Dr Sodiq Yusuff is a public health expert and an Oxford-based research fellow with extensive experience in infectious disease control across Africa. He is a physician-scientist and epidemiologist trained at the University of Oxford. He has worked with various international health organisations and collaborated with global partners such as WHO, USAID, and the Gates Foundation to lead numerous projects to strengthen health systems and combat infectious diseases. In this interview by Kingsley Alumona, he speaks about the antimicrobial resistance (AMR) burden in conflict-stricken countries, the ongoing cholera outbreak in Nigeria, among other issues.
Can you tell us about your current projects?
Currently, I am working as a researcher at the Big Data Institute of the University of Oxford. My research is focused on understanding the associations between alcohol consumption and infectious disease-related mortality. This involves analysing large-scale longitudinal data from the Whitehall Study, which has tracked the health and lifestyle factors of British civil servants for several decades.
By examining this data, we aim to uncover patterns and correlations that can inform public health strategies and interventions aimed at reducing the burden of infectious diseases exacerbated by alcohol consumption. This research is crucial because it addresses the interplay between lifestyle factors and disease outcomes, providing insights that could lead to more effective health policies and preventive measures.
Your research has highlighted the antimicrobial resistance (AMR) burden among forcibly displaced populations (FDPs). Could you share some findings from your recent studies?
Our recent studies have shown that the AMR burden among FDPs is significantly higher compared to host populations. For instance, a study published in BMC Infectious Diseases found that the prevalence of multidrug-resistant tuberculosis (MDR-TB) among IDPs in Nigeria is alarmingly high. This is compounded by poor knowledge and practices regarding antibiotic use, even among educated individuals.
In another study published in The Lancet Global Health, we found that AMR knowledge among Syrian refugees in Jordan was poor. Many refugees were unaware of the dangers of antibiotic misuse, and there was a high reliance on informal healthcare providers who often dispense antibiotics without proper prescriptions. This lack of regulation and oversight significantly increases the risk of developing and spreading resistant strains.
How do global conflicts exacerbate AMR problems?
Global conflicts create environments where health systems are disrupted, and access to essential healthcare services is severely limited. This disruption often leads to improper use of antibiotics, either due to unregulated access or unavailability of appropriate treatments. The result is an increase in the prevalence of drug-resistant infections. Furthermore, conflicts often lead to mass displacement of people, placing additional stress on already fragile healthcare infrastructures in host regions, which can further propagate the spread of resistant pathogens.
To give you a few specific examples. In Ukraine, the ongoing conflict has led to the destruction of healthcare facilities, making it difficult to maintain hygiene standards and ensure the availability of essential antibiotics.
In Syria, prolonged conflict has similarly devastated the healthcare system. Many hospitals have been bombed and healthcare workers have been displaced or killed. The lack of access to clean water and sanitation further complicates infection control, resulting in a higher incidence of resistant infections.
In Nigeria, the Boko Haram crisis has displaced millions, overwhelming already fragile health systems in the northeast. Internally displaced persons (IDPs) often live in overcrowded camps with poor sanitation, which are breeding grounds for infectious diseases.
What proactive measures could be taken to address AMR in these challenging environments?
Several measures are essential. Firstly, we need robust surveillance systems to monitor antibiotic use and resistance patterns effectively. This data can inform targeted interventions. Secondly, strengthening health systems in conflict zones and refugee camps through international support can ensure better infection control practices and more appropriate use of antibiotics. Education campaigns are also crucial to raise awareness about the dangers of AMR and promote rational antibiotic use. Lastly, research is vital to develop new antibiotics and alternative therapies to stay ahead of resistant pathogens.
How does your current work with Gavi and Gates Foundation align with these measures?
My experience has shown that a multi-faceted approach is essential. For instance, in our work on improving polio supplementary immunization campaigns, we focused on strong coordination and strategic planning, which are also crucial in addressing AMR. By ensuring that healthcare workers are well-trained and that there are robust systems for vaccine delivery and monitoring, we can reduce the incidence of infections that require antibiotic treatment, thereby reducing the potential for resistance. Additionally, leveraging digital health solutions, as we did in Lagos State, can improve access to healthcare and ensure better compliance with treatment regimens, further mitigating the risk of AMR.
Another example is my work with GAVI through SCIDaR which focuses on enhancing the management of EPI programmes in four African countries through strategic use of data. By improving leadership, management, and coordination capacities at national and sub-national levels, we aim to strengthen immunization coverage and reduce the incidence of vaccine-preventable diseases. This indirectly contributes to AMR control by reducing the need for antibiotics through the prevention of infections.
For example, our diagnostic reports have highlighted the need for better governance and coordination in immunization programmes, which we are addressing through targeted support and capacity building. This involves training healthcare workers, improving data management systems, and ensuring the availability of vaccines and other essential supplies. By creating a more resilient health system, we can better manage and prevent the spread of resistant infections.
Can you elaborate on how digital health solutions can play a role in managing AMR?
Digital health solutions can be transformative. They can provide platforms for remote diagnosis and treatment, reducing the need for physical consultations and limiting the spread of infections. Electronic health records can track patients’ antibiotic prescriptions and adherence, helping to ensure that antibiotics are used appropriately. Moreover, mobile health applications can educate communities about AMR and the importance of following prescribed treatments correctly. In our projects, these tools have been invaluable in improving healthcare delivery and patient outcomes.
There is currently a cholera outbreak in some parts of Nigeria. As an epidemiologist, what are the best measures to prevent future outbreaks of this disease and how can telemedicine help in this regard?
The current cholera outbreak in Nigeria is alarming, with over 1,141 suspected cases and 30 deaths reported so far. This situation is exacerbated by the rainy season.
To prevent future outbreaks, we need to focus on several key areas such as improving Water, Sanitation, and Hygiene (WASH) infrastructure. Ensuring access to clean drinking water and proper sanitation facilities is paramount. Contaminated water and poor sanitation are the primary transmission routes for cholera.
Public health education is needed. Educating communities about the importance of handwashing, safe food preparation, and proper sanitation practices can significantly reduce the spread of cholera. Public awareness campaigns should be intensified, especially in the most affected areas like Bayelsa, Zamfara, and Lagos states.
Telemedicine is key. Telemedicine can play a crucial role in managing and preventing cholera outbreaks. It allows healthcare providers to offer remote consultations, reducing the need for travel and limiting the spread of the disease. Telemedicine platforms can also be used for real-time monitoring of outbreaks, enabling quicker response and resource allocation.
What are your recommendations for future research in this area?
Research should focus on developing rapid diagnostic tools that can be used in low-resource and conflict-affected settings to quickly identify resistant infections. We also need to explore alternative treatments to antibiotics, such as bacteriophages and antimicrobial peptides. Additionally, understanding the socio-behavioural aspects of antibiotic use in these settings can inform more effective interventions. Finally, evaluating the impact of various public health strategies, such as mass drug administration, on AMR patterns can provide insights into more sustainable approaches to managing this crisis
By continuing to build on our current knowledge and addressing these gaps, we can make significant strides in mitigating the AMR burden in conflict-affected areas.
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