ANTIMICROBIAL RESISTANCE-AN URGENT GLOBAL CONCERN: THE NATIONAL AND REGIONAL CONTEXT

Martha Gyansa-Lutterodt Director of Pharmaceutical Services Ministry of Health Outline

• Sub- Saharan Africa- Case of Ghana • What do we know now? • The Health Systems • Mass Media Capacity • Knowledge, Attitude, Beliefs and Practices • Conclusion Ghana Map #

# ZEB ILLA #BONGO # TUMU # # # B#YOLGATANGA # LAWRA Up p er Ea st # #GAM BAGA # NADAWLI # WALEW ALE Up p er West #Y# WA

# GUSHIEGU

# Nor t h er n #

TOLON TAMALE # # #Y# #ZAB ZUGU

# # BOLE

#BIMB ILA

#

#

# KINTAMPO Br on g Ah a fo # KETE-KRA CHI # # ATE BUBU # KWAME DA NSO

TECHIMAN DROBO # # #NKORA NZA # KADJE BI #BEREK UM # # #Y# #DORMA A A HENKRO

# # Ash an t i # # TEP A #KPANDU # KENYAS E NO. 1 OFINSO # # AGONA AKROFOSO MANKRANS O # # # # KUM#ASI# #Y KONONGO-ODUMASE # ASHANTI # # # HO # #MPRAES O #Y KUNTE NASE MANSO NK WANTA # #BIB IANI # # # #JUABE SO # Vol t a # # SEFWI W IAW SO # East er n #KIB I # ODUMA SE KROBO # # KADE # # # # SOM ANYA # # SUHUM#Y # SOGAK OP E #DUNKWA- ON-OFIN # AKW APIM # # # # # #ASANK RAGUA # NSAWA M Cen t r al Gr eat er A#AcDA cFOArH a #ASSIN FOS U # # TW IFO PRASO # TEM A M UNICIP AL AREA #BREMAN ASIKUMA West er n # #Y# # AJUMA KO # # ABURA DUNKWA # WINNE BA # Ghana boundary # Regional Capital # #Y # #Y# # # District Capital #Y# SEKONDI/ TAKORADI W ater body # # AGONA NKWA NTA Regions Ashanti Brong Ahafo Central Eastern N Greater Accra 200 0 200 400 Kilometers Northern W E Upper East Upper W est S Volta W estern Prepared by Alexander Boakye Marful, July 2005 Courtesy ADMER project What do we know now? • Beta Lactamase producing E –coli and Klepsiela • High intestinal colonization of Extended Spectrum Beta Lactamase (ESBLs) • High use of cephalosporins & hospital contact are major risk factors for ESBL coverage • CTX-M15 producing E. coli constitute a significant problem in Ghana • Salmonella • Multi-drug resistance in poultry (79%) • Human non-clinical (66% )and human clinical (92%) • A worrying concern is > 87% ESBL producing strains • Staphylococcus aureus • 9/27 Methicillin-Resistant Staphylococcus aureus (MRSA) • higher risk of nasal carriage of MDR Staphylococcus • Pneumococci • Continuous monitoring system of serotypes and antibiogram is needed Our Health Systems • Continuous review of Standard treatment guidelines and Essential Medicines list • Infection Control Policy, 2011 • Data • The players • Providers – capacities of prescribing and dispensing • Users -what do they know and how to influence change

Strengthening The Health System • Improve Medicine use monitoring • Establish Antibiotic Surveillance systems • poor records on treatment failures • Strengthen regulation • Sub-standard spuriously labelled, falsified counterfeits • Political/ Technical Commitment • Apply health technology assessments to medicine selection within the linkages • Restrict antibiotic use in veterinary

KABP study @ www.ghndp.org

Mass Media Capacity?

• Antibiotic misuse occurs within our communities • Building Civil Society Organisations (CSO) and Media capacities to support change of users • Study of Knowledge, Attitude, Beliefs and Practices of CSO’s was revealing • Provider KABP is still ongoing

Study details www.ghndp.org Knowledge Gaps in Use of antibiotics and their effectiveness

• Responses for "Antibiotics are effective against bacteria" • There is a knowledge gap identified especially for CSHC; scoring 14.3% wrong responses • Responses for "Antibiotics are effective against viruses" • There is a knowledge gap identified especially for Coalition and CSHC; scoring 41.3% and 28.6% wrong responses respectively. • Also for the absence of information, 20.6% and 28.6% responses for “Don’t know” respectively for Coalition and CSHC. • Responses for "All common colds are caused by bacteria" • There is a knowledge gap especially for Coalition, CSHC; scoring 42.9% wrong responses. • Also for absence of information, 25.4% and 21.4% responses for “Don’t know” respectively for Coalition and CSHC.

Concluding Remarks • Establishing the ‘ADMER programme and culture’ • Formulate appropriate policies and build stakeholder capacities • Improve funding architecture at least 2% of funding agencies to monitor antibiotic use surveillance • Build surveillance systems with linkages to global actions • Improve Diagnosis and Improve supply chain • Responsible access to medicines especially for antibiotics