How Ghana is fighting a deadly rise in antimicrobial resistance

The adage that too much of anything is bad is reflected in the experience of Vicky Dickson’s patients. Dickson, a community pharmacist in Adentan, a suburb of Accra, Ghana, said: “About some ten years ago, there was a gentleman who came very often to complain about a cough. The cough became persistent and, unknown to me, he used to go to the market where it was easier for him to buy antibiotics, which he was using with cough mixtures he bought from my pharmacy.

“Along the line, the man’s wife came to tell me one day that her husband was coughing blood. It turned out that the man became very sick and was diagnosed with TB. Instead of being on the medication that he was given from the hospital where he was receiving treatment, he had taken solace in antibiotics. That was why he was not responding to any medication.”

When Dickson asked which antibiotics her patient had been taking, he didn’t know.  He could only describe them by their colours; “yellow and red”.

“If I had foreknowledge about this ingestion of antibiotics, I could have directed him to seek help at the hospital earlier,” Dickson added.

A particular issue is Ghana’s high rate of surgical site infections (SSIs), with research suggesting infection rates average 12.6% compared to the global average of 2.5%. Many of these infections are caused by bacteria resistant to common antibiotics, which makes treatment more difficult and costly.

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites acquire genetic mutations that mean they no longer respond to various antibiotic, antiviral, antifungal and antiparasitic drugs. The overuse or misuse of such medications is a common driver. As a result, infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.

AMR has become a national problem in Ghana. “It threatens to undermine the effectiveness of essential medical treatments, leading to increased morbidity, mortality and health care costs,” said Alhaji Hafiz Adam, chief director of Ghana’s Ministry of Health.

Antibiotic resistance

A particular issue is Ghana’s high rate of surgical site infections (SSIs), with research suggesting infection rates average 12.6% compared to the global average of 2.5%. Many of these infections are caused by bacteria resistant to common antibiotics, which makes treatment more difficult and costly.

To combat this problem, Ghana recently launched an initiative, in collaboration with the International Centre of Antimicrobial Resistance Solutions, which aims to identify and resolve challenges with antibiotic use during surgery. 

Ghana also has taken some other steps to help counter antimicrobial resistance. For instance, a recent review by Jacob Alhassan, a Ghanaian researcher at the University of Saskatchewan in Saskatoon, Canada, described how 93% of laboratories in Ghana are now conducting AMR surveillance on blood cultures to support antibiotic prescription decision-making.

However, Alhassan told VaccinesWork that a reliance on foreign aid to support Ghana’s health sector was problematic. “In most cases, it appears that our ability to respond to AMR and produce an intervention is also tied to donor funds. So, when there’s fluctuations on that side, it appears to affect our ability to respond.”

Study co-author Clement Kamil Abdallah, also at the University of Saskatchewan, added that funding to implement some of the regulatory measures introduced to curb antibiotic use was also very low.

“The regulation currently in Ghana is very poor, and it is because [although] government has a plan, the commitment is very, very low in terms of implementing it to keep and regulate the flow of antibiotics in Ghana,” Abdallah said.

Silent epidemic

Notwithstanding these lapses, long before the Ministry of Health’s initiative to control AMR, Ghana’s Public Health Association (GPHA) put in a bid to the Commonwealth Pharmaceutical Association and Tropical Health Education Trust to investigate how to strengthen antimicrobial stewardship systems in the country.

“At that time, the Minister of Health told us that the government had initiated a strategic plan to address that. It was at its infancy, and so it was a general concern that antimicrobial resistance is becoming one of the silent epidemics or pandemic challenges,” said Dr George Amofah,  a former deputy director-general of the Ghana Health Service, who now works at the GPHA.

The plan focused on three key areas: ensuring adherence to established guidelines for antibiotic use, improving antibiotic prescribing patterns in pre-and post-operative care, and reducing surgical site infections through effective infection prevention and control measures.

The GPHA initially selected the Lekma hospital in Accra as a pilot site and then extended the work to the Lekma Polyclinic.

Amofah said the project seemed to be paying off, as the managers of these hospitals periodically receive information on what is happening and meet to discuss improvements.

However, Alhassan believes the government has not done enough to educate the public about the problem of antimicrobial resistance. This could make people unwilling to accept any restrictions on antibiotic prescribing if these were introduced.

One the other hand, Ghana isn’t doing badly when it comes to ensuring that people can access vaccines, particularly during early childhood.

“Having access to vaccines very early for children in particular, can play a huge role in curbing AMR, particularly if it prevents infections in the first place,” Alhassan said.