Antimicrobial Resistance and the Nigerian Youth Champions at the Forefront.

By Kenneth Chukwuebuka Egwu

Co-founder, AMR Intervarsity Training Program

Antimicrobial Resistance (AMR) is a global health challenge with uneven distribution, posing a significant threat to modern medicine. At its current trajectory, AMR has the potential to push humanity back to the pre-antibiotics era, where minor infections could result in a devastating number of deaths. Despite gaining attention in the medical circles over the years, AMR remains a growing challenge, exacerbated by limited public awareness, particularly in rural communities where access to accurate information is constrained.

In simple terms, AMR is a phenomenon when microorganisms such as bacteria, viruses, fungi, or parasites no longer respond to antimicrobial medications that were designed to kill them. This definition not only explains AMR, but highlights the wide array of microorganisms that antimicrobials are made for. The antimicrobial medications include antibiotics for bacteria, antifungals for fungi, antivirals for viruses, and antiparasitics for parasites. Identifying the specific microorganism causing an infection is essential to ensuring proper antimicrobial stewardship.

AMR impacts every region of the world, but the burden varies significantly. In 2019, AMR was linked to nearly 5 million deaths globally¹, with sub-Saharan Africa bearing a disproportionate share of about 1.1 million deaths, highlighting critical healthcare gaps and socio-economic disparities².

Continuous exposure of microorganisms to suboptimal doses of antimicrobials allows them to mutate and develop resistance to drugs, even when the drugs are later used appropriately. Research indicates that about 30-50% of antibiotics used in humans are unnecessary, contributing significantly to antimicrobial misuse and resistance³. This is worsened by a limited of access to diagnostic equipment. A study conducted in 14 African countries revealed that only 1.3% of 50,000 laboratories conducted bacteriological testing to identify causative organism⁴. Among these, only a small fraction had the equipment to evaluate resistance further. Without accurate diagnosis, individuals might be consuming medications which the infection is already resistant to, worsening their sickness and causing extra healthcare expenditure.

Although antimicrobial misuse is the primary cause of resistance, several other factors contribute to it, including poor sanitation, overcrowding, poor animal husbandry, inadequate infection control procedures, and the mobility of people, food, and animals.⁵ The high prevalence of infectious diseases in Africa, coupled with inadequate healthcare resources exacerbates the development and spread of AMR. In addition, limited access to clean water makes proper sanitation a luxury. UNICEF reports that over 319 million people in sub-Saharan Africa lack access to clean and safe drinkable water⁶. Similar trend is mirrored in other countries across the globe, highlighting not just the importance but urgency of consolidated actions to combat AMR.

Discussing the drivers of AMR would not be complete without highlighting the implications of poverty in the development and spread. Approximately 1.1 billion people, or somewhat 18.3% of the global population live in acute multidimensional poverty⁷. This affects their purchasing power of medications and overall wellbeing, making them vulnerable to diseases and infections. To abate this, people are forced to purchase few doses of antimicrobials according to their financial strength, further contributing to resistance.

Despite this challenge, youth has been pivotal in addressing AMR through initiatives such as community awareness campaign, technological innovations, mentorship programs, research and policy advocacy. In Nigeria, the AMR Intervarsity Training Program is revolutionizing and amplifying youth engagement in AMR. Through series of training and capacity building, mentorship, and funding support, the program has empowered youths to establish AMR Clubs and to become champions confronting AMR by driving campaigns to the grassroots across the country.

The AMR Intervarsity Training Program is a youth-led initiative designed to bridge the knowledge gap on AMR among the young people. It leverages an interdisciplinary approach by creating multidisciplinary clubs to sustain efforts in addressing this global health concern. Recognizing that today’s youths are the future prescribers, policy makers, and consumers of these drugs, the program offers extensive training on critical topics, equipping participants with the knowledge and skills necessary to become AMR champions advocating for and implementing meaningful solutions in their communities and beyond. As a result, the program has grown into Nigeria’s largest AMR youth network and one of the most expansive across Africa. The program’s objectives include instilling a fundamental understanding of AMR among undergraduate students, preparing them to educate their immediate communities, establishing AMR clubs in tertiary institutions nationwide, and facilitating continued engagement at both national and international level on AMR. During its first cohort, funded by the Foundation to Prevent Antibiotic Resistance, the program established 23 AMR clubs and is set to establish 12 more in the second cohort through support from Stop Superbugs, a global health initiative of the British Society for Antimicrobial Chemotherapy, and in partnership with DRASA Health Trust.

