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Poverty and Antibiotic Resistance in Southeast Asia

Antibiotic Resistance in Southeast Asia
In September 2016, the United Nations General Assembly (UNGA) declared antimicrobial resistance (AMR) a major health threat for nations in every part of the world. AMR comes about when bacteria evolve to resist antibiotics used for the treatment of many infectious diseases such as pneumonia, tuberculosis and salmonellosis. According to the Center for Disease Control and Prevention (CDC), AMR can bring harm to people of all types and agriculture, health care and veterinary industries. Antibiotic resistance in Southeast Asia is of particular concern. 

Antibiotics have been essential to curing infections ever since Alexander Fleming discovered the first form of antibiotics, penicillin, in 1928. In the developing countries of Southeast Asia, antibiotics often do not have regulation and are available for purchase without a prescription from a physician, which exacerbates the phenomenon of AMR and causes major concern. This is an example of how poverty in Southeast Asia contributes to the antibiotic resistance crisis.

Contributions to Antimicrobial Resistance

AMR is a natural process. With or without the use of antibiotics, bacteria will always evolve to fight for survival by strengthening their resistance or by multiplying. Despite this, humans make AMR worse. A plethora of unnatural issues exaggerates AMR, but there are two that are cause for the greatest concern: unregulated sale of antibiotics and the use of antibiotics not as medicine for humans but as growth promoters and disease treatments in livestock. 

Unregulated Antibiotics and Self Medication in Southeast Asia

The World Health Organization Southeast Asia Region (WHO SEAR) includes the countries of Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. These countries are notorious for selling antibiotics as an unregulated product to the public, a reality of many developing countries around the world. In developing countries, the prevalence of infectious deadly diseases is higher than in more developed nations, making the likelihood of death from these issues higher.

Many consider the countries in Southeast Asia listed above to be hotspots for the spread of AMR. Here, the cost of antibiotics bought over the counter is lower than the cost to visit a physician or health professional. As a result, many self-medicate, making it the leading cause of AMR. Self-medication refers to the use of medication to treat ailments, diseases or infections without the guidance of a medical professional. Without curbing this habit practiced in WHO SEAR, bacteria quickly mutate to resist treatment, leading to more intense illnesses, increased medication prices and death. 

The Use of Antibiotics for Livestock in Southeast Asia

In this region, the use of antibiotics in livestock outweighs the use of antibiotics in humans. To keep livestock in countries around the world healthy, farmers commonly use antimicrobials to treat and prevent diseases and decrease mortality in livestock. Though people widely practice this, the countries of WHO SEAR use this technique excessively due to poverty. With weak regulatory laws to govern or survey the effects this has on the AMR crisis, AMR is aggressively growing. 

Where previously people ignored it when considering the causes of AMR, livestock antibiotic use has recently become a growing concern across the globe. With recognition came complication: in developing countries, farmers rely on the use of antibiotics to prevent illness or death of their animals so they can continue to make a profit. In Southeast Asia especially, the hard reality is that these issues layer and mix with other issues, such as poverty and food security. Policies regarding antimicrobial consumption in livestock that work for developed nations often do not work in underdeveloped nations, due to the complex differences of cultural differences and locations. It is for these reasons that poverty contributes to antibiotic resistance in Southeast Asia.

Efforts to Slow Antibiotic Resistance in Southeast Asia

Given that this crisis is on a global scale and affecting every nation, some are making efforts to control AMR. Unfortunately, there is no way to stop it completely. There are, however, the WHO’s action plans that can bring light to this topic. WHO has laid out five strategic goals: to increase recognition and understanding of AMR, to increase global monitoring and research, to decrease the prevalence of infectious diseases requiring antibiotic treatment, to improve the use of antibiotic treatment and to create a case for sustainable investment that includes all nations, no matter location or level of development

An example of raising awareness is World Antibiotic Awareness Week. Every year brings the annual World Antibiotic Awareness Week, created by the WHO in 2015. This week in November sets goals to increase awareness and encourage health care providers, policymakers and the public to practice healthy and sustainable techniques to slow the spread of antibiotic resistance in Southeast Asia.

– Anna Giffels
Photo: Flickr

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Azithromycin Could Help Ethiopian Children

Helps Ethiopean ChildrenAfrica has the highest child mortality rate of any continent. Ethiopia sits in the middle of the child mortality ranking of countries throughout Africa with 59 out of 1,000 children dying before the age of five. While it is not as high as the rate of 76 per 1,000 children found in sub-Saharan Africa, it is much worse than many developed nations, which average around 6 deaths per 1,000 children annually. New research, however, shows that childhood mortality can be significantly lowered in Africa using an antibiotic that could help Ethiopian children prevent blindness.

Azithromycin Helps Ethiopian Children

Trachoma is the leading bacterial infection that causes blindness. In an effort to lower the number of cases of trachoma, researchers preemptively gave azithromycin, an antibiotic effective at fighting trachoma, to thousands of children under the age of nine in Ethiopia. The researchers administered these doses of azithromycin to children twice a year.

