ENGAGING LOCAL COMMUNITIES IN THE FIGHT AGAINST ANTIMICROBIAL RESISTANCE: A CALL FOR INCLUSIVE ACTION

The global threat of antimicrobial resistance

Antimicrobial resistance (AMR) is a top global threat to human and animal health, the environment, food and nutrition, economic development and social equity. AMR poses an escalating threat to global health and the economy. It is directly linked to 700,000 deaths annually (Adebisi and Ogunkola, 2023), which could rise to 10 million annually by 2050 if no significant intervention is made (UNEP, 2023). Apart from human health, AMR is projected to cause devastating economic impacts. The World Bank estimates that AMR could cost the global economy about US$ 4.4 trillion annually by 2050 in healthcare expenses and GDP losses (Jonas et al., 2017). There is, therefore, a need to include everyone in the fight against this challenge.

Antimicrobial Resistance in LMICs

Antimicrobials such as antibiotics, antivirals, antifungals and antiparasitics are medicines used to prevent and treat infectious diseases in humans, animals and plants. Antimicrobial resistance (AMR) occurs when microorganisms causing these diseases no longer respond to antimicrobials, making the treatment of infectious diseases hard to impossible (Prestinaci et al., 2015). This global health challenge affects all countries regardless of income level. However, it is accelerated by factors such as poverty, limited access to healthcare, poor infection prevention and control measures, inadequate sanitation, and the misuse or overuse of antibiotics in both human and animal health. Hence, low-and-middle-income countries (LMICs) are disproportionately affected by antimicrobial resistance.

Consequently, Africa is the most vulnerable to the AMR threat. In 2023 alone, over 1.05 million deaths were associated with AMR (Antimicrobial Resistance Collaborators, 2023), with a staggering projection of 4.1 million AMR-related deaths by 2050 (WHO Regional Office for Africa, 2023). The high burden of infectious diseases, weak healthcare infrastructure, limited surveillance systems, and over-reliance on antibiotics further worsen this challenge. Without urgent, coordinated, and holistic actions, AMR could undermine decades of progress in public health and deepen health inequities, adversely impacting economic and social development across LMICs.

What role do local communities play in addressing AMR?

In the fight against AMR, the local communities, composed of indigenous people, local farmers and the general population, are often overlooked (Adebisi and Ogunkola, 2023). Local communities are valuable contributors to the spread of AMR as they are at the forefront of using antibiotics in agriculture and as traditional medicines in their daily lives (Hawkins et al., 2022). The misuse and overuse of antimicrobials by the local communities in human, animal and plant health are the main drivers in the development of drug-resistant pathogens. For instance, frequent antibiotic use in livestock to treat infectious diseases, coupled with traditional medicine practices where antimicrobials are used without proper guidance from experts, as well as the use of antimicrobials without prescription, significantly contribute to the development and spread of AMR (Mathew et al.,2024; Mitchell et al., 2023). These practices are driven by limited access to proper healthcare services and lack of awareness about the consequences of such actions, often prevalent in local communities.

The impact of excluding local communities in the fight against antimicrobial resistance  

Local communities are key to addressing antimicrobial resistance. Excluding them from formal strategies for fighting AMR can lead to negative outcomes, like spread of misinformation about the appropriate usage of antimicrobials. This misinformation can result in the misuse or overuse of antimicrobials, further accelerating the problem of AMR.

Local communities in low and middle-income countries are being excluded from AMR strategies, which is leading to the failure of initiatives to control the spread of AMR (Mathew et al., 2024; Mitchell et al., 2023). For example, the use of a top-down approach results in the development of policies that are not practical for local communities. Therefore, the continued spread of AMR is an evidence for the necessity of including the local communities in the fight against AMR. Previous cohort studies conducted in several regions like Bangladesh and Pakistan have demonstrated that engagement of the local communities can significantly contribute to the containment of AMR (King et al., 2020)

Strategies for building inclusiveness

Several strategies can be undertaken in order to integrate the local communities in the fight against AMR. To begin with, the promotion of community-based education initiatives to raise awareness about AMR and teach the local people about the proper usage of Antimicrobials. These initiatives should be co-developed with members of the local communities to ensure relevance and address the needs and challenges faced by the local communities. Different players, such as non-governmental organizations and youth-led initiatives, can engage the local communities and educate them on AMR. 

