With the spread of resistance to antibiotics, bacterial diseases are increasingly difficult to control and treat. Understanding resistance and identifying ways to control it are public health priorities
3-year old Nyana from South Sudan is tested for pneumonia by a community health worker. Photograph: Jenn Warren/Malaria Consortium
Pneumonia is primarily an invasive bacterial infection affecting the lungs, and kills an estimated 1.2 million young children worldwide each year in spite of the availability of effective drugs for treatment of the disease. It accounts for approximately a fifth of all childhood deaths and is the single biggest killer of children worldwide. Fully effective diagnosis and treatment, as well prevention, of the disease is therefore a global priority and essential to reducing child mortality.
Effective pneumonia treatment is one of the many areas of public health work that is suffering in the face of drug resistance. Drug-resistant Streptococcus pneumoniae (DRSP) are strains of bacteria resistant to one or more commonly used cheap first line antibiotics, such as penicillin, and these are impacting on the effectiveness with which we can manage the disease.
With the rapid emergence of resistance to antibiotics, many drugs crucial to controlling life-threatening diseases are becoming less effective. Other drugs are at risk of becoming redundant entirely.
Diseases that were easily treatable in the past have become increasingly deadly as a result.
The spread of drug resistance is also increasing the reliance on newer, often more expensive drugs. The added costs increase the healthcare burden and reduce drug accessibility, especially for the poor in the global south.
Professor Dame Sally Davies, the United Kingdom's chief medical officer, recently referred to antibiotics resistance as a "ticking time bomb", helping to raise the profile of the issue ahead of the G8 summit in London in April 2013.
Understanding and tackling resistance
The development of drug resistance is thought to be caused primarily by the inappropriate use of medicines. For example, a patient failing to finish a course of antibiotics or taking a smaller dose than required. Incorrect prescriptions, inappropriate treatment due to poor diagnosis of the true cause of a disease such as giving antibiotics for viral infections, poor quality drugs and an absence of measures to prevent and control infections are also thought to contribute.
Lack of government commitment, reduced number of treatment options and limited surveillance of the problem are also thought to hamper efforts to control resistance from spreading.
Safeguarding the effectiveness of common antibiotics and stopping the spread of resistance is widely considered the best means of ensuring that we can maintain the benefits of current health programmes.
Although the issue is finding a place on the international agenda, major gaps remain in global knowledge on how to address drug resistance and, specifically, how to improve public health interventions in order to stop it from spreading further.
Drug resistance and child mortality
Community-based interventions for health, such as community health workers, have an essential role to play in increasing access to health care and reducing child mortality among poor and marginalised populations. However, evidence on the rational use of antibiotics at community level is limited.
Malaria Consortium is implementing the integrated community case management (ICCM) strategy for malaria, pneumonia, diarrhoea and newborn health in sub-Saharan Africa. The approach strengthens community-based care of malaria, pneumonia and diarrhoea by providing training, equipment, job aids and supervision to community health workers, who are then able to encourage behavioural change among caregivers and the wider community, as well as provide free diagnostics and treatment to children under five years old, where access to facility based care is limited.
A critical component of this work is to preserve the effectiveness of existing pneumonia treatments by promoting the rational use of antibiotics. ICCM has great potential to reduce the burden of pneumonia, especially in hard to reach populations, and could offer a valuable opportunity to improve the rational use of antibiotics and control the spread of resistance in resource-poor settings.
Through Comdis-HSD, a UKAid funded research partnership between academic institutions and non-governmental organisations, Malaria Consortium has been conducting research in Zambia to understand the use of antibiotics at the community level better in order to inform action in countries implementing ICCM. The findings of this work will be published on the malaria and infectious diseases hub. Watch this space.
Find out more about Comdis-HSD and our work in Zambia here.
