WHEN Mr Mashood Lawal, a pharmacist and retired director at the Federal Ministry of Health, had terrible stomach pain, he was told at the National Hospital in Abuja that it was because of kidney stones.
“In the process of removing the stones during surgery, they discovered that water had gathered in my kidneys, and a stent was inserted between the kidney and the bladder to drain the water off,” he said.
Speaking at the 2023 World Anitimicrobial Resistance (AMR) Awareness Week (WAAW) at the University College Hospital (UCH), Ibadan, he added that three and a half months later, he was back for the removal of the stent, but two days thereafter, he started to experience a terrible cold.
His wife, according to him, linked the cold to his recent surgery as she said he was recuperating, though he thought it was malaria. A few days after completing the malaria medicine dose, the feverish feeling was back. At a medical laboratory, the reoccurring fever was diagnosed to be due to malaria and typhoid.
Despite taking another dose of malaria medicine and continuing with the antibiotics he received as a prophylaxis from the doctor, because of the kidney stone surgery, the problem resurfaced 10 days later.
“It was as if the fever was programmed into a system that, after about 10 days, it would come back,” he said.
He said he went back to the National Hospital, where his blood and urine samples were taken and tested, adding that the result said he was infected with a heavy dose of E. coli and Streptococcus aureus, with appropriate antibiotics to kill the germs in his body identified.
Speaking further, Lawal, fondly called Babalawo (native doctor) by his colleagues at Federal Health Ministry, said while battling with the recurrent fever, he contracted COVID-19 infection and was admitted to the hospital, where he received several doses of expensive antibiotics.
“It was a double jeopardy, an infection that couldn’t be cured despite taking different types of antibiotics and COVID-19. My daughter also tested positive for COVID-19,” he declared.
Lawal said he was sent away after treatment with a cocktail of drugs for COVID-19 with the fever still persisting, adding that the doctors were convinced his high body temperature was not due to COVID-19.
“Subsequent tests at a very big medical laboratory in Abuja indicated that the heavy dose of E. coli and Streptococcus aureus persisted, in spite of another course of strong but expensive antibiotics for another five weeks.
“The doctor said my case was due to an antimicrobial resistance infection; I went through hell and, at the end of the day, it was discovered that it was sensitive to a reserved antibiotic which was expensive, a sachet costing over N8,000 at the retail pharmacy,” he retorted.
Lawal, now an antimicrobial resistance survivor, said problems arising from antimicrobial resistance germs are real, adding that the situation where antimicrobials, a group of medicines such as antibiotics, antivirals and antifugal agents, are no longer working mainly because of their past misuse can happen to anyone, regardless of age or socioeconomic status.
The dilemma is that antimicrobial resistance is not a disease like hypertension or diabetes that people will easily recognise. It is neither an opportunistic disease nor an infection; rather, it creeps in like a thief at night and distracts from treating the original ailment, especially if the original ailment is not an infection.
Imagine someone who has an accident and now gets infected with an antimicrobial-resistant germ. The preoccupation will be treating that infection that has become resistant to treatment rather than the consequences of that accident.
Mr Lawal added, “My case was the simplest among the 12 survivors that WHO co-opted; the chairman of our committee had an accident, sustained multiple injuries, got infected with a flesh-eating staphylococcus, and lost her eyes.
“Another from America, with all the money spent, survived because the doctors experimented on him; they tried a virus to see whether it could consume the antimicrobial-resistant germ. So, the issue of antimicrobial resistance is not a joke.
“It is a threat to man’s survival because medicines are no longer working, people are dying and the cost of treatment is becoming very high. So, we must do all that is possible to prevent infections.”
Mr Lawal declared that solving the problem of antimicrobial resistance infections requires putting a stop to open defecation, to prevent the spread of diseases from human waste and ensuring potable water flow in taps. Also of importance is maintaining standards in health facilities, including medical laboratories.
Speaking at the symposium to mark the AMR week, tagged ‘Preventing AMR Together, One Health to the Rescue,’ Miss Folasade Olajunwon, a 500-level medical student, described antimicrobial resistance as one of the top 10 global health threats facing humanity that will cause one in six deaths in the future if left unchecked.
According to her, in Nigeria, 263,400 deaths were associated with antimicrobial resistance and 64,500 deaths attributed to antimicrobial resistance.
These germs, also called superbugs, can spread across geographical locations, from person to person or between people and animals, and have become a big challenge because they are occurring at a faster rate than humans are able to develop newer, more efficacious replacement drugs to tackle them.
Miss Olajunwon declared that ease of purchase, poor regulation, indiscriminate prescription practices by healthcare workers, poor awareness and poor infection prevention and control are major contributory factors to the rate of AMR in Nigeria.
She stated that in the human health sector, there is a need for increased awareness of antimicrobial stewardship, to formulate and enforce policies on the use of antimicrobials, multidisciplinary research to bridge research gaps on AMR, rational use of antimicrobials and access to quality medications.
In his presentation, Mr Emmanuel Olayiwola, a veterinary medicine student, said multidrug-resistant germs have emerged and spread among companion animals like dogs and cats, including livestock animals too, due to the wrong use of, abuse and misuse of drugs in animals and the improper diagnosis of diseases in animals.
Mr Olayiwola said consumption of antimicrobials in animals doubles that in humans because farmers use antibiotics as growth promoters and additives in feeds for animals, use expired antibiotics and don’t adhere to the withdrawal period of antibiotics before the animals are slaughtered for consumption.
However, Mr Olanrewaju Olaleru, a 500-level environmental health student, said environmental factors play a crucial role in the development, transmission and amplification of antimicrobial resistance because of antibiotic contamination in the environment due to agricultural practices, poor wastewater and sewage treatment, and gene transfers in environmental reservoirs.
He declared that AMR has economic costs, and a way forward will require promoting responsible antimicrobial use, developing innovative technologies to assess the environmental impact of pharmaceuticals, including antibiotics, and motivating people to change their behaviour towards the irrational use of medicines.
Dr Suraju Lateef, a lecturer in Environmental Health Sciences at the University of Ibadan, highlighted recent studies in Ibadan that found that the level of AMR germs in the effluent from waste water treatment plants into steams used for irrigation was high.
“We looked at ewedu (jute leaf), a common vegetable planted by these streams, and found it contained small doses of determinants for AMR germs. And we are not paying attention to the resistance that these germs cause through environmental means, poor waste management, the quality of manure used in farming, and so on,” he stated.
In his remark, Head of Pharmaceutical Services at the University College Hospital, Ibadan, Dr Adeyinka Ishola, said AMR underscores the importance of rational use of medicines in Nigeria, particularly because poverty is endemic and a high percent of drugs in Nigeria’s market are substandard.
He added, “It underscores the fact that quality assurance and quality control of medicines become pivotal so that resistance is not encouraged in animals, humans and the environment. If medicines are properly used, resistance will be reduced to the barest minimum.”
Meanwhile, Victoria Adetunji, a professor of food safety, food microbiology and public health at the Faculty of Veterinary Medicine, stated that breeding livestock using antibiotics as a growth promoter is wrong, adding that the residue of the antibiotics in the meat can result in adverse effects, including multidrug resistance.
Professor Adetunji suggested the use of probiotics as growth promoters for animals as an alternative to antibiotics.
She also urged people to site their septic tanks far away from their wells, because there is a strong correlation between the distance between the well and E. coli contamination.
Antibiotics have been called “wonder drugs” but can they survive a new wave of superbugs? Time will tell. It is a crucial battle, and no one must be left behind. It must be fought on all fronts.
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