Antimicrobial resistance (AMR) among newborns is a silent yet deadly public health threat of great concern in healthcare settings across sub-Saharan Africa. According to the World Health Organization (WHO), in 2021, one million newborns (neonates) in Sub-Saharan Africa did not survive to see their one-month birthday. Sub-Saharan Africa tops the global chart with the highest burden of death associated with AMR with 23.5 deaths per 100,000 people. Research projection indicates that, by 2050, AMR will account for more death than both cancer and diabetes combined.

AMR in newborns refers to the ability of microorganisms including bacteria and fungi to develop resistance against the effects of drugs used to fight them, making infections in the newborns harder to treat, increased vulnerability to illness, complication and death. The most common antimicrobial-resistant infections found in newborns in hospitals includes Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin Resistant Enterococci (VRE), Extended spectrum β-lactamases (ESBL), Carbapenem-resistant Enterobacteriaceae. Multidrug-resistant Pseudomonas aeruginosa.

Dr Abdoulie Bojang, fellow of the African Postdoctoral Training Initiative (APTI) programme and Senior Scientific Officer at the Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, explains that AMR in newborns poised a great threat not just to the healthcare system but systemic issues that require urgent action to protect the next generation of newborns.

The African Academy of Sciences (AAS) provides resources for the best minds in Africa to work in conducive research environments, produce quality and relevant data, and create innovations that have the potential to address health and developmental challenges on the continent and globally. The goal of the APTI programme is to create a critical mass of young African scientists, trained at the U.S. National Institutes of Health, and who return to their home institutions and grow into scientific leaders to help solve Africa’s challenges in global health and development.

The research guru attributed the rise in AMR in newborns to poor infection control practices in place, prevalence of nosocomial (hospital acquired) infections and environmental factors that harbour resistant bacteria and contribute to their spread.

Unlike children and adult, the newborns acquired AMR primarily through vertical transmission where resistant bacteria are gotten from the mother during childbirth or breastfeeding and horizontal transmission from the environment. While the children and adult primarily acquire resistant bacteria through interaction in the community or healthcare setting, Dr Bojang explains further.

Addressing AMR in newborns, according to Dr Bojang, requires strengthening infection control and improving antibiotic stewardship across healthcare systems.

Tackling AMR: Recommendations

Tackling AMR in neonates, Dr Bojang advocates for measures geared towards:
•    Developing antimicrobial stewardship programs comprising of multidisciplinary team such as neonatologists, pharmacist, microbiologists, nurses and specialists in infection control
•    Developing evidence-based guidelines and policy, and adhering to them for prescription, treatment, prevention and diagnosis.
•    Infrastructural support: This is essential to initiate appropriate pathogen-directed antimicrobial agent at the earliest. The microbiology laboratory should be supported with automations, molecular and biomarkers facilities for reliable, timely and accurate result generation.
•    Hospital information system (HIS): Fully functional HIS including laboratory information system will augment the stewardship program, ease communication and ensures availability and retrieval.

Despite the importance of these efforts, the implementation of AMR stewardship (AMS) in sub-Saharan Africa faces challenges. “These include lack resources, inadequate infection control practices, and limited awareness and education among healthcare workers and the general public. In addition, surveillance systems for tracking AMR are often weak, lacking the quality assessments needed to provide reliable data on infection origins and pathogen types” Dr Bojang added.

Also, the implementation of AMS in neonatal unit setting is shredded with challenges such as Inadequate human resources, Inadequate budgetary allocation to health, Poor leadership and management and Diagnostic challenges.

Strengthening AMR Prevention and Control

Dr Bojang stressed the need for improving infection prevention control (IPC) protocols to better protect newborns from AMR with emphasizes on:
•    Implementing safe delivery and postpartum protocols, such as using sterile equipment and clean birth kits, and following aseptic procedures when giving birth.
•    In compliance with the national immunization schedule, pregnant women and newborns should receive nutritional support and vaccine promotion.
•    Create, put into effect, and uphold IPC rules and guidelines that are particular to the needs of neonatal care units and the local setting.

Dr Bojang stressed the importance of community engagement to scale up awareness on AMR prevention and infection control. Strengthening collaboration with community and religious leaders to disseminate culturally relevant messages, integrating AMR education into school curriculums, and conducting public health campaigns can raise awareness on the importance of infection prevention and vaccinations.

Looking Forward: Addressing the AMR Challenge

“Combating AMR in sub-Saharan Africa required multifaceted approaches”, Dr Bojang emphasized. With key emphasis for improving data collection and surveillance system, resource mobilization, fostering research and innovation, invest in public health awareness and campaigns and developing capacity and leadership, robust infection prevention mechanism, better antibiotic stewardship and expanding access to high quality healthcare, in sub-Saharan Africa.

AMR in newborns is a silent epidemic in sub-Saharan Africa, requiring urgent and comprehensive actions across healthcare systems, government agencies, and communities to safeguard the next generation.

Dr Abdoulie Bojang is a fellow of the African Postdoctoral Training Initiative (APTI) programme. APTI is a postdoctoral training fellowship programme implemented by the African Academy of Sciences (AAS), in partnership with the U.S. National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation (BMGF).

Original article written by David Arome and published in The Development Report.