Antimicrobial Resistance: A Global Issue, Afghanistan Focused Study - Essay Sample

Abstract

Antimicrobial resistance is a global issue. The major contributing factor to this has been the increased improper use of antimicrobials such as antibiotics. Issues such as use of antibiotics for the wrong intentions, inability to maintain hygiene and uncontrolled purchase of over-the-counter drugs. This study was set to look at the issue of AMR and antibiotic resistance in Afghanistan as well as the data available and its trends and contributing factors. Besides, it was aimed at reviewing the existing policies, strategies and practices of AMR. Lastly, the study sought to review international guidelines and the best practices on AMR and make proper linkages to the country guidelines. Data reviewed was obtained from three laboratories in different regions of Afghanistan and they showed some of the most common pathogens which are resistant to antibiotics. The available data (secondary data) for 2018 and 2017 from culture/Antibiogram tests from 3 reference laboratories in Afghanistan, Central Public Health Laboratory/Kabul, Regional Reference Lab of Jalalabad and Regional Reference Laboratory of Kandahar was analyzed. Based on the data from the three regions, it is evident that there are some microorganism which are more prevalent in some regions than in others. For example P. aeroginosa is common in Kandahar but not in Kabul. However, there are some microorganisms which are present in all regions. One of these is E. coli which is found in all the three regions.

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Introduction

For a number of decades, anti-microbial resistance (AMR) has become a threat to many nations across the world. Afghanistan is one of the countries that have recorded increased cases of anti-microbial resistance (AMR), making the treatment of diseases and conditions which were previously treatable, difficult. Anti-microbial resistance (AMR) makes it difficult to treat diseases that are caused by fungi, parasites, bacteria, and viruses. The effects of anti-microbial resistance (AMR) are that it results in reduced efficacy of the drugs and treatment methods used as antiparasites, antiviral, and antifungal (Ingle et al., 2018). As a result of this, treatment becomes hard and costly, and in some cases, it becomes impossible. When drugs are administered to a sick patient, the diseases causing organisms are not affected by the drug as intended, and this results in prolonged illness as well as increased mortality. The magnitude of anti-microbial resistance (AMR) in Afghanistan, as well as its impact on human health, remains largely unknown. In some cases the resistance also apply for the medicines, we are using for the treatment of Viruses, Fungi and parasites, the resistance at this case will be called antimicrobial resistance (WHO, 2017)

We are in the midst of an emerging crisis of antibiotic resistance for microbial pathogens in the United States and throughout the world. The resistance of against antibiotics has become an epidemic, which has been described in many pathogens with different contexts, but some of the infections such as methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus Pneumonia have shown the global spread of drug resistance (Spellberg et al., 2008).

Antibiotic Resistance is also a public health problem in Afghanistan, although there is no data at country level, Some small studies have revealed that Antibiotic Reistance is existing, which is due to misuse and overuse of antibiotics are very common and additionally all the antibiotics can be easily got Over the Counter without prescription (Bahrmand et al., 2009)

Antibiotics reinforce the modern medicine of today, from a major surgery to caesarean section and as well as the treatment of cancer (Felmingham, 2002). Recently resistance among the microorganisms has become a global public health problem, where we are all in the battle to evade microbial resistance and it has become a global public health problem (Felmingham, 2002). Antibiotics are overused and misused both in human and animal health, which can threaten the effectiveness of antimicrobials (Felmingham, 2002).

The general topic from the global health perspective is Anti-Microbial Resistance, so let’s elaborate first on AMR then we will focus on Antibiotic Resistance. AMR refers to the expression of microorganism’s ability to neutralize drugs, which are commonly used for the treatment of associated infections (WHO, 2007). The microorganisms develop resistance through different mechanisms such as efflux pump (removing antimicrobials penetrating the cell), enzymatic changes of anti-microbial drugs (e.g., by production and release of beta-lactamases), new pathways of metabolic (altered enzymes synthesis), alteration of bacterial proteins alteration, which is acting as antimicrobial) targets and among others (WHO, 2007).

Anti-microbial resistance (AMR) is a global health problem and a kind of big threat to the human being. The global AMR rates have become alarming, where over 700 000 deaths worldwide attribute to anti-microbial resistant species due to TB, HIV and Malaria (Hajjeh & Mafi, 2016). During the last two decades, antimicrobial resistance became global threat to the public health systems. From the day, the first antibiotic was discovered, which provided significant benefits for the health and human medicine, the abuse and misuse of antimicrobials in human and veterinary medicine have accelerated the worldwide growing phenomenon of AMR (WHO, 2007).

