Global Forum on Food Security and Nutrition (FSN Forum)

We need to have social scientist to be part of the research on AMR.  We also need to collaborate more with everyone in the media space, coaches and speakers to make this message easier to the public to understand. Sometime scientist deliver message in way that common people find it difficult to connect with.

We need to get public figures also to be involved as ambassadors of the antimicrobial use and resistance programme and we need to also highlight the importance stewardship.

The communication tools mainly in the rural areas still dependant on the tradition way of doing things, including the traditional or tribal offices, meetings with the local farmers through the local agricultural advisors or state veterinary office. However, in towns and cities people are able to access and communicate effective using social media platform (Facebook, twitter and Instagram) etc . We will need to explore these platforms more to reach the younger generation.

This comment will be focused mainly on human antimicrobial resistance (AMR). This can be a small contribution to the general problem but as it has been deeply studied in clinical ground, some issues merit to be considered. Antibiotics have reduced mortality in LMIC, but their misuse has contributed to the present problem, clearly expressed in the Spread cycle appearing in the Topic introduction. Specific rules for antibiotics uses are beyond this comment.

One of the starting points to consider is primary care for non-severe infections such as the common upper respiratory tract infections (URTIs) and acute diarrhea especially in children and youths. Only a minority of URTIs are of bacterial origin, despite this they frequently attract antibiotic prescription which can lead to a more severe and difficult to treat situation (1). Acute diarrhea is another generalized condition that frequently still receives antibiotics despite proven inefficacy (2, 3). It is important to spread the concept that acute fever rarely requires antibiotic administration. This knowledge should be enrooted both in the population and in primary care providers. Also  basic information on adequate nutrition is most likely to be the best preventive circumstance at any age but especially in the first year of life  by promoting a more generalized breast feeding, it should be taken into account that bovine lactoferrin does not prevent infections in early life (4).  As important as this is the hand-hygiene. Additionally, providing information about antibiotic use risks (allergies, hardly recovery of microbiota…) whenever possible would be helpful. Development of ‘Antimicrobial stewardship’ programs (5) by (human and veterinary) Health Departments could be the first step for improving the use of this important tool so easily  misused. 

Answers to questions:

1: To reach individuals

2: Same way as antibiotics, but explaining that presently their resistance is not so widespread.

3: -

4: Ministry of Health and specific section/ persons dealing with health care providers (Med and Vet)

5: Ex-aequo Simple legislation and Primary Care Delivering local organization.

6: Ex-aequo Ministries of Health and the Regional Tripartite (FAO, OIE, WHO)

1. Harris C, Mills R, Seager E et al. Pediatric Deaths in Tertiary Government Hospital Setting, Malawi. Paediatr Int Child Health 2019; 39(4): 240-8.
2. Reiner RC and Local Burden of Disease Diarrhoea Collaborators. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries 2000-2017: analysis for the Global Burden of Disease Study 2017.  Lancet 2020; 395: 1779-801.
3. Florez ID, Veroniki AA, Al-Khalifah R. et al. Comparative effectiveness and safety of Interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis. PLoS ONE Dec 5 2018, doi: 10.1371/journal.pone.0207701.
4. Doyle L, Cheong J. Does bovine lactoferrin prevent late-onset neonatal sepsis? Lancet 2019; 393: 382-4
5. Septimus EJ. Antimicrobial Resistance: An Antimicrobial/Diagnostic Stewardship and Infection Prevention Approach. Med Clin North Am 2018; 102(5): 819-29.

Manuel Moya MD

University Miguel Hernández. Campus de S. Juan. Alicante. Spain

MM

We need to break the silo mentality and start to work together as a unit, therefore practicing one health system to the later. That is basically taking responsibility.

1. What is the biggest communication challenge related to AMR and inappropriate antimicrobial usage (AMU) in Africa?

As it was highlighted in this article, Antibiotics have been used for healthcare purposes in Africa for years, and the efficacy is somewhat undeniable, this is where I believe the challenge lies. The biggest communicable challenge will be that people don't believe what is being communicated because they know that antibiotics indeed works for some illnesses and conditions. 

2. What is the best approach to communicate about other antimicrobials (antifungal, antiparasitic, antiviral, pesticides), and not only antibiotics? As viruses, fungi and parasites can also be resistant to medicines commonly used to treat them, and impacting health and food systems, how do we communicate about these issues in addition to antibiotic resistant bacteria?

