ANTIMICROBIAL RESISTANCE-AN URGENT GLOBAL CONCERN: THE NATIONAL AND REGIONAL CONTEXT Martha Gyansa-Lutterodt Director of Pharmaceutical Services Ministry of Health Ghana 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 # BAWKU # ZEB ILLA #BONGO # TUMU # NAVRONGO # # SANDEMA B#YOLGATANGA # LAWRA LAWRA Up p er Ea st # #GAM BAGA # NADAWLI # WALEW ALE Up p er West #Y# WA # GUSHIEGU #SABOBA Nor t h er n #SAVELUGU TOLON TAMALE #YENDI # #Y# #ZAB ZUGU #DAMONGO # BOLE #BIMB ILA # SALAGA # NKWANTA # KINTAMPO Br on g Ah a fo # KETE-KRA CHI #WENCHI # ATE BUBU # KWAME DA NSO TECHIMAN DROBO # # #NKORA NZA # KADJE BI #BEREK UM #JASIKAN # EJURA #Y# SUNYANI #DORMA A A HENKRO #HOHOE #BECHEM Ash an t i DONKORKROM # # TEP A #KPANDU # KENYAS E NO. 1 OFINSO # # AGONA AKROFOSO MANKRANS O # EFFIDUASE GOASO # # #MAMPONTENG KUM#ASI# EJISU #Y KONONGO-ODUMASE # MAMPONG ASHANTI #NKAWIE # # HO #JUASO #MPRAES O #Y KUNTE NASE MANSO NK WANTA # #BIB IANI # #BEKWAI # BEGORO #JUABE SO #NEW ABIREM Vol t a # ATIMPOKU # SEFWI W IAW SO #OBUASI East er n #KIB I KOFORIDUA# ODUMA SE KROBO # AKATSI # KADE # # #DENU # SOM ANYA # ADIDOME NEW EDUBIASE # SUHUM#Y # SOGAK OP E #DUNKWA- ON-OFIN # AKROPONG AKW APIM # AKIM ODA # #ASAMANKESE #DODOWA # ENCHI #ASANK RAGUA # NSAWA M Cen t r al Gr eat er A#AcDA cFOArH a #ASSIN FOS U #AMASAMAN # TW IFO PRASO # TEM A M UNICIP AL AREA #BREMAN ASIKUMA West er n # AGONA SWEDRU #Y#ACCRA # AJUMA KO # # ABURA DUNKWA # WINNE BA TARKWA # APAM Ghana boundary # SALTPOND Regional Capital # DABOASE #Y # #Y#CAPE COAST #HALF ASSINI ELMINA # District Capital #Y# SEKONDI/ TAKORADI W ater body # # AGONA NKWA NTA AXIM 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 .