Based on WHO Global Anti-Microbial Resistance Surveillance System (GLASS) guidelines, there will be a shift from surveillance approaches method, which is solely based on laboratory data to a new system, which includes different aspects of epidemiological, population and clinical level data (WHO, 2007). This method can increase the understanding of the people on AMR impact on human health.

The appropriate use of antibiotics is an issue that is addressed by every other nation in the world. The reason for this is that the level of antibiotic resistance has gone up. Every country has experienced antibiotic resistance in one or the other making it necessary to address this issue. For example, in 2000, records indicate that more than 54 billion standard units of antibiotics were consumed. In ten years from 2000, the figure increased spontaneously by 36% (Naimi et al., 2017). The increase has been continuing and this has brought about a public health crisis. The problem is not only affecting the middle-income countries where the use of antibiotics is considered a right that cannot be denied. The problem is equally rampant in low income countries such as Afghanistan and Iraq among others. One of the major reasons for the increase in antibiotic resistance is increase in over-the-counter sales of antibiotics, inappropriate prescribing and high consumption of antibiotics among people even for diseases and conditions that are supposed to be treated by other means or drugs. Analysis that have been done to determine the extent of antibiotic resistance have shown an increase in antimicrobial resistance (AMR) as well as extended spectrum beta-lactamase, and plasmid-mediated colistin resistance. These and related resistance patterns to antibiotics have been associated with negative outlooks on public health burden including deaths that can be attributed to AMR.

Background Information

When bacteria grow and adapt in the environment where antibiotics exist, antibiotic resistance develops. The development of resistance among bacteria is related that how many times the antibiotics are used. Resistance to one antibiotic can lead to another antibiotic from the same group, when the antibiotics belong to the same class. The resistance among antibiotics also can rapidly spread from one microorganism and one location to another microorganism and location through exchange of genetic materials and treatment of such infections can be affected accordingly. Antibiotic resistant bacteria is transmitted among human beings and animal through different means such as water, environment and Food. The spread of such bacteria is accelerated human and animal movements, travel and trade. We can find drug resistant bacteria in the different food products; originated from plan or animal, which are consumed by human beings.(5)

Afghanistan is one of the Low-income countries where about 40 years war and conflict are ongoing in the has the population of about 35 million with the following demographic data: The population of Afghanistan in 2018 as per the Civil statistics organization is estimated at 29.7 million. With an overall sex ratio of 104 females per 100 males. The annual growth rate of the population is estimated at 2.22%. The Crude birth rate 35 per 1000 population while general fertility rate is 159 per 1000 women. Size of population in the economically productive age group of 25 to 54 years and increasing aging population indicate increase in investment in healthcare. Average family size of the country is 7.3. though Life Expectancy at birth has improved remarkably in the last decade but it is still low compared to developing nations at 63 years with females living longer than males.

The demography of Afghanistan is as follows (Year 2017)

Total population 29.7 million (CSO)

Sex ratio 104 per 100 males

Crude birth rate 35/1000 Population

Total fertility rate 5.1

General fertility rate 159/1000 women

Life expectancy at birth (years) 63.673

Country income group Low income

Total expenditure on health per capita 87 USD

Gross national income per capita 560 USD

Data from Health Profile Afghanistan reveals that communicable diseases are the chief cause of mortality in Afghanistan, followed by diseases like maternal & neonatal complications, malnutrition, congenital anomalies and drug use & suicide. Non communicable diseases cause about 20% of all the deaths in Afghanistan and about 10% of deaths happen due to war, accident or other injuries.

Data regarding non communicable diseases reveal that Cardio Vascular Disease (CVD) and Stroke contribute to the maximum number of deaths in this category. Cancer is another ailment sharing about 11% of deaths (Felmingham, 2002). Kidney diseases, Endocrine disorders including diabetes and Gastrology including liver together share about 21% of deaths equally distributed among each of them (Felmingham, 2002). Respiratory disease causes about 6% of deaths among non-communicable diseases with neurological disorders contributing about 1% to the mortality.

Problem Statement

Antibiotic resistance is major issue across the world. While this was not a major issue in the early years, recent times have recorded increased levels of antibiotic resistance making it a necessary topic to discuss in this research. New resistance mechanisms are emerging and spreading globally and this poses a great risk to the ability of treating common infectious diseases. There have been an increasing list of infections such as gonorrhea, tuberculosis, pneumonia, malaria among others which are becoming harder to...