Antimicrobial resistance (AMR) is a global health threat caused by the ability of microorganisms (bacteria, viruses, fungi and parasites) to withstand the effect of antimicrobials resulting in treatment failure. This puts pressure on health systems across much of Africa and is exacerbated by a difficulty in accessing diagnostics and a reduced availability of second-line antimicrobials. Our recent review of investigated all the information on the status of antimicrobial use, resistance and surveillance systems in food animals and the environment across Africa.
There are limited research on antimicrobial use and resistance in animal and environment, covering mostly northern and southern Africa and with little consistency in methodology or analysis. This makes it difficult to compare data on AMR from across the continent making it difficult to develop a continent-wide perspective, which is further compounded by a lack of no appropriate system for data collection, identifications, coordination and reporting.
Several studies reported resistant organisms and their genetic composition indicating potential flow of resistant genes across human, animals and the environment.
Antimicrobial use in animal and the environment
There is a high level of antimicrobial use in the region, which highlights the lack of awareness of AMR as a problem amongst farmers, and the population generally, potentially exacerbating the burden of antimicrobial resistance. The percentage of poultry farmers and swineherds reported to use antimicrobial agents was more than 80%. This high level was driven by the emerging trade opportunities and an increase in demand for meat and other animal products across the region. Amongst the 14 classes of antimicrobial agents used were some that are currently restricted for use in developed countries due to their impact in human health.
Several studies that we looked at reported resistant organisms and their genetic composition indicating potential flow of resistant genes across human, animals and the environment. We documented the levels of antimicrobial resistance (AMR) and multi-drug resistance (MDR) within and between countries. Despite the fact that higher level of resistance was identified in more than 14 classes of antimicrobials and the highest AMR and MDR rates were, perhaps unsurpringsly, on drugs that are relatively cheap and easily accessible.
Levels of resistance was as high as 100% in food animals as well as in the environment (waste water, river water and sediments, drinking water and vegetables). the resistance in these bacteria were probably due to human activities, application of manure in farming activities and agricultural wastes from community spreading resistant strains.
This all means that MDR organisms have high propensity to spread widely across Africa and cause infections that are difficult to treat. With limited laboratory capacity in many locations in Africa, the identified resistant genes could be a fraction of the multiple resistant gene circulating across the three compartments. There is a need to call for more support in establishing advanced molecular techniques for better understanding the magnitude, spread and evolution of AMR and MDR organisms.
Despite the burden of AMR and MDR with potential spread of resistant organisms we found that currently none of the African countries has reported on antimicrobial use and antimicrobial resistance surveillance programme specific for animal and environment. Some of them are at different stages of development which may take a long while before implementation. Surveillance system for AMR is critical to harmonise approaches used in data collection. We suggest that African countries should seriously consider establishing/strengthening their surveillance systems to monitor antimicrobial agent use and burden of AMR.