Community Participatory AMR Surveillance and Action in Nigeria (CPASA)

Our solution tackles critical lack of real-time data on antimicrobial resistance in Nigerian communities. We propose a technology driven One Health framework, engaging local stakeholders across human, animal, and environmental health. Through a digital tool, we enable citizen reporting, data analysis, and evidence-based decision-making, fostering community-driven AMR prevention and control.

Pharm. Estelle Mbadiwe, Dr. Kikiope Oluwarore and Ime Asangansi are co-Leads of this solution. 

Either Kikiope or Estelle will present the solution to the judges

Our submission addresses lack of critical real-time data on antimicrobial resistance (AMR), access (AMA), use (AMU) and quality (AMQ) in Nigerian communities. AMR caused at least 327,000 deaths in Nigeria in 2019 - higher than deaths from enteric and respiratory infections, tuberculosis, maternal and neonatal disorders, NTDs, and cardiovascular diseases. However, current studies and reports are not holistic or community relevant, and lack updated, real-time data across all One Health sectors involved in AMR development and spread.

Currently, AMR data mainly comes from tertiary hospitals and sentinel laboratories, and does not include data from unregulated medicine vendors, farms, abattoirs, community waste, effluent water, and air pollution especially within rural areas and internally displaced people (IDP) camps, where gross antimicrobial misuse is common, and access to quality antimicrobials is limited, leading to significant health and socioeconomic impacts. This dearth of comprehensive data hampers effective AMR response and policy implementation, notably the National Action Plan for AMR. Furthermore, the absence of a real-time AMR surveillance framework sidelines community-based primary health care centers which comprise 85% of Nigeria's healthcare system. Overall, these gaps limit data availability, research, decision making, surveillance, preparedness and response for effective One Health-driven AMR prevention and control efforts.

In our previous engagements with community members and several rural agrarian communities, prevalent AMR increases their healthcare costs, treatment period, long term complications and sometimes death. This, coupled with the weak primary healthcare system across communities in Nigeria, can lead to immense financial, mental, and socioeconomic strain. Therefore, the solution will allow us to identify antimicrobial trends in these communities, provide evidence-based recommendations to human and animal health professionals on antimicrobial prescriptions, and improve the healthcare service received by community members and their animals. 

Also, the data will improve the prediction of resistant pathogen outbreaks in animals and humans thus improving biosecurity. Through our awareness campaigns, community members will be educated on proper antimicrobial use and infection prevention and control practices. This will improve their compliance with prescriptions, promote hygiene and sanitation, and reduce drug abuse and its associated health complications. Furthermore, the data obtained will inform recommendations for local environmental health officers.

Farmers, pet breeders, and owners will also benefit from our project, as it will improve onsite biosecurity practices, vaccinations, reduce economic losses from veterinary costs and outbreaks, and ensure pet safety. This will safeguard livelihoods and minimize the risk of zoonotic spillovers.

The data collated and obtained across all sectors will be analyzed, presented, and accessible on the website through updated data visualization dashboards and periodic (daily and weekly status reports). People will be able to have access to and information on both sector-specific and intersectoral data on AMR use, quality, access, and resistance. This is a key public good as people can have access to data without bureaucratic processes of excessive costs. It can also serve as a source of information for research, and evidence-based decision making for interventions and policies. Furthermore, it will also aid the decision making of governments, private sectors, researchers, funders, CSOs, and other stakeholders, to understand key achievements, challenges, lessons learned, target areas of need, and prioritize limited resources for improved AMR prevention and control.

Our project also supports the implementation of Nigeria’s National Action Plan for AMR, a key policy and guidance tool for the country’s efforts in combating AMR. Furthermore, our solution serves the public good by actively participating in the global efforts to prevent and control AMR which in turn safeguards planetary health by preserving the effectiveness of antimicrobials and mitigating the potential environmental impact of misuse.

