In  Malawi’s overwhelmed hospitals, doctors are worried about growing resistance to antibiotics, the drugs used to treat deadly bacterial diseases such as tuberculosis and meningitis.

The lifesaving workforce is concerned that people keep dying of treatable diseases.

From their murmurs, abuse of the vital drugs, even for diseases that could be treated using other medicines, leaves them with few or no antibiotics for tackling deadly killers when it matters.

However, new data from 14 sub-Saharan countries, including Malawi, finds that only five out of the 15 antibiotic-resistant germs listed by the World Health Organisation (WHO) as priority pathogens are being consistently tested.

However, the multi-country findings released at the African Union on September 15 shows that all five demonstrated high resistance. 

The study was carried out by the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (Maap), a consortium spearheaded by the African Society for Laboratory Medicine (ASLM) in partnership with Africa Centre for Disease Control and Prevention (Africa CDC).

It provides stark insights on the under-reported depth of the continent’s antimicrobial resistance (AMR) crisis and policy recommendations to address the emergency.

ASLM director of science and new initiatives Dr Pascale Ondoa said: “Africa is struggling to fight drug-resistant pathogens, just like the rest of the world, but our struggle is compounded by the fact that we don’t have an accurate picture of how antimicrobial resistance is impacting our citizens and health systems. This study shines a much-needed light on the crisis within the crisis.”

The study financed by the Fleming Fund provided insight into the antimicrobial resistance burden and consumption in the 14 countries where most available data is only based on statistical modeling.

This effort is the first of its kind to systematically collect, process and evaluate large quantities of such data in Africa.

WHO has repeatedly termed germs resistance to antibiotics a global health priority and one of the leading public health threats of the 21st century.

A recent study published in the Lancet journal estimates that, in 2019, nearly 1.3 million deaths globally were attributed to antimicrobial resistant bacterial infections. Africa was found to have the highest mortality rate, with 24 deaths per 100 000 attributable to the crisis.

ASLM chief executive Nqobile Ndlovu: “Across Africa, even where data on antimicrobial resistance is collected, it is not always accessible, often recorded by hand and rarely consolidated or shared with policy makers.

“As a result, health experts are flying blind and cannot develop and deploy policies that would limit or curtail antimicrobial resistance.”

The researchers reviewed 819 584 antimicrobial resistant records spanning from 2016 to 2019 from 205 laboratories across Malawi, Kenya, Tanzania, Uganda, Eswatini, Zambia and Zimbabwe. Other samples were collected from Burkina Faso, Ghana, Nigeria, Senegal, Sierra Leone, Gabon and Cameroon.

They also reviewed data from 327 hospital and community pharmacies and 16 national-level AMC datasets.

Researchers found that most laboratories across Africa are not ready for AMR testing.

Only 1.3 percent of the 50 000 medical laboratories forming the laboratory networks of the 14 participating countries conduct bacteriology testing.

And of those, only a fraction can handle the scientific processes needed to evaluate AMR.

Researchers also found that in eight of the 14 countries, more than half of the population is out of reach of any bacteriology laboratory.

“The paucity of antimicrobial resistance testing services for 10 out of 15 of the priority pathogens identified by the WHO for causing the greatest threat to human health indicates that AMR levels are likely underestimated, which may directly impact patient care,” said Dr Geetanjali Kapoor, head of One Health Trust, India.

Worrisomely, across the 14 countries, clinical and treatment data are not linked to laboratory results, making it hard to understand what’s driving the growing resistance.

Out of almost 187 000 samples tested for antimicrobial resistance, nearly 88 percent had no information on patients’ clinical profile, including diagnosis and origin of infection; presence of indwelling device such as urinary catheters, feeding tubes and wound drains often associated with development of healthcare-associated infection comorbidities or antimicrobial usage. The remaining 12 percent had incomplete information.

“The disconnect between patient data and antimicrobial resistance results, coupled with the extreme antimicrobial resistance burden, makes it incredibly difficult to provide accurate guidelines for patient care and wider public health policies,” says Africa CDC AMR programme coordinator Dr Yewande Alimi.

Alimi says collecting and connecting laboratory, pharmacy and clinical data will be essential to provide a baseline and a reference for public health actions.”

 The research also found that only four drugs comprised more than two-thirds (67 percent of all the antibiotics used in healthcare settings. Stronger medicines to treat more resistant infections (such as severe pneumonia, sepsis and complicated intra-abdominal infections) were not available, suggesting limited access to some groups of antibiotics.

Deepak Batra, IQVIA head of Public Health in Africa and Middle East, says the findings highlights a dual problem of limited access to antibiotics and irrational use of those available.

“As a result, people don’t get the right treatment for severe infections and irrational use of antibiotics drives antimicrobial resistance for existing available treatment options. Routine monitoring of antimicrobial consumption could help monitor the limited access and irrational use,” says Batra.

Based on the findings, the future of modern medicine and treatment not infectious diseases hinges on our ability to control antimicrobial resistance.

I hope Maap inspires more investment in essential data collection and desperately needed resources,” said One Health trust president Dr Ramanan Laxminarayan.

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