Lack of technical and financial support hampers efforts to implement global guidelines on antimicrobial resistance

Lack of technical and financial support is hampering efforts to implement global guidelines on antimicrobial resistance in Benin and Burkina Faso, new research shows.

The shortage of suitable infrastructure also makes it difficult to produce change and develop reliable systems to solve the major problem, according to the study.

The researchers say that global initiatives to stop antimicrobial resistance must be adaptable to take into account local economic and societal issues.

They interviewed policymakers, nurses, doctors, animal breeders, veterinarians and laboratory researchers in Benin and Burkina Faso, who said changes in antibiotic use would compromise health and economic livelihoods of the people.

Farmers reported that official dosing regimens and recommendations were difficult to follow as they would lead to significant financial losses, jeopardizing the viability of businesses and the food supply of local communities. Nurses prioritized the provision of care and treatment by prescribing antibiotics without key tests and examinations, since patients could not afford them financially and very often hospitals did not have the necessary infrastructure. to perform them.

The study argues that global guidelines from organizations such as the World Health Organization are harder to implement for poorer countries. There is less surveillance data to inform veterinary or clinical decision making.

The research, published in the journal mSystems, was conducted by Salla Sariola and Andrea Butcher from the University of Helsinki, Jose Cañada from the University of Exeter, Mariette Aïkpé from the University of Abomey-Calavi and Adélaïde Compaore of the Institute for Research in Health Sciences.

The study illustrates how tackling individual behavior through increased awareness without addressing the lack of infrastructure is not an effective way to reduce antimicrobial resistance.

The article explains “that tackling the problem of RAM spreading is not something that can be fixed with a particular ‘technofix’. Interventions must respond to local needs, hotspots, determinants and circumstances that give rise to antibiotic use.

Both Benin and Burkina Faso lack strong surveillance and evaluation mechanisms and did not participate in the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) database. WHO. Sanitation and health care infrastructure, where it exists, is poorly developed. Worrying levels of RAM have been found in clinical, animal and environmental samples in both countries.

Dr Canada said: “Policy makers and experts have said that awareness of antimicrobial resistance among members of the public is low. Those who relied on antibiotics for their profession, such as pharmacists, farmers, farm managers, veterinarians, doctors and nurses, disputed that there was a lack of awareness of the need to reduce the use of antibiotics. Yet, on many occasions, they continued to prescribe and use antibiotics contrary to their best knowledge due to lack of access to diagnostic tools.

Both countries are members of the West African Economic and Monetary Union. Member States are bound by Union legislation governing the import, distribution and sale of clinical and veterinary medicinal products. In practice, antibiotics can be purchased without a prescription for human and animal use, although the informal sale of pharmaceuticals has been banned in Benin since February 2017.

The most representative data from Burkina Faso on the use of antibiotics suggest widespread informal use: 40% of patients coming to the hospital had already taken antibiotics, of which 16% had taken more than two different types of antibiotics. Among the antibiotics used, 40% were those that the WHO defines as the most crucial to secure.

In both countries, antibiotics are sold and prescribed by various front-line health care providers. Nurses prescribe antibiotics, and antibiotics can be purchased directly from pharmacies and informal markets without a prescription. In Burkina Faso, sources of antibiotics for human treatment included primary health care facilities (34%), informal vendors (27%), private vendors (29%) and hospital pharmacies (12%) .

Respondents said that antimicrobial resistance activities were often short-term projects and that unstable international funding flows meant that they had to focus their energy on applying for funds rather than designing funding strategies. Implementation.

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