Leveraging the program’s widespread network, numerous sensitization campaigns have been conducted, imparting vital information to communities across Nigeria. Activities from the first cohort included visits to markets, religious institutions, schools and hospitals where AMR awareness and education campaigns reached diverse populations. The youth champions covered 16 states during the religious and traditional institutions outreach activities, directly engaging a total of 7,754 people, including clerics and congregants, on the dangers of antimicrobial misuse and the detriments of AMR. In hospitals, AMR champions interacted with healthcare professionals on antimicrobial stewardship and educated patients on the dangers of antimicrobial misuse and resistance, and importance of infection prevention and control. This outreach spanned a total of 91 hospitals across18 States, directly engaging 4,055 patients, care givers and health professionals. The Market outreach also offered a huge opportunity for the youth champions to interact with grassroots community members. This was an innovative approach, given that a significant portion of Nigeria’s population are traders, who spend most of their days in the market environment. At the Marketplaces, population of different age ranges were met, and notably, the audience were largely uninformed about AMR challenges. Thus, an outreach with key focus on addressing harmful behavioural practices was imperative to effectively dispel myths and influence change in antimicrobial seeking behavior and use. The market outreach, conducted in 18 states where our AMR clubs exist, reached a total of 9,820 people in 95 marketplaces. In educational settings, the AMR champions kicked off activities with campus activation exercises where the AMR Clubs also organized series of activities including workshops, seminars, virtual interactive sessions and social activities to educate university students about AMR. This was followed by robust campaigns in various schools, including primary and secondary schools across18 states in the country. These provided an opportunity to catch the attention of the young population; embedding principles of responsible antimicrobial use and encouraging them to share their knowledge with their families and communities. A total of 23 universities and 67 primary and secondary schools were covered in the campaign nationwide. Throughout the first cohort of this program, a total number of 41,128 students, 512 teachers, 511 healthcare workers, 3,544 patients and care givers, and 20,073 community members (via market, religious institutions, sports and animal farms), totalling to 65,768 individuals were educated and empowered to champion the fight against AMR.

These efforts mark a turning point in youth engagement in AMR in Nigeria, Africa and the globe at large. It is important to note that the contributions of young people are crucial to driving meaningful change. To effectively tackle AMR, youth must be actively involved in designing interventions and drafting policies. While they cannot address all factors fueling AMR, their efforts set a strong precedent for the government and other stakeholders to join forces in combating this issue. Antimicrobial resistance is an ongoing challenge, but by adopting adequate measures, we can slow its progression and preserve the efficacy of these life-saving drugs our antimicrobials.

References

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Moyo P, Moyo E, Mangoya D, Mhango M, Mashe T, Imran M, et al. Prevention of antimicrobial resistance in sub-Saharan Africa: What has worked? What still needs to be done? Journal of Infection and Public Health. 2023 Feb;16(4).

Spivak ES, Cosgrove SE, Srinivasan A. Measuring Appropriate Antimicrobial Use: Attempts at Opening the Black Box. Perl TM, editor. Clinical Infectious Diseases. 2016 Sep 28;63(12):1639–44. DOI: 10.1093/cid/ciw658

Collignon PC, Conly JM, Andremont A, McEwen SA, Aidara-Kane A. World Health Organization Ranking of Antimicrobials According to Their Importance in Human Medicine: A Critical Step for Developing Risk Management Strategies to Control Antimicrobial Resistance From Food Animal Production. Griffin PM, editor. Clinical Infectious Diseases. 2016 Jul 20;63(8):1087–93. Available from: https://academic.oup.com/cid/article/63/8/1087/2389125

Collignon PC, Conly JM, Andremont A, McEwen SA, Aidara-Kane A. World Health Organization Ranking of Antimicrobials According to Their Importance in Human Medicine: A Critical Step for Developing Risk Management Strategies to Control Antimicrobial Resistance From Food Animal Production. Griffin PM, editor. Clinical Infectious Diseases. 2016 Jul 20;63(8):1087–93. Available from: https://academic.oup.com/cid/article/63/8/1087/2389125

Kwakwa V. Celebrating Water day: Why access to clean water is vital for Africa. World Bank Blogs. 2024. Available from: https://blogs.worldbank.org/en/africacan/celebrating-water-day--why-access-to-clean-water-is-vital-for-af

United Nations Development Programme and Oxford Poverty and Human Development Initiative. Global Multi-dimensional poverty index. 2024.

Kenneth Chukwuebuka Egwu, Abdulkarim M, Shadrach Chinecherem Eze, Oluchi Mbamalu. “Cut medicine for me”: addressing suboptimal dosing of antimicrobials as a critical issue to combat AMR in Nigeria. JAC-Antimicrobial Resistance. 2024 Jul 3;6(4). Available from: