Antimicrobial resistance - a global public health threat

"Proper infection control practices and antimicrobial stewardship will be important to address this emerging threat" is the conclusion of a new publication from Sub-Saharan Africa on trends and reasons why resistance to antibiotics is becoming an increasing international problem.

The study, just published in the latest issue of the American Journal of Tropical Medicine and Hygiene, looked at data collected over a 5 year period on sensitivity of bacterial cultures to a wide range of WHO essential list as well as newer antibiotic medicines.

The data were collected in Kigali, Rwanda, at King Faisal Hospital, a major teaching and referral hospital for patients from throughout
Rwanda and from neighbouring countries.

The research team comprised international researchers from the USA (Yale AIDS Programme and the Department of Public Health, Philadelphia), the UK (Fellowship of Postgraduate Medicine, London) and SMBT Institute of Medical Science and Research Center in Nashik, India, in collaboration with clinicians from the King Faisal Hospital in Kigali, Rwanda.

"Differences in antimicrobial susceptibility between the first and fifth year of the study for each bacterial species was assessed using 2 test. Of 5,296 isolates collected, 46.7% were Escherichia coli, 18.4% were Klebsiella spp., 5.9% were Acinetobacter spp., 7.1% were Pseudomonas spp.,
11.7% were Staphylococcus aureus, and 10.3% were Enterococcus spp. Colistin and imipenem had greatest activity against gram-negative bacteria. 
Acinetobacter spp. showed the greatest resistance profile to antimicrobials tested, relative to other gram-negative bacteria. Vancomycin retained excellent activity against S. aureus and Enterococcus species (average susceptibility was 100% and 99.4%, respectively). 
Trend analysis determined that resistance to imipenem increased significantly among Klebsiella, E. coli, Pseudomonas, and Acinetobacter isolates; there was also rising resistance to colistin among E. coli and Pseudomonas species. 
Only E. coli demonstrated increased resistance to gentamicin. For gram-positive pathogens, vancomycin susceptibility increased over time for Enterococcus species, but was unchanged for S. aureus. Our data suggest that resistance to imipenem and colistin are rising among gram-negative bacteria in Rwanda."

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International Symposium on Medicines and Patient Safety: Kigali, Rwanda – 5th November, 2014

Education on how to ensure safe and effective use of medicines is vitally important for patients and health services.
Registration and abstract submission on the themes below is now open for the International Symposium on Medicines and Patient Safety in partnership with Pharmacology for Africa. The symposium will take place on Wednesday 5th November 2014 in Kigali, the capital city of Rwanda, under the auspices of the College of Medicine and Health Sciences of the University of Rwanda.
 
The 3 major themes of the symposium are:

• Educating health professionals  in safe and effective use of medicines
• Regulating drugs, including pharmacovigilance and quality of medicines
• Reducing harm from high risk medicines and in patients with high risk conditions

University Hospital, Kigali

Key topics to be discussed and welcome as submitted abstracts include

• education in pharmacology and clinical pharmacology
• developing good prescribing skills
• developing rational treatment guidelines
• drug regulation including quality of medicines
• Drugs and Therapeutics Committees
• medicines for non-communicable diseases
• pharmacovigilance
• safe systems for using medicines for high risk therapeutic areas, including retroviral disease, maternal and paediatric health, cancer, and renal disease
• traditional medicines

This Symposium will be of particular interest to health professionals and policy makers

View over Kigali hills

interested in the safe and effective use of medicines.
These include doctors, pharmacists, nurses and managers working in referral, district and community hospitals, community pharmacists, experts interested in the safe regulation and supply of medicines, health professionals interested in pharmacovigilance, and educators interested in postgraduate and undergraduate training of health professionals in clinical pharmacology, therapeutics and safe dispensing.
The symposium will also be of interest to professionals working in NGOs and patient safety organisations concerned with public health and with disease prevention and treatment.

Community work - Umuganda - in Rwanda

Quiet streets on Umuganda morning in Kigali

On Saturday, around 100 members of the international Human Resources for Health faculty and their families met in Rwanda's capital Kigali for early breakfast. We had been invited to join local Rwandans for Umuganda, a countrywide community integration and work programme which takes place thoughout the morning on the last Saturday of the month. No traffic on these mornings is allowed except by permit to contribute to a Umuganda activity. 
Other countries may have community work times on an annual calendar - for example the embryo Mandela birthday (18th July) 67 minutes call for of community contribution in South Africa and internationally; or the annual post-winter melt environmental clean-up by students in Kazakhstan. However the scale of engagement in the Rwandan programme is astonishing, with an estimated up to 80% of those eligible taking part.

 It is estimated that these monthly Rwandan communiity efforts, for example through land clearance and building projects, may be saving the Rwanda economy in the order of $60 million per year.

Rural Rwanda

The traditional form of Umuganda is said to date back at least 150 years, and continues to be coordinated by local village (Umudugudu) mayors. In modern, post-genocide Rwanda, the Umuganda process has also been applied as an important tool to help to promote local and national integration and reconciliation. Citizens with mental health problems currently may be exempt, however, in recognition of the potential benefits, there are plans to engage these people too in Umuganda, where practical.

We travelled in convoy in small white buses around 10 km into the countryside, passing wetlands and a turbid, storm-swollen river. Once off the excellent main road, we had a challenging drive into the hills, up unmade roads crevassed by early Autumn rains.

Our task was to work with villagers to clear weeds from the brick-walled grounds of the Mwendo 

HRH team and villagers 

Community Hospital, preparing the area for planting vegetables for patients and staff. Under a hot late August sun, we formed a close line, armed with pick-axes, mini-ploughshares and hoes to break the hard earth and remove at least the worst of the deep roots. The atmosphere was relaxed and happy, with frequent ad lib breaks to make new friends. In the background, loudspeakers played cheerful Rwandan instrumental music.

The morning ended suddenly with a call to refreshments - the typical conscious Rwandan

Local HRH staff with Permanent Secretary Dr Solange Hakiba

choice of warm or chilled soft drinks, speeches by local and national Rwandan leaders, and invitations to join energetic village Rwandans in free-for-all dancing.

Our brief first experience of Umuganda showed its power to bring together visitors and Rwandans in a spirit of mutual understanding and respect, while making a modest but real contribution to a local community - a good 300 man and woman hours of tough manual effort donated by and for the community. From our shady marquee, we had however a glimpse of other realities of local cooperative life: an ill farmer borne at speed towards the hospital doors on a makeshift stretcher held shoulder high by four young men.