Antibiotic Resistance: Hidden Rates in Rural Areas of the Developing World

When the age of antibiotics commenced in the 1950s, diseases and infections that typically would lead to humans being stigmatized by society, a permanent stay at a sanatorium, and then ultimately death were suddenly able to be treated quickly and efficiently. Penicillin and Streptomycin, not only improved a patient’s quality of life and longevity, but reshaped the very nature of treating infectious diseases. Health care professionals now possessed a cure to end the spread of the ailment and to eliminate the actual microorganism that created the suffering. However, these agents brought with them negative consequences that the global health community is still combating today – antibiotic resistance being one of the most significant issues. Antibiotic resistance is the predator’s (bacteria, virus, other microorganism) ability to resist an antibiotic that once was able to eliminate it. Although antibiotic resistance can occur naturally due to the cleverness of bacteria, fungi, and protozoa, the misuse of antibiotics in humans has tremendously accelerated the rate and severity of resistance. This inappropriate use of medicine and skills has led to difficult to treat infections like Extended-spectrum beta-lactamase (ESBL) producing strains of Enterobacteriaceae and even untreatable infections with no known drug on the market able to help an infected patient. The concept of antibiotic resistance often differs within the medical community when comparing the developed world, particularly urban areas, and the developing world, particularly rural areas. The amount of research, minds, and technology mobilized to address this unruly behavior by microorganisms varies drastically between the two sets.

In the urban developed world where physicians are equipped with the most innovative antibiotics known to man like daptomycin or the “Crispr” agents, antibiotic resistance is frequently a topic of discussion along with funding, human resources, and technology available to address it. Also, common ideology is that antibiotic resistance arises from the direct misuse of antibiotics rather than of natural causes. Contrasting the rural developing world, the aforementioned necessities to deter antibiotic resistance are often lacking due to health inequalities that unfortunately are ubiquitous throughout this fragile planet. More interesting though, health care professionals have formed an impression that antibiotic resistance more commonly stems from the dissemination of resistant organisms. With this mindset ingrained in world health leaders, the agenda has been to focus on prevention through this venue in the rural developing world – often lacking a call of funding to determine actual causes of antibiotic resistance and their associated rates in the rural developing world. While the dissemination of strains of Escherichia coli through feces and Multi-drug resistance Tuberculosis through poor air quality certainly needs to be addressed, the Centers for Disease Control and Prevention (CDC) released a report in 1999 encouraging health care professions to consider a range of socioeconomic and behavioral factors including misuse of antibiotics by physicians, unskilled practitioners, the public, counterfeit medications, inadequate surveillance, and political factors. To follow up with this theoretical account, the World Health Organization (WHO) conducted a survey across twelve (12) low to middle income countries across the world in 2015 to interview the population about their beliefs towards antibiotics and resistance. Some of the results are presented below:

  • In lower income countries, it was reported that antibiotic use is higher (42%) than in higher income countries (29%).
  • Across the countries, the range of patients obtaining their antibiotics with a physician’s prescription ranges from 56% to 93%.
  • The percentage of individuals believing they can use the same antibiotic as a family member did to treat a similar illness is 25% while 43% believe it is acceptable to buy the same antibiotic from a local pharmacy.
  • When patient’s start to feel better, 32% of the those interviewed believe they can stop the antibiotics and not follow through with full course.
  • When treating colds and viruses, 62% of respondents believe antibiotics could be used to treat these ailments.
  • Finally, 44% of those interviewed believe antibiotic resistance is only a problem for those regularly taking antibiotics.

