Addressing Antimicrobial Resistance in Accra

Some years ago, while working as a medical officer in a rural hospital, I saw a patient die after failing to respond to all the available antibiotics used for managing her septicaemic condition. I am sure such experiences are common even now, as antibiotic resistance is becoming a growing pandemic.

It is under this scenario that in February 2019, Ghana Public Health Association and a coalition of UK partners led by UK Faculty of Public Health successfully applied for a 15-month grant from THET. Working within the Commonwealth Partnerships for Antimicrobial Stewardship Scheme, the grant established an Antimicrobial Stewardship (AMS) project with the aim of tackling Antimicrobial Resistance (AMR) in LEKMA hospital in Accra, Ghana.

There was an initial extension of the project for 3 months and later for another 7 months to the end of May 2022, to cover LEKMA polyclinic and community pharmacies.

What is antimicrobial resistance?

AMR is the development of resistance by microorganisms to antimicrobial drugs to which they were previously sensitive, such that they no longer respond to treatment with the same drug or dosage regime. Resistance of microorganisms to antimicrobials results in increased morbidity and mortality, with huge socio-economic ramifications at the individual, family, and national levels. Socially, patients lose confidence in the healthcare system, and resort to alternative avenues for cure.

Antimicrobial resistant microbes are ubiquitous, and can be spread between people, animals, food, and the environment. There is therefore the need for multi-agency collaboration to address the problem.

Response

The project at LEKMA focused on improving antimicrobial surveillance, infection prevention and control (IPC) practices, and building sustainable capacity of the workforce on antimicrobial prescribing practices. The project team includes clinicians, public health experts, veterinarians, biomedical scientists, and local government officials.

Key activities undertaken include:

• Establishment of a functioning multiagency AMS Advisory Committee.
• Development of simplified antibiotic prescribing guidelines for adults and children based on national guidelines.
• Completion of two separate snapshot audits of out-patient antimicrobial prescribing data in June and December 2019.
• Implementation of a successful pilot on delayed/back-up prescribing in out-patient department of LEKMA Hospital.

Challenges and impact

The key challenge has been limited funding to sustain gains chalked and expand project to community level. Despite these challenges, some successes have been chalked, among which are:

1. 110 staff trained on AMS, including AMS facilitators.
2. 28.2% reduction in use of 3rd generation beta lactamase between June and November 2019.
3. Antibiotic resistance and sensitivity patterns established in the hospital.
4. Increased confidence among patients accessing the facility. One patient remarked recently, “A friend told me if I come to LEKMA hospital I will not be taken good care of and I will die, but ever since I came, I have been well taken care of.”
5. Hospital adjudged the best health facility in Greater Accra region for 2021.

Conclusion

We aim at extending the project to the community level and making LEKMA hospital a centre of excellence for AMS with capacity to support other facilities.

– Dr Amofah George, President, Ghana Public Health Association