AMR in AFRICA Dr Marc Sprenger Director AMR Secretariat 1
AMR in AFRICA Infectious diseases (including malaria and TB) still result in a very high burden of disease. HIV has exacerbated this. 2
Why AMR is an issue in Africa Massive progress against the MDG Africa has made huge gains against priority health problems Access to cheap, effective antibiotics has supported all of this These gains are vulnerable if antibiotics less effective Av % Reduction Africa 1990-2013 54.2% Child mortality 40.7% Maternal mortality ratio 42% Malaria incidence 57% HIV prevalence 31%TB mortality 3
Why AMR is a challenge in Africa Weak health systems Health systems lack money African Region total per capita health expenditure 171 USD (2012) Human capacity. Physician to pop ration 2.7/10 000 (Europe 32.1) Nurse ration 12.4/10 000 (Europe 80.2) Weak management and supervision 4
Why AMR is a challenge in Africa Weak health systems Drug supply Weak supply chain management Weak regulation Stock outs very common Substandard, fake and counterfeit medicines common 5
Why AMR is an issue in Africa People more vulnerable to infection (Malnutrition, HIV) People have a huge appetite for antibiotics Belief in antibiotics as strong medicine` High consumption rates (although still much unmet need) % Respondents that have consumed antibiotics in the last month (WHO 2015): Egypt 54%; Sudan 49%; Nigeria 40%; S Africa 31% 6
Antibiotics A substitute for better care Cheap Accessible antibiotics have allowed progress, despite very weak systems and poor care. (50% hospital births are in a facility without basic water, sanitation and hygiene) Poor diagnosis (unskilled staff, weak labs) Very weak Infection prevention and control Treatment very variable, non standard. But if the bugs become resistant and the drugs more resistant, health care becomes much more risky, and universal coverage much harder to achieve. 7
Why AMR is an issue in Africa High rates, and total disease burden 8
Why AMR is NOT an issue in Africa Other Priorities Ebola, Yellow Fever, political instability, drought etc. etc. Lack of Awareness Little data on AMR in Africa Lots of other reasons for treatment failure First Steps not Clear Doing something about it is perceived to be difficult and costly 9
DATA is PATCHY Available National Data* on Resistance for Nine Selected Bacteria/Antibacterial Drug Combinations, 2013 10
What we do know Available data suggests major problem, although published studies may not be representative of general population 59% of Central African children under 5 years, are asymptomatic carriers of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E); one of the highest prevalence ever described in the world. Ecoli resistance to Aminopenicillins 80% S Africa, 88% Kenya Tanzania Resistance of Strep Pneumoniae, to Trimethoprim Sulphamethexazole in children under 5 increased from 25% in 2006 to 80% in 2012 High rates of resistance seen by MSF in rural Niger 11
Prosperity and urbanisation Trends and Drivers Increasing reliance on the largely unregulated private market (quacks and traditional healers to hospitals) Increasing use of poor quality drugs and diagnostics. Very poor environmental sanitation Increasing demand for cheap meat and more intensive agriculture 12
What needs to happen : GAP in AFRICA 1. Awareness Political commitment to act Change of mind-set (Population & HCW) 2. Evidence Better surveillance data to inform prescribing and advocacy 3. Infection prevention and control Improve WASH in communities and health facilities Increase Immunisation (esp Pneumoccocus, rotavirus etc) Hand washing, cleaning and IPC practices 13
What needs to happen : GAP in AFRICA 4. Responsible Use Improve adherence to (local) treatment guidelines Improve Drug supply of first line drugs Improve Regulation systems Phase out use in agriculture for growth promotion and mass prophylaxis 5. Investment and New Products Mainstream AMR into Health and agriculture sector development programmes African needs reflected in New product development and TPP 14
Progress : National Action Plans NAPS Developed S Africa, Ethiopia, Ghana, Kenya, Zambia, Guinea-Bissau Under development Tanzania, Mozambique, Zimbabwe, Liberia, Swaziland, Cote d'ivoire 15
Progress : Surveillance 19 countries trained in methodology for assessing total consumption 8 countries attending GLASS workshop 7 expressed interest for GLASS 16
WHO Response Close collaboration between AFRO and HQ Joint programming health systems & security teams Ali Yahaya is focal point, working closely with Jean Bosco Additional resource via Fleming fund (primarily for NAPs) 20 Countries have national focal points essential medicines Incorporated into Country assessments for emergency preparedness (GHSA and JEE) 17
Take Home Message Political support & engagement needed for the fight against AMR Developing a NAP is going through a multisectoral process and should result in implementation Without good health systems no AMR control 18
THANK YOU THANK YOU 19