For me, the best approach is to channel just as much energy into these other areas as well. Specific dates should be set out to create awareness about antifungal resistance, antiviral resistance,  etc.

3. How can we get the topic of AMR included more often in the media? How do we ensure the visibility of AMR amongst other “hot topics”?

I would say, more people should be encouraged to tell their stories about their AMR journey so people can see practical examples.

4. What communication channels, methods or mechanisms are more suitable and will have the greatest impact at field level in African countries?

The media. Social networks through a systematic approach. Let us engage more professionals outside of  the healthcare space with discussions that center around AMR.

5. Which group of stakeholders do you think should be considered as priority for targeted key messages aiming at raising awareness on excessive AMU and AMR?

Healthcare workers (pertinent to one health) are a priority group, but owners of local drug stores where people are very likely to get these antibiotics from should be considered as priority too. Pharmaceutical companies responsible for the manufacturing and distribution of these drugs should also be encouraged to include a caveat on the packaging of antibiotics. 

6. At national, regional and continental levels, who to do think should take leadership and responsibility for awareness and advocacy activities on AMU and AMR

Everyone that identifies with the one health system in the country, including organizations like the food and drug administration, ministry of health etc.

Ogunleye Akinlabi Oladele

Department of Veterinary Microbiology,

University of Ibadan

Nigeria

One of the biggest problems in the communication about AMU and AMR in Africa has to do with difficulties in using African contextualized scientific facts on the subject to successfully educate the stakeholders to the level of achieving the anticipated necessary changes towards attainment of good stewardship. A number of factors such as the level of awareness, knowledge, attitude, emotional undertone behind the current practices and behavioral tendencies associated with the subject are often undermined or sometimes ignored during the attempt to communicate to the stakeholder. One more fundamental challenge has to do with the need for consensus definitions of some important concepts and terms regarding AMR and AMU based on African realities. For example, could the term: prudent/ judicious use of a particular antibiotic mean exactly the same thing in terms of specific details as applicable for example in USA, Europe as well as in Africa? This is open to discussion in our African context. Correct answers to some of these issues will go a long way in helping us to overcome our challenges communicating about AMU and AMR in Africa.

In an attempt to communicate about other antimicrobials (antifungal, antiparasitic, antiviral and pesticide), we must take into consideration the complex nature of the subject and approach it with the application of one health concept. Necessary information about them can be communicated based on African contextualized integrated research findings, education on the subjects and extension programmes. And just as mentioned for antibacterial agents, the correct assessment of the prior knowledge, awareness, attitudes, emotional undertone that inform the stakeholders current positions must be given a priority. Connection with the targeted stakeholders this way may help them to accept the new concept and information that may result into the actualization of the desired outcome.

In order to get topics of AMR and AMU more included in the media among hot topics: we must present it to the public as a one health problem that requires multidisciplinary approach to be handled.

Every stakeholder such as Veterinarians, medical doctors, environmentalist, Agriculturist must work together as a team by honestly acknowledging the contribution from their respective sectors to AMU and AMR problems as well as their contribution to the desired solution. The general public and media will be interested in the dissemination of such information.

Communication through extension service team comprising necessary stakeholders well equipped with the required knowledge about AMU and AMR to the targeted stakeholders will be very practicable and effective in the African context.

Based on the one health nature of AMU and AMR the following stakeholders should be targeted as priority group with the key messages about raising awareness on excessive AMU and AMR:

Animal Agriculturists, Veterinarians, medical doctors, environmentalists and general public.

At the national, regional and continental levels: Veterinarians, medical doctors, relevant scientists/ researchers should take leadership and responsibilities for awareness and advocacy activities on AMU and AMR.

Good day colleagues,

The challenges of communication on AMR is not far from the issue of addressing multiple/ different stakeholder groups in the animal health sector unlike the human health sector. Here the one-cap fits-all does not work, hence the need to utilize different strategies of communication to capture different groups of stakeholders.

In communicating resistance of other antimicrobials, we can use same approach, same opportunity as communicating on antibiotics however my suggestion is to allow farmers consume messages on AMR on antibiotics before gradually introducing other antimicrobials.  

