Understanding Antibiotic Resistance in Kenya, and the Implications

Antibiotic resistance (ABR) occurs when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. This means the germs are not killed and continue to grow, making resistant infections difficult or even impossible to treat (Prestinaci, Pezzotti and Pantosti, 2015).

In Africa, a significant proportion of patients receive antibiotics without consulting a doctor or obtaining a prescription, contributing to inappropriate use. The prevalence of antibiotic-resistant bacteria in developing countries, such as Kenya, is increasing, emphasizing the need for effective strategies (Gitaka et al, 2020). 

There has been found to be four main risk factors for ABR: sociodemographic factors, patient clinical information, healthcare settings admission, and drug exposure (Chen et al, 2021). The misuse of antibiotics is identified as a primary driver of AMR, leading to the implementation of antibiotic stewardship programs (ASPs) in hospitals. However, the variations in program implementation prompts an exploration of practical experiences and data related to using antibiotic guidelines and stewardship programs in the public health sector (Majumder et al, 2020). 

However, antibiotic use alone does not significantly explain AMR prevalence. Instead, poor sanitation, hygiene, and environmental contamination emerge as pivotal factors influencing antibiotic-resistant illnesses, such as E. coli. Key associations include children consuming soil and informal hand-washing stations increasing antibody resistance, while rainy conditions decrease it. A study underscores that, in unsanitary conditions, addressing these factors, rather than merely altering antibiotic use, is crucial to combating antibiotic-resistant bacteria. In addition, AMR is not solely a medical concern but an evolutionary challenge influenced by social, cultural, and economic factors fostering antimicrobial misuse. Ultimately, rigorous social science research to understand the drivers of AMR suggests that sustainable solutions should balance equitable access to, conservation of, and innovation for antimicrobials. The authors argue that effective actions against AMR require collaboration within and between social science disciplines. Despite progress in understanding systemic causes and feasible interventions, challenges remain, including scaling up access to antimicrobials without increasing resistance and delinking the price of antimicrobials from development costs (Omulo et al, 2021).  

Furthermore, additional research stresses that antibody resistance is not solely a medical concern but an evolutionary challenge influenced by social, cultural, and economic factors fostering antibody misuse (Minssen et al, 2020). The misuse and overuse of antibiotics in human medicine and animal agriculture contribute to the emergence of drug-resistant bacteria, with certain regions and healthcare institutions reporting high resistance levels (Berriere, 2015).  

There are a number of implications of antibiotic resistance, which include: 

• Increased mortality rates, as common infections become harder to treat.  

• Impact on healthcare systems, as the need for more advanced treatments and resources to combat resistant infections can overwhelm the existing healthcare infrastructure in Kenya. 

• The threat to medical procedures due to antibiotic resistance jeopardising medical procedures like surgeries, chemotherapy, and childbirth.  

• An economic burden as there is an increased healthcare costs, lost productivity, and the financial strain on affected families can lead to a cycle of poverty. 

• An impact on vulnerable populations, including the elderly children, and those with compromised immune systems, are more susceptible to the consequences of antibiotic resistance (Dadgostar, 2019). 

While antibiotic stewardship is acknowledged as a potential solution to reduce resistance, there is a need to highlight the prevalence of injudicious antibiotic use in Africa, particularly in Kenya, where a significant proportion of patients receive antibiotics without proper consultation (Abubakar and Salman, 2023). There are potential benefits of implementing antibiotic guidelines and stewardship programs. The involvement of hospital management teams in stewardship committees is proposed to ensure informed decision-making and resource allocation. A study intends to start with six selected hospitals, aiming for successful strategies that can be replicated in other healthcare institutions.  

The ultimate goal is to evaluate the impact of implementation strategies on reducing treatment costs, hospital stays, and the overall burden on the healthcare system, contributing valuable insights for policy development at community, national, and regional levels (Gitaka et al, 2020).  

References: 

Abubakar, U., & Salman, M. (2023). Antibiotic use among hospitalised patients in Africa: a systematic review of point prevalence studies. Journal of Racial and Ethnic Health Disparities, 8. 1-22.  

Barriere, S. L. (2015). Clinical, economic and societal impact of antibiotic resistance. Expert Opinion on Pharmacotherapy, 16(2). 151-153. 

Chen, Q., Li, D., Beiersmann, C., Neumann, F., Moan, B., Lu, G., Muller, O. (2021). Risk factors for antibiotic resistance development in healthcare settings in China: a systematic review. Epidemiology & Infection, 149. 

Dadgostar, D. (2019). Antimicrobial resistance: implications and costs. Infectious Drug Resistance, 12. 3903-3910.  

Gatika, J., Kamita, M., Mureithi, D., Ndegwa, D., Masika, M., Omuse, G., Ngari, M., Makkah, F., Mwaura, P., Mathai, R., Muregi, F., & Mwau, M. (2020).

Combatin antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach. BMJ Open, 10. 

Majumder, A. A., Rahman, S., Cohall, D., Bharatha, A., Singh, K., Haque, M., Hillaire, M. G. (2020). Antimicrobial stewardship: fighting antimicrobial resistance and protecting global public health. Infection and Drug Resistance, 13. 4713-4738. 

Minssen, T., Outterson, K., Rogers Van Kaywyk, S., Batista, P. H. D., Chandler, C. I. R., Ciabuschi, F., Harbarth, S., Kesselheim, A. S., Laximinarayan, R., Liddell, K., Osterholm, M. T., Price, L., & Hoffman, S. J. (2020). Social, cultural and economic aspects of antimicrobial resistance. Bulletin of the World Health Organization, 98(12). 

Omulo, S., Lofgren, E. T., Lockwood, S., Thumbi, S. M., Bigogo, G., Ouma, A., Verani, J. R., Juma, B., Njenga, M. K., Kariuki, S., McElwain, T. F., Palmer, G. H., & Call, D. R. (2021). Carriage of antimicrobial-resistant bacteria in a high-density informal settlement in Kenya is associated with environmental risk-factors. Antimicrobial Resistance & Infection Control, 10(18).  

Prestinaci, F., Pezzotti, P., & Pantosti, A. (2015). Antimicrobial resistance: a global multifaceted phenomenon. Department of Infectious, Parasitic and Immunomediated Diseases, 109(7), 309-318.