These specific social results from patients in the developing world directly conflict with the thought of the major distributor of antibiotic resistance being through dissemination of the disease. The beliefs presented through these percentages seem to lead to a whole host of factors being involved similar to the developed world. In addition to these social results, PLOS Biology released data in 2018 that Escherichia coli was resistant to commonly prescribed antibiotics like ampicillin (92%), ceftazidime (90%), cefoxitin (88%), streptomycin (40%) and tetracycline (36%) in the rural areas of Sikkim, India in pre-school and school-going children. The Journal of the Pediatric Infectious Diseases Society reported similar rates among children in 2015 with Klebsiella pneumoniae having a median resistance to ampicillin with a rate of 94% in Asia and 100% in Africa, and cephalosporins having a rate of 84% in Asia and 50% in Africa. Also, The World Health Organization informed the global community that in Malawi in 2018, nearly 100% of Neisseria gonorrheae genital isolates were non-susceptible to ceftriaxone and roughly 15% were non-susceptible to azithromycin. When analyzing both the social and technical results from above, a renewed emphasis and novel perspective needs to be created in order to properly address antibiotic resistance in the rural developing world.

At the beginning of this year (January 2018), the World Health Organization released its initial reports utilizing an innovative reporting system for antibiotic resistance christened Global Antimicrobial Surveillance System (GLASS). This system was developed in order to preserve human and animal health throughout the globe in relation to antibiotics and their resistance. Although GLASS was officially launched in 2015, it is still in its early implementation period with only 22 countries reporting on actual resistance within their nation states and 40 countries reporting on their national surveillance program. However, GLASS aims at a variety of measures that will ensure antibiotic resistance is more appropriately addressed in the rural developing world by providing a standardized approach to collection, analysis, and dissemination of information to participating countries. GLASS will strengthen nation states antibiotic resistance surveillance systems and modify the data being studied from solely laboratory data to epidemiological, clinical, and population-level data. The preliminary results that were released by WHO revealed that across the 22 reporting countries, there were 500,000 individuals suffering from an infectious disease with antibiotic resistance. Although this data varies with completeness and accuracy across countries, the outcomes highlight the global emergency antibiotic resistance posses from the urban developed world to the rural developing world and everywhere in between – these mutated organisms will fail to respect national borders.

The global health bodies throughout the world have initiated programs and offered advice to nations that will serve the battle against antibiotic resistance well. However, the concealed rates of resistance in the rural developing world will need to be undertaken medically and socially in order to properly end this global emergency. Pipeline innovative antibiotics like relebactam, a novel beta-lactamase inhibitor and an educational emphasis on behavior habits will aid these parts of the world – but the health community will fall short unless the world changes its perception of antibiotic resistance in the countryside of Cambodia, the rice terraces of Vietnam, the jungles of Belize, and areas with similar socioeconomic status.

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Global Health News, Week of September 26-30

SECTION NEWS
The Advocacy/Policy Committee would like to invite you to participate in our first Advocacy Day, led in partnership with the Global Health Council. The day, scheduled for Thursday, November 3rd, 2011, immediately following the annual meeting in Washington, D.C., will be an opportunity for us to voice support for a continued focus on international health to our elected officials. With the intense Congressional pressure to cut the budget, our voices can make a real difference. As a participant during this exciting day, you will be provided with training materials on effective advocacy techniques to ensure your message is clearly heard. Even if you do not have advocacy experience, you need not hesitate to sign up because you will be teamed with others. Please consider joining your fellow International Health Section members on Thursday, November 3rd, 2011 on Capitol Hill to advocate for a healthy globe. Interested parties should register here. Please note that registration will close on October 14th. Any questions should be directed to Peter Freeman, Advocacy/Policy Committee Chair, at pffreeman@gmail.com or 773.318.4842.


The University of Washington has launched the first full year of its Global Health Minor program!

