Global Health Action | 2019
The AMR emergency: multi-sector collaboration and collective global policy action is needed now
Abstract
This Special Issue of Global Health Action showcases original research, critical review, innovative methods and informed commentaries on antimicrobial and antibiotic use and resistance. The compilation of eleven papers underscores complex inter-relationships and drivers of resistance across human and animal health, agriculture, the environment, and industry. A common view is that multi-sector collaboration is urgently needed to tackle antimicrobial resistance. The scoping review is a comprehensive synthesis of 399 papers on antibiotic resistance and prevention from the peer-reviewed and grey literature (2000–2017) [1]. The findings indicate gaps in surveillance systems, particularly in low – and middle-income countries and an abundance of information on local and national uses and misuses of antibiotics. An epidemiological framework with potential entry points for antibiotic resistance is suggested. New social and behavioural research methods are needed to complement existing biomedical and clinical approaches. A second review article appraised microbiological evidence on the prevalence of multidrug-, extensive drug-, and pandrug-resistance in escherichia coli isolates from human sources in community settings in lowand middle-income countries [2]. Nkansa-Gyamfi and coauthors call for greater community-level efforts in designing new and improved public health policies to counter the global threat of antibiotic-resistant infections and bacteria. Three papers used qualitative methods to explore awareness of antimicrobial resistance in lowand middle-income countries. Pearson and Chandler conducted interviews with human and animal healthcare professionals in Ethiopia, India, Nigeria, the Philippines, Sierra Leone and Vietnam [3]. Their finding that awareness of antimicrobial resistance did not translate to reduced prescribing is concerning. Barriers persist in contextual and structural factors such as accessibility and affordability, lack of local antibiotic information, and poor hygiene and sanitation. Contextual factors such as affordability and accessibility are also highlighted in a qualitative study of antibiotic use in rural communities in Bangladesh by Chowdhury et. al. [4]. Cultural and religious beliefs inform medicine use. Advice on antibiotics is typically sourced from unregulated village pharmacies. Lack of trust in government run hospitals and clinics is a sharp contrast. The focus on individual behaviour change needs to take the precarity of individuals’ socioeconomic circumstances into account. In another study conducted in Bangladesh, Darj, Newaz and Zaman conducted in-depth interviews with retail pharmacists in Dhaka to help understand their perceptions regarding antimicrobial resistance [5]. Participants reported self-medication, old prescriptions, inadequate regulation and readily available antibiotics as main contributors. We have noted a lack of educational and stewardship programmes for antibiotic resistance [1]. Hospitalbased antibiotic stewardship programs can improve patient outcomes and lower the risk of antibiotic resistant infections. McKnight et. al. [6] used mixed methods to investigate antibiotic stewardship policies and structures in 16 Kenyan hospitals. National policies should build upon existing structures, responsibilities and practices to manage the supply and prescription of antimicrobials. Antibiotics are used in high volumes to enhance growth and prevent disease in food producing animals. The Short Communication article by Mohsin et.al [7]. describes the results of an important baseline study which highlights worrying concerns about the use of antimicrobials in the poultry industry in Pakistan. The country’s consumption intensity of 250.84 mg of active ingredient per kilogram of chicken in Pakistan is second only to China’s. In their Short Communication article, Thornber et. al investigated digital communication as a means of rapidly and effectively communicating antimicrobial resistance messages to farmers in rural aquaculture in Bangladesh [8]. Disciplines such as psychology, sociology and anthropology are critical for understanding the developmental, socioeconomic and political contributors