Since 2015, Doctors Without Borders/ Médecins Sans Frontières (MSF) has been working on antibiotic resistance in collaboration with the health authorities in West Bengal, India. As the world discusses this growing challenge during the Antibiotic Awareness Week (November 12 to 18), the medical humanitarian organisation shares some of its findings on the reasons behind this phenomenon and how this challenge can be addressed.
Since 2015, MSF has been working on antibiotic resistance in collaboration with the Ministry of Health in West Bengal, India. As part of this project, MSF worked in the outpatient clinic of a district hospital and two primary health care centres, treating acute respiratory illness in 6 months to 12 year-old children. A baseline audit of prescribing practices of district hospital doctors as well as health promotion activities for the local communities were conducted along with medical consultations.
MSF’s prescription audit collected and analyzed prescriptions of out-patients who consulted doctors at the district hospital as well two primary health care centres. The study revealed that antibiotics were heavily (and irrationally) prescribed in a large percentage of the cases. In some instances, there was no diagnosis mentioned in the prescription, but just a listing of medication. None of the prescriptions had any mention of the severity of the medical condition. Both sites included in the study received over hundreds of patients per day, with only one medical doctor overseeing the consultation. “Without a doubt, this affected the quality of the consultation, given the limited time allotted to each patient. Patient expectations for specific types of drugs, such as antibiotics, are hard to manage when pressed for time, as observed by a doctor from the hospital”, says Dr. Samsuddin Kham, Project Medical Referent, MSF India.
“Antibiotic resistance is a major concern linked to the overuse of antibiotics and this serious threat has the potential to affect anyone, of any age, in any country. Doctors, pharmacists and all of us should come forward to overcome this threat,” says Dr. Debashish Halder, Chief Medical Officer of Health, Paschim Bardhaman, West Bengal.
“The need to monitor and address antibiotic resistance is urgent in resource poor settings in developing countries like India”, says Leena Menghaney, South Asia Head of MSF’s Access Campaign. “The challenge is to restrict the over-the-counter sale of broad-spectrum antibiotics while ensuring poor and marginalized people have access to essential antibiotics for life threatening infections in a timely manner. At the same time we cannot ignore the role that surveillance and diagnostics can play in strengthening the response to antibiotics resistance in the community.”
Drug-resistant infections are a looming challenge for MSF’s work around the world. MSF teams see them in war-wounded people in Jordan, in newborns in Niger, and in people in the organisation’s burns units in Iraq. MSF doctors have documented the presence of highly resistant bacteria such as ESBL, CRE and MRSA, in several projects and have recently started using last-line antibiotics such as polymyxin to treat multi-drug resistant gram negative bacteria. However there is limited evidence of the drivers of antibiotic resistance as well as the prevalence of the problems, especially in countries like India, which is one of the largest consumers of antibiotics.
“Anecdotal evidence of irrational prescribing practices among doctors, unregulated over the counter access to medication, as well patients’ demand for antibiotics is found in plenty. However this requires the collection of scientific evidence and more research in these areas, says Dr. Amit Harshana, Deputy Medical Coordinator, MSF India.
On November 16, MSF will conduct a workshop called ‘Antibiotic Resistance: Broader Implications for Humanity’ in Asansol’s Gupta College of Technological Sciences, seeking to bring together technical experts, medical students and government officials on a single platform for a discussion. A community level awareness campaign for the local population will be conducted during the same week at Asansol district hospital premises.
About the project
From January-October 2017, MSF worked on febrile illnesses and antibiotic resistance in Asansol, West Bengal, in collaboration with the Ministry of Health. Due to the emergence of antibiotic resistance as a pressing global health problem, especially in India, our team also worked to explore ways to help healthcare providers in the district to ensure rational prescription of antibiotics.
At the beginning of 2018, the project was handed over to the Ministry of Health, West Bengal.
MSF is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural disasters and exclusion from healthcare in around 70 countries. MSF offers assistance to people based only on need and irrespective of race, religion, gender or political affiliation. MSF has been working in India since 1999, providing free-of-charge essential healthcare in the states of Andhra Pradesh, Bihar, Chhattisgarh, Delhi, Jammu & Kashmir, Jharkhand, Maharashtra, Manipur, Telangana, Uttar Pradesh, and West Bengal. MSF received the Indira Gandhi Prize for Peace, Disarmament and Development in 1996 and the Nobel Peace Prize in 1999.