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The Lowdown Hub

Antibiotic resistance in Africa: ‘a pandemic that is already here’Drug-resistant pathogens and poor

A hospital in Benin © Godong/Alamy

In 2016, doctors in Gambia became alarmed about two apparently different outbreaks of hospital-acquired bacterial infection in a neonatal ward in Banjul. Baby after baby receiving non-intensive care at the Edward Francis Small Teaching Hospital ended up with infections that did not respond to normal antibiotic treatment. Many died of their illnesses.

Local investigators at the Medical Research Council (MRC) unit of the London School of Hygiene and Tropical Medicine used whole-genome sequencing — a technology rarely available in poorer countries — to identify the cause. They found it was intravenous fluids and medications that had been contaminated during preparation.

Saffiatou Darboe, who worked on the study, says it demonstrates the gravity of antibiotic resistance, also known as antimicrobial resistance (AMR), and how it makes infections more dangerous. “It is no longer a looming pandemic; it’s a pandemic that is already here,” she says. “Antimicrobial resistance is an erupting volcano.”

Some 1.27mn people died of antibiotic-resistant infections in 2019, according to modelling recently published in the Lancet — much more than previously thought and about the same death toll as malaria and HIV combined. The paper found that the burden was highest in west Africa, where it estimated there were 27.3 deaths per 100,000 directly related to antibiotic resistance. That was more than four times higher than the ratio in Australasia, the best-performing region.

Darboe, a microbiologist at the MRC unit in Banjul, says one of the main problems in west Africa — and sub-Saharan Africa, more generally — is the lack of diagnostics, meaning most infections go undetected. “My lab is the only quality-assured lab in the country,” she says.

As well as killing people, antibiotic resistance increases the cost of healthcare by causing patients to stay longer in hospital or to buy more expensive second- or third-line medicines, Darboe adds. Often, however, these drugs are beyond the reach of poorer patients. Many skip treatment or use cheaper drugs that may not be effective.

A combination of drug-resistant pathogens and poor hygiene protocols in some facilities can even mean that something as seemingly simple as a tooth extraction deteriorates into a lengthy and costly infection, she points out. “That especially affects patients in this part of the world where poverty is really a huge problem.”