In addition, AMR policy-making should include frameworks involving the local communities in AMR initiatives. These policies can involve resource provision for local projects like the establishment of community health programs aimed at monitoring the usage of antimicrobials and the creation of platforms that encourage dialogue between local community members and AMR experts, ensuring the continued relevance and effectiveness of implemented AMR strategies.

Another strategy is fostering partnerships among local leaders, community members, and healthcare experts, which can facilitate a forum in which knowledge and resources can be shared and allow effective AMR interventions. Since traditional knowledge in making formal strategies is often overlooked, these partnerships can help include the voice of the local communities. For example, the integration of the practices and knowledge of indigenous healers with modern medicine leads to holistic AMR strategies.

In conclusion, global efforts in combating antimicrobial resistance may fall short without the active participation of the local communities. It is, therefore, essential to include them through awareness campaigns, policies, and partnerships, ensuring their active involvement in tackling AMR.

Reference list

Adebisi, Y. A., & Ogunkola, I. O. (2023). The global antimicrobial resistance response effort must not exclude marginalised populations. Tropical Medicine and Health, 51(33). https://doi.org/10.1186/s41182-023-00524-w 

Antimicrobial Resistance Collaborators. (2023). the burden of bacterial antimicrobial resistance in the WHO African region in 2019: A cross-country systematic analysis. Antimicrobial Resistance, The Lancet 12(2), e201-e216. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00539-9/fulltext 

Hawkins, O., Scott, A. M., Montgomery, A., Nicholas, B., Mullan, J., van Oijen, A., & Degeling, C. (2022). Comparing public attitudes, knowledge, beliefs and behaviors towards antibiotics and antimicrobial resistance in Australia, United Kingdom, and Sweden (2010-2021): A systematic review, meta-analysis, and comparative policy analysis. PloS one, 17(1), e0261917. https://doi.org/10.1371/journal.pone.0261917 

Jonas, O. B., Irwin, A., Berthe, F. C. J., Le Gall, F. G., & Marquez, P. V. (2017). Drug-resistant infections: A threat to our economic future (Vol. 2): Final report. HNP/Agriculture Global Antimicrobial Resistance Initiative. World Bank Group. http://documents.worldbank.org/curated/en/323311493396993758/final-report 

King, R., Hicks, J., Rassi, C., Shafique, M., Barua, D., Bhowmik, P., Das, M., Elsey, H., Questa, K., Fieroze, F., Hamade, P., Huque, S., Newell, J., & Huque, R. (2020). A process for developing a sustainable and scalable approach to community engagement: community dialogue approach for addressing the drivers of antibiotic resistance in Bangladesh. BMC public health, 20(1), 950. https://doi.org/10.1186/s12889-020-09033-5 

Mathew, P., Chandy, S. J., & Ranjalkar, J. (2024). Community engagement to mitigate antimicrobial resistance in low-and middle-income countries – An essential strategy for implementation of national action plans on AMR. The Lancet Regional Health – Southeast Asia, 24, Article 100379. https://doi.org/10.1016/j.lansea.2024.100379 

Mitchell, J., Hawkings, H., Latham, S., Fieroze, F., Arjyal, A., Barrington, D. J., Baral, S., Saify, M. B., Cooke, P., Hamade, P., Huque, R., Parajuli, A., Siddiki, A. Z., & King, R. (2023). Addressing antimicrobial resistance through community engagement: A framework for developing contextually relevant and impactful behaviour change interventions. JAC-Antimicrobial Resistance, 5(6), Article dlad124. https://doi.org/10.1093/jacamr/dlad124 

Prestinaci, F., Pezzotti, P., & Pantosti, A. (2015). Antimicrobial resistance: a global multifaceted phenomenon. Pathogens and Global Health, 109(7), 309–318. https://doi.org/10.1179/2047773215Y.0000000030 

United Nations Environment Programme. (2023). Antimicrobial resistance: A global threat. https://www.unep.org/topics/chemicals-and-pollution-action/pollution-and-health/antimicrobial-resistance-global-threat 

USAID. (2023). Combating antimicrobial resistance. U.S. Agency for International Development. Retrieved September 8, 2024, from https://www.usaid.gov/global-health/health-systems-innovation/health-systems/combating-antimicrobial-resistance

World Health Organization, Regional Office for Africa. (2023). Antimicrobial resistance (AMR). World Health Organization. Retrieved on September 8, 2024, from https://www.afro.who.int/ResistAMR