When it comes to antimicrobial, experts say it is important to first understand microbes or microorganisms, which are living organisms that are too small to be seen with naked eyes. Bacteria, viruses, fungi, and parasites are microorganisms that cause diseases like tuberculosis, malaria, HIV, and pneumonia just to name a few. In Rwanda, antimicrobial resistance is a common problem as shown by different studies carried out on humans and animals. For instance, the Wiley Online Library, a collection of scientific databases that provide access to a multidisciplinary collection of full-text online resources, has shown that resistance in Mycobacterium tuberculosis strains is known to cause Tuberculosis. Hygienic practices like hand washing or using sanitizers may help to prevent most of the infections caused by antimicrobial-resistant pathogens. Photos: Net Also, antimicrobial resistance in human immunodeficiency virus (HIV) associated with acquired immunodeficiency syndrome (AIDS) has been reported. However, according to experts, the available literature mainly focused on a limited number of microbes and did not cover the whole country. Therefore, national-wide studies are needed to know the extent of antimicrobial resistance for the major pathogens causing diseases in both humans and animals. Meanwhile, globally, it is estimated that 750,000 people die every year due to antimicrobial resistance and if appropriate measures are not taken, 10 million people may die of AMR-related diseases by the year 2050. Understanding antimicrobial resistance Dr Noel Gahamanyi, Ph.D. in Molecular Epidemiology and AMR of campylobacter species says many people confuse antimicrobial resistance with antibiotic resistance. To understand this, he explains that antibiotic resistance is the resistance developed by bacteria to the drugs designed to kill them while AMR concerns all the microbes (bacteria, viruses, fungi, parasites). “AMR is a natural evolutionary phenomenon but very slow in nature. When an antimicrobial (medicine) is used, most of the microbes are killed,” he expounds. However, he mentions that a small number of that microbe, survive and develop genes that confer resistance to that antimicrobial. He goes on to note that the resistant microbes multiply and become the predominant population which easily spread. This, he says, is complicated by the ability of antimicrobial-resistant microbes to share resistant genes with other microbes that were sensitive through horizontal gene transfer. However, Dr Gahamanyi says misuse or excessive use of antimicrobials in humans, animals, and the environment accelerates this process. For instance, he says that when one buys antibiotics or other antimicrobials without a prescription or they don’t complete the prescribed dose, the microbe may develop resistance to that antimicrobial (drug). “The next time one uses the same drug, it will not treat them because the microbe became used to it,” he explains. Challenges Prosper Dusengeyezu, a public health officer says when microbes develop resistance to existing antimicrobials, infections caused by them become harder to treat or control than those caused by non-resistant ones. He says that antimicrobial resistance leads to increased medical costs (more expensive drugs), prolonged hospital stays (hospitalization), and increased mortality rates. Dr Gahamanyi notes that the sick person and the caretaker spend time at the hospital instead of going on with their income-generating projects considered as an economic burden to their families and society at large. “When a person has AMR pathogen, he may serve as a reservoir for a longer period, thus putting at-risk members of his family or the community and healthcare workers,” he adds. He goes on to note that this would be a problem to the Public Health authorities because it may require more investment to deal with that recurrent infection which sometimes may become an outbreak. “In the community, we have most vulnerable people like children and immuno-compromised people (living with HIV or cancer). Due to antimicrobial resistance, an infection caused by AMR pathogen may be fatal to that category due to reduced immunity,” he says. Emile Ngabo, operational Director at OAZIS Health and senior medical student at University of Rwanda says many infectious diseases risk becoming untreatable and uncontrollable. He says that antimicrobial resistance has been associated with increased morbidity and mortality, lower production, and economic losses all affecting food security leading to poor nutrition and health. Gahamanyi says the discovery of new antimicrobials is also very slow and very expensive, and that due to AMR, pharmaceutical companies are reluctant to invest in antibiotic discovery with little chance to get benefits before resistance emerges. Way forward According to medics, programs need to be adopted to increase the awareness of the AMR issue to all members of our communities through media. Second, national-wide studies are needed to know the extent of the problem in Rwanda. Surveillance studies may help to know the trend and know when to intervene. For instance, when a drug is no longer effective, we will know when to replace it with a stronger one. In addition, care should be given priority to preserve the limited antimicrobials we have as well as adopting a One Health Approach (a collaborative, multisectoral, and transdisciplinary approach working at the local, regional, national, and global levels with the goal of achieving optimal health outcomes. Also, hygienic practices like hand washing or using sanitizers may help to prevent most of the infections caused by antimicrobial-resistant pathogens.
