FEATURE: Towards Enhanced Surveillance of Antimicrobial Resistance in the WHO African Region

Over the past couple of years, a number of international organizations, including the World Health Organization (WHO) have issued grim warnings about the growing incidence of antimicrobial resistance (AMR), defined as  resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive.

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Resistance has been reported in disease-causing agents such as some bacteria, viruses and parasites which are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials.

As a result of this resistance, standard treatments become ineffective and infections persist and may spread to others. AMR is a consequence of the use, particularly the misuse of antimicrobial medicine.

Experts at the World Health Organization (WHO) say that AMR is rapidly becoming a major public health risk in the African Region where it threatens the effectiveness of successful treatments for infections.

In the African Region, surveillance of drug resistance is limited to a few countries, resulting in incomplete data on the true extent of this problem. Available information indicates that the Region shares the worldwide trend of increasing drug resistance. For example, significant resistance has been reported for diseases such as malaria, tuberculosis, HIV/AIDS and bloody diarrhoea due to dysentery.

According to Dr Benido Impouma, Regional Adviser for Epidemic Preparedness and Response at the WHO Regional Office for Africa (WHO/AFRO), some of the earlier attempts by Members States in the WHO African Region to address the challenge of AMR included their endorsement of the Integrated Disease Surveillance and Response (IDSR) strategy in 1998.

Member States also recommended the implementation of the International Health Regulations (IHR 2005) in the framework of IDSR. Effective implementation of IDSR is expected to strengthen networks of public health laboratories and thus contribute to effective monitoring of antimicrobial resistance.

Currently there are few well-established national programmes that regularly collect and report relevant data on drug resistance. Clearly, weak surveillance systems mean generally poor access to accurate laboratory results on antimicrobial susceptibility testing in the African Region.

Also, some countries not only lack essential reagents but do not have in place standard operating procedures which comply with internationally recognized guidelines on antimicrobial susceptibility testing that can accurately identify resistant microorganisms. In particular, there is scarcity of accurate and reliable data on the microorganisms that cause meningitis, who’s appropriate AMR testing methods are complex and are not done well in many countries. This impairs the ability to detect emergence of resistant microorganisms and take prompt actions.

 

“Accurate, reliable and timely laboratory testing is an essential component of effective disease prevention and management”,   says Dr Francis Kasolo,   head of the Disease Surveillance and Response programme at WHO/AFRO.   He adds that high quality AMR testing is essential for clinicians to formulate treatment plans and subsequently monitor the effects of treatment.

 

In order to contribute to the improvement of surveillance of antimicrobial resistance at the country level, WHO/AFRO has developed a Guide for establishing laboratory-based surveillance for antimicrobial resistance. 

 

The Guide provides background information and defines the key steps for countries to conduct AMR surveillance for meningitis, bacteraemia and common enteric epidemic-prone diseases in a national bacteriology reference laboratory.

 

The 25-page guide is divided into two broad sections: (a) elements of a laboratory-based surveillance system for AMR and (b) steps for establishing laboratory-based surveillance for AMR.

 

The first section deals with requirements for laboratory based-surveillance of AMR; the selection of antimicrobial agents and disease-causing microorganisms to be used in the surveillance programmes; standard operating procedures and quality control;  data management and information sharing; expansion of the national surveillance for AMR,  and monitoring and evaluation.

 

The second section outlines and explains the key steps for establishing laboratory-based surveillance for AMR.

 

It is recommended in the guide that the document be used alongside the IDSR strategy.

 

“The expectation”, says Dr Kasolo, “is that application of this guide will strengthen the capacity of bacteriology reference laboratories to monitor AMR; improve the quality of AMR data by harmonizing laboratory techniques; and enhance the regional database on AMR. It will improve the standardization process used by bacteriology reference laboratories to confirm the bacterial causative agents of severe diseases such as meningitis, bloodstream infections and infections caused by viruses and bacteria that enter the body through the mouth or intestinal system, primarily as a result of eating, drinking and digesting contaminated foods or liquids.”

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