MEZIESBLOG

Nigeria has a multifactorial health system and a large but young population.

The major causes of morbidity and mortality are communicable diseases, and these are generally managed using antimicrobial drugs whose usefulness is being threatened by antimicrobial resistance. AMR threatens all countries in different ways and to varying extents. This document lays out the situation in Nigeria where much of the disease burden comes from acquired immunodeficiency syndrome (AIDS),
tuberculosis (TB) and malaria. In children less than 5 years of age, malaria, pneumonia, diarrhoea and meningitis are among the leading causes of death.

Antimicrobials are a cornerstone of disease management in Nigeria and there is a pressing need to discover how best to conserve them.

This situation analysis was performed by the Nigeria Centre for Disease Control in collaboration with the Federal Ministries of Health; Agriculture and Rural Development, and Environment as well as the Global Antibiotic Resistance Partnership (GARP) project. GARP is an initiative of the Center for Disease Dynamics, Economics & Policy (CDDEP), which establishes resistance related policy development capacity and policy analysis in selected low- and middle-income countries.

The Scope and Extent of Antimicrobial Resistance in Nigeria
In Nigeria, tuberculosis, respiratory infections and diarrhoeal disease are
leading causes of infectious disease morbidity and mortality. Nigeria also suffers considerable burden from systemic infections including Human Immunodeficiency Virus (HIV), malaria, bacteremia and meningitis. There are, as yet, no available studies outlining the full burden of AMR and its health and economic impact on
Nigerians. However, these data are available from elsewhere and Nigeria-specific data demonstrates that AMR rates of many disease-causing organisms are untenably high in Nigeria.

Community-acquired Infections in Humans

The most common bacterial infections are community-acquired diarrhoeal diseases, respiratory, urinary tract and invasive infections. Among organisms causing diarrhoeal disease, including the life-threatening childhood diarrhoeas that are an important contributor to Nigeria’s excessive infant mortality rate, resistance is rife. There is widespread antimicrobial resistance among enteric Escherichia coli in
Nigeria particularly to penicillins, aminoglycosides, cephalosporins, chloramphenicol, tetracyclines and cotrimoxazole. Resistance patterns among Shigella and nontyphoidal Salmonella are just as high and appear to be increasing. In North-West Nigeria, resistance rates of over ninety per cent were reported for Shigella- the cause of dystentery, each to ampicillin, fluoroquinolones, chloramphenicol and
cotrimoxazole. These are the currently recommended options for treating the disease.

As reported by the Cholera Regional Platform, Nigeria in 2014 had 35,996 cases of cholera, which represented about 39 per cent of all cases in the region, making her the most affected country by cholera in west and central Africa. A cause for extreme concern was the rise of cholera case-fatality rate (CFR) to 4.76%, as at the end of April 2015- 2,108 cholera cases, with 97 deaths.

The systematic review of literature for this situation analysis revealed that resistance was predominantly documented to trimethoprim/ sulphamethoxazole, sulfonamides and nalidixic acid, again obliterating most of the options for antimicrobial-based containment of outbreak cholera. Many countries are moving towards vaccine-based strategies but these are yet to be applied in Nigeria.

A systematic review in Nigeria found marked resistance to all drugs commonly prescribed for urinary tract infections in the country. There are high rates of resistance to ceftriaxone, ampicillin and cotrimoxazole. Most organisms demonstrated 100% resistance to ampicillin and cotrimoxazole which have long been used as first line drugs in the treatment of UTI. Among the first line drugs, Nitrofurantoin hadthe
lowest resistance levels with resistance rates as low as 6.5% in E.coli and less than