June 26, 2015
In his preface to the GARP-Tanzania Situation Analysis and Recommendations on Antibiotic Resistance in Tanzania, Professor Said Aboud, Chairman of the GARP-Tanzania Working Group, writes:
Antibiotics and other antimicrobial agents are invaluable lifesavers, particularly in resource-limited countries where infectious diseases are abundant. Both uncomplicated and severe infections are potentially curable as long as the bacteria that cause them are susceptible to antimicrobial drugs. The rapid rate with which antimicrobial agents are becoming ineffective due to resistance acquired as a result of unchecked overuse and misuse threatens to undo the benefit of controlling infections. Resistant bacteria, which in many cases are resistant to more than a single antimicrobial agent, have been observed globally. In Tanzania, this evidence comes from relatively few scattered studies from different parts of the country, in a multitude of settings including health care facilities, the community, domesticated animals and wild animals. Resistant organisms are passed from animals on to even antibiotic-naïve humans through consumption of meat, milk and other animal products. This contributes to the decline towards ineffective antibiotics, like an approaching siren, getting louder and louder.
At the same time, ensuring access to high quality, life-saving antibiotics is also a continuing challenge and the need to institute control on use to conserve the power of antibiotics must not be misconstrued as an obstacle to access. We need to reach a balance where, on one hand antibiotics are optimally available, and on the other, limiting access to unwarranted use.
This situation analysis is a locally generated report with proposed recommendations for immediate and long-term action plans. It is part of a global project, the Global Antibiotic Resistance Partnership (GARP), which recognizes the need for both global and national contributions to maintaining an effective antibiotic supply. Prior to development of this report, the evidence had never been consolidated to give a summary picture of what is known of the entire country’s antibiotic use and resistance status, both in humans and animals. With the policy recommendations and areas of focus discussed, there is an urgent call for a coordinated response. Changing the status quo on irrational use of antibiotics among humans and their animal counterparts is key to rationalizing antibiotic use in Tanzania.
Some of the recommended changes may cause upheavals in what are accepted standard procedures and may be met with resistance. Hospital managers may not appreciate the added constraints on the budget that antibiotic stewardship may entail during the start-up of such programs. Some antagonism may be felt from drug outlets that profit from dispensing prescription-only as over-the-counter drugs. Patients may also offer some resistance due to the belief that treatment is incomplete without an antibiotic prescription. Farmers may be highly opposed to reducing antibiotic use in their livestock.
These anticipated reactions result from a prevailing lack of knowledge—which this report should start to remedy—and reluctance of those who should know better. With this report and further work, policies that will fill the current gaps can be developed and enforced. The GARP-Tanzania working group will continue to champion this noble cause by allocating technical and other expertise in meeting various milestones to mitigate the current AMR problem. We welcome ideas, comments and collaboration in this effort.
Said Aboud, MD, PhD
Associate Professor and Head, Department of Microbiology and Immunology, MUHAS
The GARP-Tanzania Situation Analysis and Recommendations on Antibiotic Resistance in Tanzania will be released in late July 2015.
