The antimicrobial crisis in East Africa and its relation to poverty
At this moment, all our eyes are focused on one communicable disease: COVID-19. But in low- and middle income countries, including countries from East Africa, communicable diseases were already a part of daily life before the corona-crisis. In fact, the total number of healthy life year lost per capita due to infectious diseases is 15-times higher in developing countries than in developed countries. In Ethiopia for example, diarrheal diseases, lower respiratory infections, tuberculosis, HIV/AIDS and meningitis are in the top 10 causes of death, and other countries in East Africa deal with the same and other similar communicable diseases. For most of these communicable diseases there are curing medicines, which are called antimicrobials. Then why are communicable diseases still such a burden in developing countries?
Overall, in developing countries there is a higher burden of communicable diseases because of poverty, poor education, low health knowledge, poor infrastructure, geographic factors, and environmental factors such as limited access to clean water. Also, people in developing countries are more susceptible to infections due to malnutrition, chronic or repeated infections and lack of access to uncontaminated food and water. But this doesn’t explain everything. There is also a global problem that contributes to this, the so-called antimicrobial crisis. This means that there are bacteria that have a developed resistance for the medicines used for them so they don’t work, while this resistance can be spread between pathogens. The resistance rates are high in East Africa, and rising faster than in developed countries.
This can be explained by various reasons. Antimicrobials need to be used correctly to reduce the risk of developing resistance. The right antimicrobial and the right dose needs to be used for the right period of time. This way all of the pathogens will be killed, so they cannot develop resistance. Health systems in poor countries are less developed, so there is a lack of routine drug sensitivity testing and surveillance and there are shortages in drug supply. This means that there is a lack of antimicrobial drugs and the drugs that are being used are overused and used wrongly. Also, because lower income individuals have less money to spend, purchasing only a part of the treatment is very common or people decide to not go to a health consult and try to cure it by themselves through self-medication. This self-medication is purchased by unregulated outlets and often includes antimicrobials. Misuse due to lack of access to correct information is also common. Besides this, the quality of antimicrobials in Africa is often lower and because of this the dose that is being prescribed is often not the right dose. All of these factors contribute to rising antimicrobial resistance in East Africa. For example, up to 54% of E. Coli is resistant to third-generation cephalosporins in East Africa, compared to the 5–25% in Western Europe.
In conclusion, because of poverty related factors developing countries are more susceptible to communicable diseases and also face a higher burden of this diseases. Antimicrobial resistance is contributing to this problem, while also being influenced by many factors related to poverty. All of this influences the health system and has a negative impact on it, so the health system becomes more fragile. It also puts a financial burden on countries and thereby contributes to already existing poverty in the developing countries. Thus, this problem is very complex and deeply rooted, and contributes to the cycle of poverty.
