November 25, 2014
As we take another turn down the winding dirt path of the market, I struggle to keep up with the research team as they maneuver deftly around the crowds of locals buying tomatoes and onions from stalls made of long wooden branches, women impossibly balancing loads of groceries and firewood atop their heads, pop music blasting. We are looking for a certain kind of stall, one with precious medical goods hidden well out of sight. We are looking to interview Mozambique’s informal sellers of antibiotics and other prescription medications.
The Global Antibiotic Resistance Partnership (GARP)-Mozambique is part of CDDEP’s largest global project, which has similar groups in seven other countries. GARP brings together a small group of active local experts to generate scientific evidence that can be used to advocate for policies that increase access to antibiotics while ensuring their sustainable and effective use.
This month I was fortunate enough to work closely with the chairman of the GARP-Mozambique working group at the Center for Health Research in Manhiça (CISM), 80 Kilometers north of the capitol city of Maputo. Betuel Sigauque is a senior clinical researcher at CISM, focusing on pneumococcal infections and antibiotic resistance.
In Mozambique, antibiotics are not subsidized by the government, as treatments for malaria and HIV are, and this presents an opportunity for profit outside the formal health setting. CISM’s research on informal sales found that sellers range from local businessmen to doctors selling products out of their homes. Drugs sold in the informal sector are likely to be stored in poor conditions, and the potential for counterfeit or substandard drugs to make their way into informal shops is high.
In Maputo and other cities, and even towns like Manhiça, people can choose to go to a clinic or buy antibiotics directly from a drug seller, but in remote villages, the informal market may be the only feasible point of access to life-saving drugs. Half of Mozambique’s population lacks access to a primary healthcare facility, and the mortality burden for treatable bacterial diseases, particularly in children under five, remains high.
Antibiotic resistance is already a serious health issue worldwide, In Mozambique, limited information on resistance rates is available, but high rates of resistance to first line antibiotics have been documented in many pathogens, including those that cause potentially deadly childhood diseases such as sepsis, pneumonia and bacterial diarrheal diseases.
CISM is the most prominent center conducting research on antibiotic use and resistance in Mozambique. In partnership with the Manhiça District Hospital, CISM runs a health surveillance program that extends through the entire district of Manhiça, keeping track of births, deaths and illnesses. The center is currently conducting a number of studies, including the effect of pneumococcal vaccination on antibiotic resistance in Streptococcus pneumoniae. Studies CISM has carried out have found resistance rates to first-line antibiotic treatments as high as 97 percent for cholera, 75 percent for Salmonella and 90 percent for Staphylococcus aureus, among others.
Other GARP partners, such as the Veterinary Faculty at Eduardo Mondlane University, bring the animal health perspective to the table. The use of antibiotics in animals for disease prevention and growth promotion can have serious consequences for human health.
On my last day at CISM, we paid a visit to the district hospital. We made our way to the pediatrics wing, where children fill the cots, the worried faces of their mothers and aunts hovering close by. I watched as a local nurse drew up the antibiotic treatment for pneumonia, the third largest cause of death for children under five in Mozambique. The antibiotics administered, the nurse marked off the girl’s information on her chart. I thought of the simplicity with which this infection has been averted, and the important role GARP has to play in preserving the vitality of antibiotics for the generations to come.
Molly Miller-Petrie is a Senior Research analyst at CDDEP working on the Global Antibiotic Resistance Project.
Photos courtesy of Molly Miller-Petrie.
