, higher health care expenditures, and a greater risk of death. According to infectious diseases experts, death rate for patients with serious infections caused by common bacteria treated in hospitals can be about twice that of patients with infections caused by the same non-resistant bacteria. The first-ever global surveillance report on antimicrobial resistance notes that “people with MRSA are estimated to be 64% more likely to die than people with a non-resistant form of the infection.”
Efforts to control infectious diseases in the clinical settings are scuttled under the weight of AMR. Patients afflicted with antimicrobial-resistant strains of germs remain contagious for a longer time, increasing the risk of spreading resistant microorganisms to others as already existing treatments become ineffective. The implication of this is that, the war against certain infectious diseases that have gained remarkable prominence over the decades--HIV, TB, and Malaria--may be far from being won anytime soon.
Among the consequences presented by antimicrobial resistance is the increase of cost of health care as first-line drugs have to give way to more expensive therapies. Prolonged duration of treatment and its translation into longer hospital stay drives up health care costs as well as the economic burden on families and societies. Beyond this, health security, trade and economies are threatened in the wake of AMR. WHO again estimates that AMR may give rise to losses in Gross Domestic Product of more than 1% and that the indirect costs affecting society may be more than 3 times the direct health care expenditures. Developing economies are affected proportionally more than developed ones. The dire nature of the situation finds expression in the quotation below:
WHO’s 2014 report on global surveillance of antimicrobial resistance reveals that antibiotic resistance is no longer a prediction for the future; it is happening right now, across the world, and is putting at risk the ability to treat common infections in the community and hospitals. Without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.
There are many ways in which the health system in Ghana on its own continues to contribute negatively towards the growth AMR--from abuse and misuse of antimicrobials on the part of patients and health care givers to a multitude of other interconnected factors. The apparent inability of health regulatory bodies to rein in activities of health facilities and their professionals seems to compound the situation.
The supply of higher classes of antibiotics to lower level health centres from regional medical stores in addition to the unbridled sale of these medicines to over-the-counter medicine sellers (previously known as licensed chemical sellers) by pharmaceutical wholesalers is a widespread practice in this country. It is important to point out that existing health laws and policies limit the scope of these facilities to handle such medicines. In all these, it appears little is being done by the Ghana Health Services and the Pharmacy Council in enforcement of such regulations
Substandard, spurious, falsely labeled, falsified and counterfeit medicines (SSFFCs) beyond their presentation of serious health risks promote the development of AMR in the long term. Yet still the Food and Drugs Authority seems not have gained any appreciable level of mastery in smothering the influx of SSFFCs into the pharmaceutical supply chain as their post-market surveillance reports—which is analogous to a fire-fighting approach instead of an efficient preventive regulatory measure--occasionally shows.
All over our health facilities, certain prescribing practices of clinicians also appears to encourage the development of AMR. Physicians’ over reliance on presumptive treatment, haphazardly prescribing antibiotics without recourse to due laboratory investigation is a documented factor making the human race lose grip on the war against infectious diseases. Finding a patient on a ward who has not undergone more than a single desultory cross-over from one antibiotic to another would be as difficult as locating the missing flight MH370.
In spite of the danger presented by AMR, pharmacies across the country continue to practice with flagrant disrespect to practicing standards and pharmacy laws. On a daily basis, prescription only medications are continually doled out to clients without prescriptions.
To help keep under control this global threat the WHO encourages using antibiotics only when they are prescribed by a certified health professional; completing the full treatment course, even if you feel better; never sharing antibiotics with others or using leftover prescriptions.
Protecting the present and future generation from the consequences of AMR is as important as every step taken to address the ever-occurring global warming and its impact on the world.

By:
Frank Kumi
Registered Pharmacist
Tamale Teaching Hospital
Contact: [email protected]