Antimicrobial Resistance Surveillance and Raising Awareness

Limited awareness of AMR as public health issue leads to inappropriate usage of antimicrobials in humans and animals. Research-based solutions is a way to improve surveillance and raising awareness of local communities, health service providers, police makers on AMR in Mozambique 

Clemencio Nhantumbo, Primery Investigator

AMR is caused due to usage of antibiotics in the hospitals and in animal production; and once established it can spread through the entire ecosystem. Antibiotic resistance can be transmitted between bacteria of different species within the ecosystem and if bacteria with antibiotic resistance reinfect humans or animals it is difficult to treat.

Mozambique is characterized by informal settlements with poor sanitation that facilitates the spreading of AMR bacteria, contaminating the entire ecosystem, including water, animals, and ultimately people. Additionally, Mozambique is among the 10 countries with the highest mortality rate in the world and children under 5 years old contribute more to this rate. This situation can be worsened due to antibiotic resistance.

The National Action Plan Against Antimicrobial Resistance states that there is lack of information regarding AMR in every stratum of society. The limited access to information does not only affect local communities, but also nurses that in most cases have to giving prescriptions to sick people, due to limited medical staff. This leads to high usage of antibiotics which fasten the establishment of antibiotic resistance. Nevertheless, that there is a regulation to control commercialization and usage of antibiotics in Mozambique it is not well implemented yet.

This solution serves the general community, mainly the poor strata of society, that are more prompt to be affected by the effect of antibiotic resistance. Local communities and hospital service providers will be involved in studies conducted by MSc, and PhD students supervised by multidisciplinary team aiming to understand the level, and the main means of establishment and spreading of AMR. The results of the studies will be used to propose solutions for the problem of AMR and as stated before, the solutions will be conveyed to police makers, health care providers and general community.

The solution will generate several public goods that include: (1) public and policy makers informed on the AMR problem and methods to mitigate  and adapt to the problem; (2) hospital service providers trained on AMR in selected hospitals; (3) training and dissemination materials on AMR that can be used to replicate; (4) scientific community informed on the applicability of multidisciplinary approach to seek solution for the problem of AMR that can be replicated to other countries; (5) data and information on AMR in Mozambique that can be used for public planning and research and (6) consolidated multidisciplinary research team on AMR in Mozambique. The goods listed above will contribute to reduction of AMR in Mozambique.

The solution will include applied research and raising awareness. The applied research will (1) consolidate the multidisciplinary research team on AMR in Mozambique, (2) generate spatial and temporal data and information on AMR in the environment, particularly water, in humans, food and animals in Mozambique; (3) successful methods and results of the multidisciplinary applied research to seek solutions for the problem of AMR shared with scientific community. The raising awareness activities will result on: (1) training materials for hospital service providers on AMR prepared and consolidated; (2) public service providers trained on AMR; (3) raising awareness materials that include, videos, flyers and public talks prepared and implemented. The outcome of the reduction of AMR and mortality rate in Mozambique and methods developed for this solution replicated in other countries.

Training of MSc and PhD students, as well as publishing the methods and results in open access scientific journals aim to ensure that the results can be further replicated. Additionally, some health care service providers will be trained to train others to ensure that the results and replicated even after the completion the period of implementation of the solution. Finally, the Ministry of Health will be looped into the solution activities through the Faculty of Medicine to ensure that the raising awareness a materials are circulated during and after the completion of the period of implementation of the solution.

The success of the solution will be measured through:

(1)  Number of MSc and PhD students trained during the implementation of the solution;

(2)  Number of scientific publications.

(3)  Raising awareness material prepared and circulated, including videos, talks and flyers;

(4) Training material on AMR prepared;

(5)  Number of hospital service providers trained on AMR.

(6)  Number of hospital service providers trained as a trainers on AMR; and

(7)  People involved in the raising awareness activities. 

The common barriers to the implementation of the solution are already well known, they were identified during the implementation of SARA project. The barriers include limited suppliers of reactants and equipment in the country and the solution for that is to purchase reactants and equipment abroad. Detailed risk assessment will be prepared during the inception of implementation of solution.

I am applying to The Trinity Challenge because most developing countries, including Mozambique are facing the problem of AMR due to inappropriate usage of antibiotics, one of the main findings of Mozambican Team during implementation of “Surveillance of Emerging Pathogens and Antibiotic Resistances in Aquatic Ecosystems” (SARA) Project. This is also an opportunity ensure continuation of activities of the team created, while contributing to improve the understanding of AMR, training PhD and MSc students, raising awareness of public and making use of available laboratories and staff.

I expect to collaborate with three institutions abroad, that include:

• Microbial Water Laboratory - Higher Technical Institute at Lisbon University in Portugal
• TZW: DVGW Water Technology Centre - in Germany
• Lund University in Sweden - through a sandwich program to train PhD students.