Frequent engagement of media personnel (journalists), getting them to understand what AMR is, providing them with the right information on AMR will enable them amplify and pass the messages correctly. This will also enhance wider coverage of stakeholders and AMR will be a hot topic on print, electronic and social media platforms

In my opinion the best approach for reaching out to target groups is focus group discussion. That way you can pass your messages to them, get their perception and possibly opinions, faster way of getting feedback for you to possibly modify your messages or approach. It also offers opportunity for them to seek clarification to further enhance message consumption. Radio programs such as jingles and phone-in programmes on AMR is also a very good approach.

The group of stakeholders to prioritize for raising awareness on AMR and AMU in my opinion are livestock farmers, feed millers and Veterinary drug retailers because they are the greatest users of antibiotics. Feed millers use quantities of antibiotics to prevent feed contamination and for growth promotion of animals.

Thank you

Zainab Abdulkareem

Dear colleagues

My name is Japhta Mokoele based at the University of Pretoria, Department of Production Animal Studies.

I am involved with the survey of Antimicrobial use and resistance in the pig farms in Gauteng.  what I see is that the pig farmers want to solve all the problems with drugs and that is not how it should be.

We need do more veterinary extension work to help train farmers on the role of antimicrobials and when and how they need to be used. This need to be a coordinated work for all the professions within animal agriculture.

What is the biggest communication challenge related to AMR and inappropriate antimicrobial usage (AMU) in Africa?

In South Africa, we have two acts controlling AMR, mainly Fertilizers, Farm Feeds, Agricultural Remedies and Stock Remedies Act, 1947 (Act No. 36 of 1947) controlled the Department of Agriculture  and The prescription only medicines in South Africa, is controlled by a second drug control act, known as the Medicines and Related Substances Control Act, 1965 (Act No. 101 of 1965), administered by the Department of Health (DOH) i.e. the major difference between the Medicines Act and the Stock Remedies are restricted to veterinary prescription, while stock remedies are typically over-the-counter drugs.

The challenge is that most of these drugs (tetracyclines, sulphurs)  are registered under act 36 and that is the challenge because this drug is sold by big cooperatives that are manned by people with less know how about the drugs.

My view is that we need to have this place employing para-vets or working with the veterinarians to assist with this important messaging on dosages, withdrawal periods and the best way of storing and usage of drugs at farm level.

How to improve communications for Antimicrobial Resistance (AMR) in Africa.

Written by Malik Olatunde Oduoye.

Member of Antimicrobial Resistance Stewardships, Optimum Access and Use, Uganda.

Overview

First of all, I will like to commend the efforts of the Tripartite members responsible for AMR control in African Region, including the African Union (African Centre for Disease Control and Prevention – Africa CDC, African Union Inter-African Bureau for Animal Resources - AU-IBAR) and Regional Economic Communities (RECs) for their collaborative efforts towards the combat against Antimicrobial Resistance in African communities in a holistic continental One Health approach.

Talking about Antimicrobial Resistance (AMR) and inappropriate Antimicrobial Usage (AMU) in Africa, I think the biggest communication challenge poor individual understanding of antimicrobial usage at the grass-roots. Most individuals do not have the forehand knowledge of antimicrobial usage.

Hence, tackling antimicrobial resistance in African communities requires multi-sectoral approach and strategic measures. To achieve maximal, improve in communication for AMR, below are my views and opinions.

Firstly, I think the best approach to communicate about other antimicrobials in addition to antibiotic resistant bacteria is through a very strong Advocacy and Campaigns about these antimicrobial agents through reaching out to:

Each household in the African Communities, by communicating with them about the dangers of AMR in their local languages. Through this, there will be proper understanding about AMU and AMR. As we all know that ‘Charity begins at home’

The community and Religious leaders in all African Communities. I believe these set of human beings can also talk and preach to the community members about AMU and AMR especially during community meetings and religious gatherings. Africans listen well to their community leaders and Religious Leader.

Among the African Schools, that is, elementary, basic, high, and tertiary institutions. AMU and AMR should be included in the academic curriculum. Also, seminars on AMU and AMR should be held at regular intervals for the student s and also the teachers. This will give more room for better understanding about antimicrobials.

Government and Non-Governmental agencies in all African States. These are key bodies in policy and advocacy making. I believe they can regulate the dispensing of antimicrobials in all the African States, towns and Villages across the various health care facilities and inter-professionals that is, the physicians, pharmacists, veterinary doctors, agriculturists, nurses etc. Also, these policy makers should give a strict law on irrational dispensing of antimicrobials by all the aforementioned health care professionals and placing punishments on whoever break the law. Also, use of Over The Counter Drugs (OTCs) should be minimized.