POLITICS AND POLICY

  • Tobacco companies knew that cigarettes contained a radioactive substance called polonium-210, but hid that knowledge from the public for over four decades, a new study of historical documents revealed.
  • Latin American leaders have agreed to accelerate their efforts to address maternal health at the 51st Directing Council of the Pan American Health Organization/World Health Organization.
  • Journalist Georgianne Nienaber looks at the impact of PEPFAR and how it may be impacted by budget battles in Congress.
  • Earlier this week, the World Health Organization released a report analyzing air pollution levels in nearly 1100 cities in 91 countries. The analysis was based on air particulate levels between 2003 and 2010.
  • When it came out a while ago that the CIA had used a fake vaccination scheme to try to find out where Osama bin Laden might be in Pakistan, many said it would undermine real health and humanitarian efforts. Here’s one group’s story.
  • Foreign aid has acquired a bad reputation in recent years, as something usually wasteful and useless. Yet all this sound and fury has overshadowed the evidence that aid often can work.
  • A report by the Partnership for Maternal, Newborn & Child Health finds that over 100 countries have increased financing for maternal and child health initiatives.
  • The humanitarian impact of the world economic crisis became clearer this week, as the UN warned of huge job losses, a rise in the number of people afflicted by chronic undernourishment, and the “extraordinary price” being paid by children as “austerity programs” constrict the developing world.
  • There is enough water in the world’s rivers to meet the demands of the expanding global population, but the rivers have to be better managed, according to a series of studies released today at the 14th World Water Congress in Porto de Galinhas, Brazil.
  • UNICEF has called on the IMF and World Bank to ensure that children are not negatively impacted by austerity measures carried out by various countries.

PROGRAMS

  • The New York Times shows how male circumcision is one of the most effective and simple solutions in HIV reduction, but has so far been hard to implement.  Meanwhile, a group of economists, including Bjorn Lomborg, are casting doubt on the cost-effectiveness of voluntary male circumcision campaigns as an HIV prevention measure.
  • The New York Times features an article about the simple innovation of using vinegar to detect if a woman has cervical cancer by applying it with a brush to the cervix.
  • The Global Fund, the world’s largest funder of global health, is set to radically shake up the way it disburses and manages donor money, in a move to boost efficiency that could reallocate a third of its financing in order to save more lives.
  • On Tuesday, the Global Alliance for Vaccines and Immunization announced that it will be expanding its target vaccine areas to directly address diarrhea and pneumonia.
  • UNFPA has announced that it is now collaborating with UNICEF to combat Female Genital Mutilation.

RESEARCH AND INNOVATION

DISEASES AND DISASTERS

  • Roads may accelerate spread of antibiotic resistance: Samples from villages by major roads in Ecuador compared to more rural villages shows antibiotic resistant E. coli is spreading along roads.
  • The recent heavy flooding caused by the monsoon in Pakistan, most devastating in Sindh, has affected the lives of over five million people. The Health and Nutrition Cluster is appealing for US$45.9 million. WHO requires US$14.8 for response for Health, Nutrition and Water and Sanitation intervention.
  • New enterovirus causes respiratory disease: Promed reports on 6 clusters of respiratory illness associated with human enterovirus 68 in Asia, Europe, and the United States during 2008–2010.
  • More than 20 percent of the population of Latin America and the Caribbean lacks basic sanitation and 15 percent has no access to drinking water because of poor management, said experts at a meeting that ended Thursday in Brazil.
  • The likelihood of water-borne disease outbreaks is high in areas in Philippines recently devastated by Typhoon Nesat.
  • Aid groups are criticizing the U.S.government delay on deciding whether to resume large-scale food donations to North Korea. The charities warn that many vulnerable people in the impoverished communist state could die from starvation.
  • In a new report on rabies, the WHO finds that 45% of cases in the world take place in Southeast Asia.
  • A decade-long study of 135,000 men found that those who did not have children had a higher risk of dying from heart disease than those who did, raising new questions over the links between fertility and overall health,U.S. researchers said on Monday.
  • More money is needed to save lives in famine-ravaged East Africa, with the UN saying it’s something like $700 million through year’s end. The World Bank announced from Washington it would boost its aid to area countries to nearly $1.9 billion.  As if famine weren’t enough, Nick Kristoff tells us that as Somalis stream across the border into Kenya, at a rate of about 1,000 a day, they are frequently prey to armed bandits who rob men and rape women in the 50-mile stretch before they reach Dadaab, now the world’s largest refugee camp.
  • An explosion of new technologies and treatments for cancer coupled with a rapid rise in cases of the disease worldwide mean cancer care is rapidly becoming unaffordable in many developed countries, oncology experts said on Monday.

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