FEELING beat after a long day’s work, Vanessa (not her real name), who is a business woman in her 60s arrived home at around 9 pm.
She spent over an hour in a traffic jam with a throbbing headache that she decided to take some few pills that included pain killers and some flu medication.
An act that has become part of her daily routine, and never forgets to fill her medicine cabinet, where she just goes to the pharmacy and buys her own list of medication that she has prescribed to herself for almost all ailments that she believes she can treat.
Due to her work she always finds herself fatigued, with aches from head to toe; and because of her type of work day offs are a rare thing, hence it becomes easier to pop a pill and feel better.
“I have to wake up the next morning. So it is easier to medicate myself. I often take the pills after a self-diagnosis… I feel like a cough coming up I would swallow some cough pills and tomorrow if I feel like am coming down with malaria then I will take those pills. But what are constant in my menu are the painkillers,” she explained.
Revealing that, she can get most of the medicine from any pharmacy in the city of Dar es Salaam without the need of having a doctor’s prescription. This has been the trend in the country, where antibiotics are sold openly and without asking customers for any prescription and at any amount, disregarding all treatment guidelines.
The misuse With such a system there are a lot of people like V anessa who believe they can self-medicate. However, this is only one of the many ways antibiotics being misused leading to the resistance in microbes.
According to a story published by Down To Earth magazine, more than 70,000 people are dying across the world each year due to infectious diseases that have become resistant to antibiotics… the only line of treatment that could have saved them.
Since the development of antibiotics in the 1940’s, these drugs have been used extensively. Over the years of use, overuse and abuse of antibiotics, the microbes have become resistant to them. Antibiotic resistant diseases (antimicrobial resistance AMR) are undoing the great strides in modern treatment.
More than misuse Another cause for this rise involves the act where livestock’s are fed antibiotics to speed their growth and enlarge them, and are then consumed by people.
Muhimbili University of Health and Allied Sciences (MUHAS) Professor of epidemiology, Japhet Killewo said that animals can also cause antimicrobial resistance in human beings if the withdrawal period is not considered after treating them.
“When animals are treated with the same type of medicine used to treat humans, and a person eats the produce like eggs, milk or mea t of such animal before the safe period, this means the produce still has antibiotics and the person consuming it will in the long run be affected.”
He stressed that, it does not matter how long the animal produce is cooked, the antibiotic will still be there. Animals need 14 days after being treated for its produce to be consumed. Humans use antibiotics to rear their livestock’s an act caused by pressure and greediness for more produce and profit; Such malevolent acts have been increasing over the years.
However, WSU study, publish in ‘ Sunday News’ of last week finds that environmental transmission rather than antibiotic use explains the presence of antibiotic-resistant bacteria in people, domestic animals and wildlife. The study explains that antibiotic-resistant bacteria are prevalent in people, wildlife and the water in northeastern Tanzania, but it’s not antibiotic use alone driving resistance.
Instead, researchers at Washington State University found transmission of bacteria in the environment is the most important factor. These conclusions come from a four-year study led by researchers from WSU’s Paul G. Allen School for Global Animal Health.
The results of the study were just published in Nature Communications. “We were surprised to find these microbes everywhere,” said Douglas Call, a Regents professor and associate director for research at the Allen School, “but it appears that within impoverished communities, there are many opportunities for bacteria to spread between animals and people via contact with waste or through consumption of contaminated food and water.”
The prevalence of antibioticresistant bacteria was highest for people, but it was also high for other domestic animals even when those animals were never exposed to antibiotics. “It’s not an antibiotic use problem; they are coming into contact with antibiotic-resistant bacteria in the environment.”
More than 50 percent of wildlife feces contained ampicillin-resistant bacteria, which was higher than the average across people, chickens, livestock, and dogs. The prevalence of resistance to the remaining eight antibiotics was highly correlated with results from domestic samples, exposes the report.
Consequencs AMR is a major threat to health and human development, affecting our ability to treat a range of infections. The World Health Organisation (WHO) recognizes AMR as a threat to global health and estimates 10 million deaths worldwide by 2050 if no effective interventions are made.
Treatments for a growing number of infections have become less effective in many parts of the world due to resistance, reveals WHO Report on Surveillance of Antibiotic Consumption 2016 -2018. In most countries amoxicillin or clavulanic acid were the most frequently consumed antibiotics.
These substances belong to the Access category of the Model List of Essential Medicines, which includes antibiotics recommended as first-or second-line therapy for common infectious diseases and which should be available in all countries, mentions the report.
Broad spectrum antibiotics such as third generation cephalosporins, quinolones and carbapenems are categorized as Watch antibiotics and should be used with caution because of their high potential to cause the development of antimicrobial resistance and or their side effects.
Curing the cure One health approach is needed in Tanzania as part of the solution to help reduce the Antimicrobial resistance in humans is caused by themselves as well as by medicine injected into animals.
Giving the warning during a professorial public lecture on wicked health problems and the one health approach in Tanzania, Professor Killewo explained that, “when you consume antibiotics with no ailments then the body is creating a certain familiarity with the medicine slowly, and will later create antimicrobial resistance, and when in need of such medicine it will no longer cure you.”
“The problem of antimicrobial resistance is increasing at an alarming rate, my worry is that it will reach one day we will go to the hospitals with just normal ailments and the doctors will fail to treat us; because instead of fetching medicine we will be fetching sweets as they will no longer cure us.”