Nigeria, a lower-middle income country, relies heavily on agriculture. According to FAO, at least 70% of Nigerians most of whom are in rural, remote, and underserved communities engage in it.  This highlights the importance of aquaculture and livestock farming in livelihoods of Nigerian communities. Our solution ensures that real-time data is available to these farmers and animal health professionals to improve treatment outcomes, antimicrobial use, prevent and control AMR, and improve farm biosecurity. All these ensure optimal animal health, thus ensuring good yield and minimal losses. It also reduces the risk of zoonotic spillovers and AMR spread from these animals to humans.

Due to the recent economic downturn in Nigeria, prices of medications have increased exponentially, further reducing access to antimicrobials in poor resource communities. Our solution improves IPC in communities, thus reducing the likelihood of being infected and sick. It also ensures that communities with reduced access to antimicrobials are identified by stakeholders for interventions. The outreach, training and routine reports will also improve service delivery in healthcare settings across these communities, solving unnecessary medical care costs due to AMR. The optimal health of the community members will also boost productivity and that of the nation at large.

In our first year, we will pilot this solution in Ibadan and Abuja - located in southern and northern Nigeria respectively. They both host or are proximal to several agrarian communities, poultry, cattle, sheep and goat, pigs, and aquaculture farms, with community human, animal and environmental health practitioners, patent medicine vendors and other stakeholders. Also, we have had previous engagement with community stakeholders in both states for AMR education, outreaches, and policy advocacy. 

Nigeria has 36 states across 6 geopolitical zones and following the 1-year pilot, we will implement our monitoring and evaluation framework to improve the solution, address any concerns, implement lessons learned and scale up to other states over the next 2 years. Altogether, over the 3 years, our goal is to reach at least 1 state per geopolitical zone in Nigeria with concerted stakeholder training on data collection tools, engaging at least 2 communities per state, while country-wide public engagement and data collection will be employed. We will then assess country-level deployment of the framework, improve on the solution and advance scale-up to every state in Nigeria. Consequently, we will extend the solution to other African countries through identified regional and continental governmental and non-governmental organizations. 

We intend to monitor indicators across the One Health spectrum on antimicrobial resistance, access, use, and quality over time. Over the human, animals and environmental health spectrum, our success indicators will include but are not limited to: 

• Number of community members and public reached on with information on AMR, AMQ, AMU and AMA via in-person and online engagements

• Number of community members and practitioners across the One Health spectrum engaged, trained and using our digital solution to log and report data 

• Amount and quality of data being collected and reported per time from the human, animals and environmental health on AMR, AMQ, AMU and AMA

• Level of knowledge of community members on AMR and AMS

• Number of states and communities in Nigeria reporting on AMR, AMQ, AMU and AMA 

Human health indicators will track AMR, AMQ, AMU and AMA via the WHO AWaRe classification, patient clinical outcomes, over-the-counter sales of antimicrobials and more. Animal health will track use of antimicrobials, patient clinical outcomes, over-the-counter sales of antimicrobials, IPC practices in farms and more. Environmental health will evaluate antimicrobial levels in solid and effluent waste and water bodies in households, farms, and abattoirs and more. 

Current Barriers

1. Limited Funding: To fund a broad data collection, we're exploring grants, government and NGO partnerships, and utilizing the social enterprise model

2. Technological know-how: Data collection may be hindered by inadequate technological know-how. Therefore, we will invest in user-friendly technology, and offer community-level training.

3. Data Quality: We will provide thorough training for stakeholders and data collectors to minimize errors.

4. Community Participation: Encouraging active community involvement may meet resistance due to skepticism or lack of awareness. 

Barriers in the Next 3 Years:

1. Sustainability: Ensuring ongoing data collection is a challenge. We plan to develop capacity-building programs, partner with local institutions, and integrate the system into existing healthcare infrastructure for long-term sustainability.

2. Policy Integration: Integrating data into policymaking may face hurdles. Through advocacy, collaboration with policymakers, and demonstrating tangible benefits we can facilitate policy integration.

3. Evolving Community Dynamics: Evolving community dynamics can impact data collection efforts. There will be regular reassessment, open communication, and adaptable engagement in order to address this challenge.

Others include; Data Privacy, Insecurity, and Emergencies in the country.

By proactively addressing these challenges through strategic planning, community engagement, regular evaluation and adaptation to changing circumstances our solution aims for success in the short and long term.