Poverty and prevalence of AMR

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Poverty and prevalence of AMR in invasive isolates this is the title of a recently (October, 4th) published study. We asked study co-author Prof. Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy (CDDEP).

Prof. Laxminarayan, the aim of the study was to examine the association between the income status of a country and antimicrobial resistance (AMR) prevalence in the three most common bacteria causing infections in hospitals and in the community (third generation cephalosporin (3GC) resistant Escherichia coli, methicillin resistant Staphylococcus aureus (MRSA), and 3GC resistant Klebsiella species). Which countries were used for comparison?

Overall 45 countries were examined (also Austria). The study looked at the association between Gross National Income Per Capita (GNIPC) of a country and AMR prevalence. Lower the income of a country, higher is the AMR prevalence. India, Vietnam or Ghana, which are all low middle income countries have very high AMR prevalence.

Does the country-list also include some of the so called CEE countries? And how the situation is there? 

Yes – among the 45 examined countries were Bulgaria, Romania, Poland, Hungary, Slovenia and Slovakia.  In general, the AMR prevalence is higher in CEE countries when compared to Western European and Scandinavian countries; however AMR prevalence in CEE countries is lower than in India, Vietnam and Ghana.

What is the reason for the association between GNIPC and the prevalence of dangerous germs? Is this just a question of prescription habits, or is it also a question of competence (patients)? In a recently published study of Prof. Petra Gastmeier from the Charié Berlin (article), the authors found considerable knowledge gaps in regard to AMR – for example only 24percent of the participants knew that bacteria could develop antibiotic resistance. So if even in Germany there are knowledge gaps, how must it look like in countries with low GNIPC?

Certainly, the knowledge gaps with regard to AMR are high in low income countries, however the reason for high AMR prevalence in low income countries is due to a combination of prescription habits, competence and most importantly poor environmental sanitation and poor infection control practices in healthcare facilities.
In the abstract of your study there can be read that “the results underscore the urgent necessity of new policies aiming at reducing AMR in resource-poor settings”. How those new policies must look like? And how difficult is it to implement them?  

New policies should aim at improving access to clean water, sanitation and increasing immunization rates in resource limited countries. However, these interventions are costly, requiring strong political commitment and it needs a behaviour change among general public. Secondly, the use of antibiotics must be strongly regulated both in humans and animals in resource limited countries. However, the challenge is balancing the issue of excess vs. access, because lack of access to effective antibiotics still kills more children in resource limited countries than AMR.

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Carola Timmel is journalist for print and radio and professional speaker. Her focus lies on the topic Medicine & Health.

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