“That is why there is a need of one health approach to solve the complex wicked health problems through the interdisciplinary strategy to address health from an integral perspective. That is the combination of environmental, animal and human health,” he said.
This was a paradigm formulated by public and animal health professionals, conservation and ecologists to solve complex and wicked health problems. It identifies the future wellbeing of humans, animals and the environment as interconnected, he explained.
“There are strategic plans that involve the corporation of various sectors already set for one health, antimicrobial resistances, and disease spill from animal to humans problems in place, it is just the matter of implementing them.”
He urged Stakeholders to retrieve the strategic plans and implement them. “The prime minister’s office is ready to assist in the coordination and implementation of one health since its acceptance and official launch in Dar es Salaam and Arusha. He further recommended that regulatory bodies should rationalize antibiotic sales, use and disposal in the community for humans and animals.
Adding that the ministry of agriculture, livestock and fisheries in collaboration with regulatory bodies is to reduce antibiotic use in agriculture and livestock especially growth promoters in food producing animals.
Government to the rescue Speaking to ‘ Daily News’ Deputy Minister of Health, Community Development, Gender, Elderly and Children Dr Faustine Ndugulile commented that we have had the drug resistance challenge which is caused by humans themselves and animals.
The world has now come up with one health to cub this challenge, the aim is to ensure that veterinary physician and doctor’s work together and restrict the use of antibiotics especially in animals so that its use may not affect human health.
He explained that the ministry through its national action plan on AMR 2017-2022 is preparing guidelines concerning antibiotics, such as who can sell, and what type of antibiotics are sold. Another guideline that wants to be initiated is that it will be prohibited to sell antibiotics to a person without doctor’s prescription.
The ministry is also preparing strategies to continue providing awareness to the society on the importance of being aware of the antimicrobial resistance. Like the livestock keeping communities that inject antibiotics to their livestock to increase the weight of chickens to get more profit that also causes drug resistance.
He explained that once the ministry is able to restrict selling of antibiotics, and create awareness to the society, while working closely with veterinarians; we believe we will have made a step in solving the rising persistence in AMR.
Raising voices across the world In the World Antibiotic Awareness Week (WAAW) celebrated from the 18 to 24 November last year, Centre for Science and Environment (CSE), New Delhi calls for regulating all non-human use of antibiotics, to contain AMR.
CSE, recently released findings of its new assessment as it marked WAAW in a press release, suggesting that antibiotics that are important for humans, are being rampantly used in crops instead.
In their report they discovered that farmers in Delhi, India, were found to be using streptocycline… a 90: 10 combination of streptomycin and tetracycline routinely and indiscriminately in high doses in crops, including on those crops which they not approved for.
CSE Food and Toxins Programme director Amit Khurana stated, “We found that farmers are unaware about the recommended use and spray antibiotics frequently like pesticides as a regular practice.” In humans, streptomycin is used for previously-treated tuberculosis (TB) patients, who make up over 10 percent of the total estimated TB incidence in India.
It is also used in multi-drugresistant TB patients and in certain cases of TB meningitis (brain TB). Resistance to streptomycin is quite high and its large scale non-human use could add to the problem. WHO, classifies it as a critically important antibiotic for humans.
AMR is a growing threat to global public health, and India is expected to be heavily impacted by it. Antibiotics are becoming ineffective as bacteria-causing infections are getting resistant to the antibiotics that are being used to kill them.
Bacterial infections, which are quite common in India, are becoming difficult to treat or completely untreatable, leading to a huge health and economic burden, state’s the director.
“The health ministry’s ban on using colistin in food-producing animals is a welcome step. But to limit AMR from this sector, it is imperative that no medically important antibiotic is allowed to be used for promoting growth of food animals,” explains Khurana.
Meanwhile, antibiotic pollution into the environment through waste from point sources such as pharmaceutical manufacturing units is another area of huge concern. It is known to escalate resistance in the environment, which can pass on to humans.
Therefore, antibiotics in such waste should be considered and treated as hazardous chemicals. Unsafe disposal of unused and expired drugs also needs to be checked and controlled. CSE researchers point out that extended producer responsibility must be introduced to take back unused antibiotics.
This best practice can minimize antibiotic pollution in the environment, they add. CSE Director General Sunita Narain, who was a member of the United Nations Interagency Coordination Group on AMR commented that, “Considering the progress made so far, we strongly feel that concrete and timely action is required by Central and state governments to contain AMR, particularly from animal and environmental routes.”
Oth er emerging th reats In the professorial public lecture, Prof Killewo dwelled on two examples of wicked problems in the health sector that require a one health approach in their solution; Naming them as Emerging Pandemic Threats’ (EPT) and AMR.
Over the last decade, nations worldwide have been grappling with an increase in emerging and re-emerging diseases at the human, animal and environmental interface. With people continuing to trade wildlife, encroach on habitats, and interact with animals, epidemics like the current outbreak will keep happening.
The pathogens responsible for the emergence or re-emergence of these diseases can spread rapidly, not only nationally but regionally and globally.
Recent outbreak experiences, especially with avian influenza and the now Corona virus have spurred increasing recognition of the importance of an ongoing multi-sectorial effort to proactively address EPT. A one health approach has been internationally endorsed by FAO, OIE and WHO to improve prevention, detection and response.