Addressing the challenge of antimicrobial resistance in Ethiopia

Recent disease surveillance findings from more than 4000 health centres across Ethiopia have shown a rising trend in cases of antimicrobial resistance, which occurs when pathogens change over time and no longer respond to medicines. For instance, resistance by the bacteria that causes typhoid surged nearly nine-fold to 87% of cases in 2019 from 10% in 2006. Equally, strains of infection-causing E. coli bacteria are showing increasing resistance to stronger antibiotics.

Antimicrobial resistance makes infections harder to treat and increases the risk of a disease spreading, severe illness and death. 

Ethiopian health authorities are taking measures to tackle the rising threat. With support from World Health Organization (WHO), with funding from the Kingdom of Saudi Arabia, the Ministry of Health is developing policies and training health workers to promote the appropriate use of antimicrobials, improve treatment, reduce antimicrobial resistance and decrease the spread of infections caused by drug-resistant germs.

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.

However, 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 the antibiotic she was taking to cure the TB was not working because the bacteria that causes the infection had developed resistance to it. This led to Yeshiembet’s lung 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 multi-drug resistant TB 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 is multi-drug resistant 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 the health and pharmaceutical sectors, that generate this necessary data have increased from 9 to 21 between 2021 and 2023. This again makes Ethiopia one of the first countries in the African region to have antimicrobial consumption surveillance in health facilities.

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 are now producing localized tests that show how resistant certain germs are to different antimicrobials (called antibiograms).

“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.

Distributed by APO Group on behalf of World Health Organization (WHO) – Ethiopia.