Addressing the challenge of antimicrobial resistance in Ethiopia

The past two months have been agonizing for 45-year-old Yeshiembet Moges. It all started in 2022 with what was thought to be influenza, which was later identified as Tuberculosis (TB) and treated accordingly. Although the TB was treated it took a toll on her lungs and they became vulnerable to infection.

A couple of months ago, Yeshiembet's world turned upside down as she started experiencing a terrifying mix of symptoms ‒ fainting, breathlessness, fever and sweating, among others.

“This has been the most exhausting and challenging period of my entire life,” says Yeshiembet. “Each breath was a struggle, and the simplest task became an obstacle.”

It turns out that Yeshiembet’s fragile lung tissue became infected with antimicrobial resistant bacteria. This led to the tissue becoming damaged and inflamed, requiring immediate medical attention and breathing support.

Luckily, Yeshiembet was admitted to the ALERT Comprehensive Specialized Hospital in Addis Ababa, where antimicrobial stewardship is being implemented, thanks to the leadership of Ethiopia’s Ministry of Health and technical support from WHO.

Although her case presented complications due to a multi-drug resistant infection and required prolonged ventilation, Yeshiembet’s case is being managed by a team of health workers well trained in antimicrobial stewardship. With close monitoring, laboratory culture testing and appropriate medication, her health outcomes look good.

“The number of people we admit into our antimicrobial stewardship ward every month is increasing steadily,” says Dr Eliud Teshome. “Yeshiembet’s case is one of the many that we treated this month. Our investigations indicated that she has a multi-drug resistant infection and thus requires an intensive follow-up where we provide carefully selected and measured medication,” he says.

Ethiopia is one of the few countries in the African region that has a costed, multisectoral antimicrobial resistance national action plan, signed by the ministries overseeing the human, animal and environmental sectors. The plan includes the integration of antimicrobial surveillance and stewardship into the health emergency response and at a primary health care level, supported by policy makers, health managers, health professionals and the public.

Recording and reporting of data on antimicrobial resistance is critical for data-driven policy and decision making. According to a report from the Ethiopian Public Health Institute, the number of surveillance sites, from both health facilities and public health laboratories, that generate this necessary data have increased from 9 to 21 between 2021 and 2023. Furthermore, the Ethiopian Food and Drug Administration authority, with support from WHO, has started antimicrobial consumption surveillance at health facilities, making the country one of the few in the African region to undertake this activity.

The data is in the process of being compiled and will form the basis for a prevalence survey which will demonstrate the extent of antimicrobial resistance in the country. With this information, government can develop activities that are strategic, tailored and practical.

“WHO is encouraged by the proactive leadership and commitment of the Government of Ethiopia to tackle this burgeoning public health threat,” says Dr Nonhlanhla Rose Dlamini, acting WHO Representative in Ethiopia. “Valuable partners like the Kingdom of Saudi Arabia have also been instrumental in supporting WHO to provide support to move the dial on this issue.”

More than 250 health professionals, including doctors, pharmacists, and laboratory workers, in 70 health facilities have been trained to implement antimicrobial stewardship and evidence-based therapy for infection management. The government has also introduced e-training for health professionals across the country. Many health facilities have started to produce comparative analysis charts of antimicrobials (called antibiograms) which shows effectiveness of medicines against different drug resistant germs.

“We are benefiting greatly from the capacity building programme that was provided to laboratory workers, doctors and pharmacists in order to handle antimicrobial resistance in our clients efficiently,” says Tigist Shimeles, a pharmacist at the ALERT Comprehensive Specialized Hospital.

“Since the ‘next pandemic’ poses a threat to human life, these cases require much more attention. The leadership of healthcare facilities needs to be further sensitized to provide health professionals with up-to-date information and data, and offer more e-training sessions,” she says.

This experience has been a wake-up call for Yeshiembet. “I've always heard advertisements on radio and television encouraging people to take their drugs as prescribed. I always believed that does not concern me. Now, I am facing a variety of serious problems in my life. I am fortunate enough to have made it through this ordeal alive and thank all of the hospital's medical staff,” she says.