After observing the children for several years, they came to a shocking discovery: azithromycin will help Ethiopian children live longer. Not only did the bi-annual antibiotic prevent against trachoma, as the researchers believed it would, but it also protected against many other common ailments as well. For those children in the case study, the childhood mortality rate was cut in half.

The discovery seemed too good to be true, so this group of researchers tried to replicate their findings in other African nations with higher child mortality rates. Close to 200,000 children were given azithromycin in Tanzania, Malawi and Niger. While the results were not quite as impressive as cutting the child mortality rate in half, as seen with Ethiopia, the results were still high. The twice-yearly drug lowered child mortality rates between 14 to 19 percent in each country.

Research Into Other Illnesses

Research must continue before Africa will see widespread use of azithromycin for children. If approved for widespread use, this antibiotic could help prevent some of the common illnesses that lead to child mortality. These common illnesses include:

  • Pneumonia: Pneumonia kills nearly 100,000 children per year in Africa. This accounts for 16 percent of childhood death under the age of five. Currently, when children contract pneumonia, only one third are able to receive lifesaving antibiotic treatment.
  • Diarrhoeal disease: Diarrhea is the leading cause of death in children under the age of five. Diarrhea is a common infection in the bowels. It is completely preventable and treatable, yet it is estimated that 525,000 children in Africa die annually from this illness.
  • Malnutrition: Malnutrition contributes to childhood mortality rates. While the use of azithromycin will not be able to prevent malnutrition, it may be able to help prevent other ailments that the body is not able to fight off because of the lack of nutrients and calories.

Long term effects of azithromycin used to prevent ailments in children are not known. However, the studies have shown promising results in saving the lives of hundreds of thousands of African children. With a few more years of research and more funding, these researchers may be able to permanently lower the childhood mortality rate in Africa. Not only will this research continue to help Ethiopian children but it will also help children of other nations, ensuring they live into adulthood.

– Kathryn Moffet
Photo: Pexels

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Drug Resistant Infections: A Global Crisis

Drug Resistant Infections
Antibiotics have long been considered one of the greatest marvels of modern medicine. Since their discovery in the early 1900s, antibiotics have promoted a previously unprecedented large-scale fight against disease. Their effectiveness, however, is starting to show its limits.

CDC Analysis

According to the Center for Disease Control (CDC), antibiotic resistance—also known as antimicrobial resistance or general drug resistance—is becoming more and more prevalent, with over 23,000 people dying from a drug-resistant infection or disease in the United States alone. Studies have shown that over 700,000 people die annually worldwide from drug-resistant infections. Diseases once thought to be treatable, such as tuberculosis and common bacterial infections, are slowly becoming harder to cure with standard antibiotics and antimicrobial drugs.

A Mounting Crisis

The sheer overuse of antimicrobial drugs, such as antibiotics, antimicrobials, or antifungals, is often cited as a factor in the rise of drug resistance. Numerous studies show that these medications are grossly overprescribed, specifically drugs in the antibiotic category. The overexposure of antimicrobial drugs to different bacteria drastically reduces the drug’s ability to fight infections and diseases, leading to a resistance that is almost impossible to treat. This phenomenon is only growing, with the United Nations estimating that resistant infection could kill up to 10 million people annually by the year 2050.

The Developing World at Risk

Developed nations like the United States and Western Europe have far greater chances of eliminating the problem by fighting diseases from the backend, with access to clean water, food and sanitary living conditions. But for underdeveloped countries where over half of the population lives below the poverty line, drug-resistant infections pose even more serious risks. These countries rely on antimicrobial drugs and vaccines to stave off epidemics and diseases and cannot afford to develop drug resistance of any kind. The United Nation’s (UN) latest findings point towards economic hazards of drug resistance as well, showing that if resistance continues to develop, healthcare costs and lack of resources could potentially send the economy into a decline similar to that of the 2008-2009 era.

Innovative Solutions

Finding innovative ways to combat drug resistance is the most urgent goal. The UN is among several groups looking to solve the resistance crisis, calling upon major pharmaceutical companies, research groups and investors to accelerate funding and assistance. Emphasizing the need for a worldwide plan, Dr. Margaret Chan, Director General for the World Health Organization, has stressed the need for a timely response, “Antimicrobial resistance is a crisis that must be managed with the utmost urgency. As the world enters the ambitious new era of sustainable development, we cannot allow hard-won gains for health to be eroded by the failure of our mainstay medicines.”

As a part of the much-needed urgent response plan, the WHO proposed a new strategy to the World Health Assembly in 2015 that highlights five main goals to fight drug resistance:

  1. Raise awareness
  2. Gain knowledge
  3. Reduce risk of infections overall
  4. Optimize the current use of antimicrobial drugs
  5. Increase investment in research and technology for new antimicrobial drugs

Hope for the Future

The CDC has also constructed what is known as the National Action Plan, a five-year goal with similar objectives working under their Antibiotic Resistance Solutions Initiative. Despite the imminent threat of drug resistance, the crisis is being taken seriously with appropriate responses in progress and clear plans of action to follow.

– Olivia Bendle
Photo: Pixabay