Addressing supply and demand of antibiotics in Tanzania
Many strains of bacteria have developed resistance to antibiotics due to their overuse around the world. Compounded by access to antibiotic drugs without prescription, and failure to complete recommended minimum courses, this has reduced the effectiveness of antibiotics in treating serious medical conditions and has led to the emergence of more ‘superbugs’.
Consequently, infections that should be treatable via a course of antimicrobials become prolonged illnesses that can even prove fatal. Antimicrobial Resistance (AMR) is a widespread healthcare crisis and poses a significant risk to global public health and economic development.
While pharmacological research continues in the search for drugs effective against the more resistant strains, there is a global challenge of antibiotic supply and demand.
The University is addressing the microbiological and social sciences challenges of AMR through the interdisciplinary project, ‘Holistic Approach to unravel Antibacterial Resistance (HATUA) in East Africa’. Led by Professor Matthew Holden the School of Medicine, the project combines insights in microbiology social science from the School of Geography and Sustainable Development (SGSD).
Building on HATUA’s previous work, Dr Mike Kesby and Dr Kathryn Fredricks (SGSD) have piloted an intervention that seeks to address the supply and demand of unregulated over-the-counter antibiotics sales using participatory citizen science.
They are partnering with the Catholic University of the Health and Allied Sciences; the Tanzanian Ministry of Health; the Tanzanian Pharmacy Council; and the award-winning grassroots NGO Roll Back Antimicrobial resistance Initiative in this impact- oriented project.
Dr Kesby, Dr Fredricks and their team set out to open dialogue with policy makers, practice groups, drug sellers and communities to create cost-effective ways to intervene in the supply and demand sides of the drug sales market. Their strategy will tackle the issue of bringing public health education together with a certification programme that identifies which pharmacies are responsible prescribers.
The team used a three-pronged approach. Firstly, they worked in collaboration with stakeholders in Tanzania to distribute public health information on antibiotics and AMR throughout local communities. Secondly, pharmacies were given easy-to-use stickers that could be applied to antibiotics to help spread awareness of which drugs fall into this category. Thirdly, ‘mystery shoppers’ were asked to assess the pharmacies’ antimicrobial stewardship, including providing customers with appropriate advice on their use.
Certificates of good performance are awarded to consistently well-performing pharmacies. Accredited by the Tanzanian Pharmacy Council, these certificates give sellers a commercial incentive to pursue improved practice. The team has also been exploring the potential development of an app that would allow citizens to access a list of trusted pharmaceutical traders generated from the ongoing monitoring data and good advice on antibiotic use.
Working in collaboration with the School of Computer Science, the team has co-supervised a project by MSc students which modelled prototypes for an app design. The project is also supporting a PhD Sustainable Development student, with the longer-term goal of undertaking a project based on similar themes in Nigeria.