Keywords: Drug resistance
Kwa sababu ya kuenea kwa upinzani wa viuavijasumu, magonjwa yanayosababishwa na bakteria yanazidi kuwa magumu kudhibiti na kutibu. Kuelewa upinzani na kutambua njia za kuudhibiti ni vipaumbele vya afya ya umma Nyana mwenye umri wa miaka mitatu kutoka Sudan Kusini anachunguzwa kwa ugonjwa wa mapafu na mfanyakazi wa afya wa jamii. Pneumonia ni ugonjwa wa bakteria unaoathiri mapafu na unaua watoto wapatao milioni 1.2 kila mwaka duniani kote licha ya kuwa na dawa za matibabu. Ni sababu ya karibu theluthi moja ya vifo vyote vya watoto na ni muuaji mkubwa wa watoto ulimwenguni. Kwa hiyo, kugundua na kutibu ugonjwa huo kwa ufanisi na kuuzuia ni jambo la kipaumbele ulimwenguni pote na ni muhimu kwa kupunguza vifo vya watoto. Matibabu ya ugonjwa wa mapafu ni mojawapo ya mambo mengi ya afya ya umma yanayokabiliwa na upinzani wa dawa. Streptococcus pneumoniae (DRSP) ni aina ya bakteria inayokabiliana na dawa moja au zaidi za kwanza za antibiotic, kama vile penicillin, na inaweza kusababisha ugonjwa wa ugonjwa wa Streptococcus. Kwa sababu ya kuenea kwa upinzani wa dawa za kuua viini, dawa nyingi muhimu za kudhibiti magonjwa yanayohatarisha uhai zinakuwa na matokeo machache. Dawa nyingine ziko katika hatari ya kutumiwa tena kabisa. Kwa sababu hiyo, magonjwa ambayo zamani yangeweza kutibiwa kwa urahisi yamekuwa hatari zaidi na zaidi. Kuenea kwa upinzani wa dawa za kulevya pia kunaongeza utegemezi wa dawa mpya, mara nyingi zenye gharama kubwa zaidi. Gharama za ziada huongeza mzigo wa huduma za afya na kupunguza upatikanaji wa dawa, haswa kwa maskini kusini mwa dunia. "Mwanamke mmoja wa Uingereza, Profesa Sally Davies, ambaye ni afisa mkuu wa afya nchini Uingereza, amesema kuwa ""kugundulika kwa virusi vya corona ni kama bomu la wakati"" na amesema kuwa tatizo hilo linaweza kusababisha matatizo makubwa ya afya katika nchi hiyo." Kuelewa na kukabiliana na upinzani: Uendelezaji wa upinzani wa dawa unafikiriwa kuwa unasababishwa hasa na matumizi yasiyofaa ya dawa. Kwa mfano, mgonjwa hawezi kumaliza dawa za kuua viini au kuchukua kipimo kidogo kuliko kinachohitajika. Matibabu yasiyofaa, matibabu yasiyofaa kwa sababu ya utambuzi duni wa sababu halisi ya ugonjwa kama vile kutoa antibiotics kwa maambukizi ya virusi, dawa za hali ya chini na ukosefu wa hatua za kuzuia na kudhibiti maambukizi pia hufikiriwa kuchangia. Ukosefu wa kujitolea kwa serikali, idadi iliyopunguzwa ya chaguzi za matibabu na ufuatiliaji mdogo wa tatizo hilo pia unafikiriwa kuzuia juhudi za kudhibiti upinzani kutoka kwa kuenea. Kuhifadhi ufanisi wa dawa za kawaida za kuua viini na kuzuia kuenea kwa upinzani ni njia bora ya kuhakikisha kwamba tunaweza kudumisha faida za mipango ya sasa ya afya. Ingawa suala hilo linapata nafasi katika ajenda ya kimataifa, mapungufu makubwa bado yanapatikana katika maarifa ya kimataifa juu ya jinsi ya kukabiliana na upinzani wa dawa na, haswa, jinsi ya kuboresha hatua za afya ya umma ili kuzuia kuenea zaidi. Uvumilivu wa dawa na vifo vya watoto: Hatua za afya za jamii, kama vile wafanyakazi wa afya wa jamii, zina jukumu muhimu la kuongeza upatikanaji wa huduma za afya na kupunguza vifo vya watoto miongoni mwa watu maskini na walioondolewa. Hata hivyo, uthibitisho kuhusu matumizi ya busara ya viuavijasumu katika jamii ni mdogo. Malaria Consortium inatekeleza mkakati wa Integrated Community Case Management (ICCM) kwa malaria, nimonia, kuhara na afya ya watoto wachanga katika Afrika Kusini mwa Jangwa la Sahara. Mkakati huu unaimarisha huduma ya msingi ya malaria, nimonia na kuhara kwa kutoa mafunzo, vifaa, vifaa vya kazi na usimamizi kwa wafanyakazi wa afya wa jamii, ambao wanaweza kuhimiza mabadiliko ya tabia kati ya watunzaji na jamii kwa ujumla, na kutoa utambuzi wa bure na matibabu kwa watoto chini ya miaka mitano, ambapo upatikanaji wa huduma ya kituo ni mdogo. Sehemu muhimu ya kazi hii ni kuhifadhi ufanisi wa matibabu ya nimonia yaliyopo kwa kukuza matumizi ya busara ya viuavijasumu. ICBM ina uwezo mkubwa wa kupunguza mzigo wa nimonia, haswa katika idadi ya watu ambao ni vigumu kufikia, na inaweza kutoa fursa muhimu ya kuboresha matumizi ya busara ya antibiotics na kudhibiti kuenea kwa upinzani katika mazingira ya rasilimali. Kwa njia ya ComDIS-HSD, ushirikiano wa utafiti unaofadhiliwa na UKAID kati ya taasisi za kitaaluma na mashirika yasiyo ya kiserikali, Malaria Consortium imekuwa ikifanya utafiti nchini Zambia kuelewa matumizi ya antibiotics katika ngazi ya jamii ili kuelimisha hatua katika nchi zinazotekeleza ICCM. Matokeo ya kazi hii yatatolewa kwenye kituo cha malaria na magonjwa ya kuambukiza. Angalia nafasi hii. Pata maelezo zaidi kuhusu ComDIS na kazi yetu nchini Zambia hapa. Maneno muhimu: Upinzani wa dawa