Iruka N. Okeke
"Antimicrobial resistance in Africa: Uncovering and Combating a Hidden Epidemic"

The resistance of disease-causing organisms to the drugs conventionally used in their treatment is a burgeoning global problem. The African antimicrobial resistance epidemic is to a large extent under-recognized due to insufficient surveillance and confounding from a high infectious disease burden and poor access to health care. In Nigerian studies, employing readily cultivatable indicator bacteria, we have observed exceptional steep and steady increases in the prevalence of resistance to commonly used, cheap, broad-spectrum antibacterial drugs. Likely contributors to these disturbing trends include unregulated antimicrobial misuse, diagnostic insufficiency and poor quality drugs. Our studies also demonstrate that resistance is also more common in urban than rural areas in Nigeria and other parts of sub-Saharan Africa potentially due, at least in part, to crowding and inadequate sanitation. Acknowledging that human activities are a large part of the resistance problem, the World Health Organization (WHO) recently issued a global strategy for containment in 2001. Added to issues faced internationally, special considerations will need to be made for African countries to prioritize and implement the provisions of the WHO strategy. This is because factors such as the high infectious disease prevalence, limited access to health professionals coupled with unregulated access to drugs, and poor drug quality assurance mean that more interventions are needed to meet optimal standards. Also resistance affects individual quality of life in an indirect way, more needs to be done to emphasize the problem. Programs that impact resistance but also offer additional benefits may be initially more easily justified. Examples include Short-course Directly Observed Therapy (DOTS) for tuberculosis, the Integrated Management of Childhood Diseases (IMCI) initiative as well as pneuomococcal vaccination. Drug use policies, particularly if implemented at national and regional levels and sensitive to unofficial as well as official markets also show promise for resistance control.