Antimicrobials are essential to treating some human and animal diseases like sepsis, pneumonia, and other life-threatening infections. Microbes, such as bacteria, can develop resistance to antimicrobials when they are used improperly meaning the bacteria is no longer susceptible to what should have been an effective drug. Globally, antimicrobials are increasingly becoming ineffective due to the inappropriate use of these drugs including the prescription of and use of antibiotics, which target only bacteria, during viral infections (like the flu), or as a growth promoter in agriculture. As a result, antimicrobial-resistant superbugs develop under this pressure of antibiotic abuse which confers on them a transmission advantage that allows them to spread more efficiently since they are now resistant to properly prescribed treatment.
According to the Lancet publication in 2022, an estimated 4·95 million deaths were associated with bacterial AMR globally in 2019. At the regional level, the burden of death rate attributed to resistance was highest in western Africa, at 27·3 deaths per 100,000 making it a super region for death due to drug-resistant pathogens. Furthermore, according to the World Health Organization (WHO), there are 15 priority antibiotic-resistant pathogens causing the greatest threat to human and animal health - 4 of which have been detected in Nigeria.
Available evidence and projections suggest that by 2050, AMR could cost US$300 billion to US$1 trillion annually globally. In addition, the need for more expensive and intensive care, prolonged hospital stays, expensive and intensive treatments add to the direct monetary effects of AMR on health care via escalation in resource utilization. AMR is also associated with the loss of livestock and increased cost of livestock production that indirectly affects the livelihood of farmers which in turn has a deleterious impact on GDP.
In reference to antimicrobial use in Nigeria, 7 out of 10 persons in the community access antibiotics outside licensed health facilities or pharmacies while many patients in the hospitals are overprescribed antibiotics that have a higher risk of bacterial resistance selection (above the 60% target set by WHO). In the animal health sector, antimicrobials are available in the open markets without restriction, hence the misuse of these products especially in food-producing animals. Residues of these antimicrobials in eggs, milk, and meat, when consumed by humans can potentially cause cancers, allergies, and mutations.
In May 2015, the World Health Assembly (WHA) endorsed a global action plan on AMR under Sustainable Development Goal 3 (SDG 3) urging all member states including Nigeria to develop national action plans. The political declaration on AMR, as approved by Heads of State and adopted at the 71st session of the UNGA in October 2016, reiterated the commitment of UN Member States to support the implementation of the One Health Global Action Plan at all levels. The novel COVID-19 pandemic is a constant reminder that, for us to achieve “good health and well-being for all”, there is a need for stronger coordination and collaboration among all stakeholders using a One Health approach that assumes human health is inherently linked with that of animals, plants, and our shared environments.
Nigeria’s AMR response commenced in 2017 following a situational analysis led by the Nigeria Centre for Disease Control and Prevention (NCDC) in collaboration with the Federal Ministries of Agriculture and Rural Development and the Environment. It investigated antimicrobial-resistant pathogens found in hospitals, animals, agricultural, and environmental sources, as well as antimicrobial prescriptions. Some of the identified challenges for Nigeria’s AMR response include suboptimal coordination between relevant sectors (regulatory authorities and components of the healthcare delivery system), poor surveillance and response on account of limited availability of diagnostics and inadequate resources, suboptimal adoption and practice of standardised infection prevention and control practices in the community and health facilities, limited access to proper medications, inappropriate prescription practices, and poor enforcement of legal frameworks in place to regulate antimicrobial use. These informed the development of the National Action Plan (NAP) on AMR. The NAP is a five-year plan addressing five key pillars in agreement with the WHO Global Action Plan on AMR:
1. Increasing awareness and knowledge of health workers and the public on AMR
2. Building a ‘One Health’ surveillance system
3. Intensifying infection prevention and control and biosecurity
4. Promoting rational use of antimicrobials and access to quality medications
5. Research into alternatives to antimicrobials, new diagnostics, and therapeutics.
Nigeria joins the global health community to commemorate the annual World Antimicrobial Awareness Week (WAAW) which takes place from November 18th – 24th. As part of creating awareness of AMR during National Antimicrobial Awareness Week (NAAW), several activities have been outlined by the One Health National Antimicrobial Resistance Coordination Committee (NAMRCC). These activities include:
? Press Briefing - Flag-off with partners from the Ministry of Agriculture and Rural Development, Federal Ministry of Environment, and one Health Stakeholders
? Media Appearances across all platforms
? Sensitisation activities in health facilities
? Awareness campaign among secondary schools students
? Awareness talks at religious gatherings
? Continued engagement with Borno and Kebbi States who have subnational AMR-TWGs and with other States
? Sensitisation workshop for Poultry Value Chain actors (poultry farmers, live bird marketers, feed millers, transporters, poultry drug manufacturers/vendors, members of the Poultry Association of Nigeria (PAN)
? Virtual Community of Practice on AMR meeting on phage, vaccination, and probiotics led by the Chairman (Professor Onyebuchi Chukwu)
? Twitter space discussion on antimicrobials and antimicrobial alternatives: a panel discussion on indiscriminate use of antibiotics and the way forward (pharmacists, patent medicine vendors, physicians, regulatory authorities, etc)
The NCDC and One Health stakeholders continue to urge Nigerians to use antimicrobials responsibly by
? Asking for laboratory tests where possible to guide the use of antibiotics and other antimicrobial agents e.g., antimalarials
? Complete the dose of antibiotics as prescribed by licensed human and animal health workers
? Do not share or use leftover antibiotics
? Do not use antibiotics as prophylaxis or for growth promotion
? Practice hand hygiene and environmental sanitation consistently
? Ensure effective biosecurity practices on farms
? Vaccinate your family, children, and animals appropriately
“Though Antimicrobial resistance does occur naturally, the concern lies with the current high rates of development and spread. Other than overuse and misuse of antimicrobials in human and animal health, other AMR drivers include limited availability and uptake of vaccines; limited diagnostic capacity to support appropriate treatment; lack of access to clean water, sanitation and hygiene; poor infection prevention and control practices; poor disposal practices; and the presence of antimicrobials in the environment and water bodies” and “WHO joins hands with FMOH, NCDC, FMARD and FMEnv with United Nations agencies and other partners in advancing and accelerating the efforts to combat AMR, through the One Health approach” - Dr Kazadi Mulombo, WHO Representative to Nigeria.
The Federal Government of Nigeria through the NAMRCC led by the NCDC remains committed to contributing to the global response to AMR and sustaining advocacy towards the responsible use of antimicrobials.
The Nigeria Centre for Disease Control and Prevention (NCDC) is the country’s national public health institute, with the mandate to lead the preparedness, detection, and response to public health emergencies. The Bill for an Act to establish NCDC was signed into law in November 2018 by President Muhammadu Buhari. The mission of the NCDC is ‘To protect the health of Nigerians through evidence-based prevention, integrated disease surveillance and response, using a One Health approach, guided by research, and led by a skilled workforce.
NCDC Toll-free Number: 6232 | SMS: 08099555577 | WhatsApp: 07087110839 Twitter: @NCDCGov | Facebook: @NCDCgov | Instagram: @NCDCgov | NCDC Media Releases
Dr Ifedayo Adetifa
Nigeria Centre for Disease Control and Prevention.