Still on the government and non-governmental bodies. The Tripartite members responsible for AMR control in African Region should advocate for more sophisticated and modernized and a well-organized, equipped health care centers to be constructed in all African communities with more health care workers. This will increase the willingness of a common and average man to seek appropriate health care, with optimal health care access and will also reduce the abuse of drugs especially antimicrobials.

Inter-professional health organizations and collaborations should be encouraged among all African States in order to achieve ONE HEALTH approach in solving AMR. It is sad and obvious that most African Health Organizations do not practice proper and organized Inter-professional health care especially in the management of patients.

Strong considerations of Animal Health. Majority of African States, for example, Nigeria, do not really much efforts and priorities in good and proper care of the Animals. Most Animals are left untreated each time they are infected with a disease, and by so doing, human beings could be infected, and prompting him or her to the abuse of antimicrobials.

In addition to my first answers, the ways I think we could get the topic of AMR included more often in the media with more visibility of AMR amongst other “hot topics” include the following:

Creating an accessible social media application for all the African Community members. For example, “AMR- APP FOR ALL”. This this social media can be installed on our phones, laptops. Making AMR and AMU discussions to be easily taught among the African

All African Health Students should also be incorporative in the media strategic measures and campaigns for AMR amongst other “hot topics”. They will also benefit from the Media APP also.

However, more suitable communication channels, methods and mechanisms that I think will have the greatest impact at the field in African Communities include:

Religion Channels

Youth Organizations and Forums

Family meetings and discussions

Social Media Networks especially WhatsApp, Facebook, Instagram, and twitter.

Note: All kind of method, ideas, mechanisms should also be interpreted to most common African languages e.g. Swahili, French, Hausa, Yoruba, Igbo, etc. As this will improve proper and better communication for AMR.

Speaking about the group of Stakeholders to be considered as the priority for targeted key messages, aiming at raising awareness on excessive Antimicrobial Use (AMU) and Antimicrobial Resistance (AMR), I think it is necessary to include the community and religious leaders, primary and high school teachers, university students especially those studying health related courses, including the lecturers among the stakeholders in combating AMR. As this will go along way in reducing the excessive AMU and AMR.

As for the leadership and responsibility roles, I think the key health care professionals, that is the Medical Doctors, Pharmacists, Veterinary Physicians, including other prominent health care personnels should be appointed for the awareness and advocacy activities on AMR and AMR at national, regional and continental levels. As this create more strong and effective combat against AMR.

Dear colleagues,

I propose that institutions update a new chart related to the  "on-going cycle of AMR spread between human, animals and the envrionnement" mentioned on this page by adding the fish, as aquaculture contributes to the pool of genes of resistance shared with the others activities. it is important for raising awarness regarding AMR in aquaculture as well. 

Please find here an article : https://doi.org/10.1038/s41467-020-15735-6

Kind regards

Hello intellectuals

Good morning to you all. Allow me once more to contribute to our hot topic on AMR & AMU this has really impacted a lot of communities. The use of antibiotics has become the order of the day,use of antibiotics as growth promoters for instance in my country most people are in  small scale or back yard garden poultry rearing in most antibiotics are used to survive in the day to day life through selling the chickens.

Therefore in my observation I feel the group of stake holders to be considered as a priority are small scale farmers who need to be educated on the prudent use of antibiotics. The awareness needs to to be emphasized on these group of people. The other group of stakeholders are the big farmers and some company's dealing in livestock rearing in feedlots  the AMR & AMU are mostly common due to sustain their business and to meet the demand. 

The other stakeholders are the consumers who need a lot of sensitization on the use of antibiotics by the farmers they buy livestock and livestock products. There is need to air programs on dangers of AMR &   AMU on local radio stations to run a program that will raise awareness on this topic then we will win the battle. 

The academia also needs to be targeted to raise awareness, in primary schools and secondary schools the message needs to be communicated to so as to create awareness to pupils who will eventually educate others on the same, we the food safety people we need to go round the farms and monitor the use of antibiotics on the animal and environment, since this is the source of these antibiotics use.

Booklets or small pamphlets can be printed in all local language's so as to raise awareness. Also holding of public symposiums to engage the community to participate and asses their level of understanding on AMR & AMU then will be able to asses how much knowledge is on the same topic.

For now let me end here.

Kind regards

James