Antimicrobial resistance (AMR) has emerged as one of the most serious public health issues of the twenty-first century, threatening the effective prevention and treatment of an ever-increasing range of infections caused by bacteria or other parasites that are no longer susceptible to the common antibiotics used to combat them.

Antimicrobials — including antibiotics, antivirals, antifungals, and antiparasitics — are medicines used to prevent and treat infectious diseases in humans, animals, and plants. Antibiotics are used to treat bacteria-caused illnesses and disorders. They have made a significant contribution to increasing human health and life expectancy.

Many infections that used to kill individuals are now effectively treated with antibiotics. However, certain bacterial strains have developed antibiotic resistance. Antibiotic resistance refers specifically to resistance to bacteria. Antimicrobial resistance refers to resistance to bacteria, viruses, fungi, and parasites. For this article, we will mainly discuss antibiotic resistance.

According to the World Health Organization, it is estimated that bacterial Antimicrobial Resistance was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths worldwide. It also reports that the misuse and overuse of antimicrobials in humans, animals, and plants are the main drivers in the development of drug-resistant pathogens.

The World Bank estimates that AMR could result in US$ 1 trillion in additional healthcare costs by 2050, and US$ 1 trillion to US$ 3.4 trillion in Gross Domestic Product (GDP) losses per year by 2030.

Like elsewhere in the world, antibiotic resistance is a growing problem in Rwanda. Although not much data is available, certain studies, especially in health institutions have shown a high prevalence of antimicrobial resistance among common bacterial isolates in a tertiary healthcare facility in Rwanda.

Another study conducted in 2012 at a teaching hospital in Southern Province found that antibiotics commonly used for the treatment of Urinary Tract Infections in Rwanda are becoming less effective. Similar studies within the region have shown the same results and suggest that it’s a growing problem.

In June 2021, the Ministries of Health, Environment, Agriculture, and Animal Resources launched the National Actional Plan on Antimicrobial Resistance 2020-2024. This document serves as the guide to the national strategic direction to ensure access to good quality and safe medicines, this document also provides context-specific recommendations for multi-faceted actions in Rwanda, including enhancing AMR awareness and information; providing evidence-based knowledge to reduce the burden of AMR; reducing the incidence of infections in public and private institutions; maximising the use of antimicrobials in animal and human health; creating an enabling environment for sustainable investment in AMR reduction.

In addition to this, there was the creation of a National Multi-Sectoral Coordinating Committee on AMR, a central national steering body that shall supervise and coordinate all AMR-related activities in all sectors.

Antimicrobial resistance can affect anyone, no matter the age. But if you often get sick and need medicines to fight infections quite often, or if your immune system is not very strong, you are more likely to be at risk. When your immune system is not strong, it’s easier for resistant germs to attack you. So, if you find yourself needing medicines frequently, there’s a higher chance that you might encounter these resistant germs. It’s important for everyone, especially those who get sick often, to be aware of this issue and take steps to address it. Antimicrobial resistance germs can spread between people, animals, and plants and through food. They’re also found in the water, soil, and air.

Healthcare workers also have a critical role to play in combating antibiotic resistance. Antibiotic overprescribing is a particular problem in primary care, where viruses cause most infections. About 90 per cent of all antibiotic prescriptions are issued by general practitioners, and respiratory tract infections are the leading reason for prescribing.

Preventing antibiotic resistance involves adopting proactive measures to limit exposure and promote responsible use of antibiotics. While complete elimination of antibiotic resistance is challenging due to the adaptability of microbes, individuals can play a crucial role.

Working closely with healthcare providers to discuss symptoms and determine the appropriate medicine for treatment is essential. Strict adherence to prescription instructions, avoiding the use of someone else’s medication or sharing one’s own, and refraining from saving old antibiotics for future use are vital practices.

We also need to stay up-to-date on vaccinations and practice good general health habits, such as maintaining a proper diet, regular exercise, sufficient sleep, and rigorous hygiene practices such as frequent hand-washing. These measures can collectively contribute to preventing illness and reducing the reliance on the need for antibiotics.

Dr Vincent Mutabazi is an applied epidemiologist.

X: @VkneeM