Poor regulations, ignorance fueling anti-microbial resistance in Nigeria – Prof. Manga

Professor Muhammad Manga is a professor of clinical microbiology and provost of the College of Medical Sciences at the Gombe State University (GSU), Gombe. He also works with the Federal Teaching Hospital (FTH), Gombe. In this interview, Manga spoke on antimicrobial resistance (AMR) and the mitigation, prevention and control of sexually transmitted infections and HPV. […]

Professor Muhammad Manga is a professor of clinical microbiology and provost of the College of Medical Sciences at the Gombe State University (GSU), Gombe. He also works with the Federal Teaching Hospital (FTH), Gombe. In this interview, Manga spoke on antimicrobial resistance (AMR) and the mitigation, prevention and control of sexually transmitted infections and HPV. Excerpt:

You talked about Anti-Microbial Resistance (AMR) during your professorial inaugural lecture that was held recently. Briefly tell us what AMR is all about?

Anti-Microbial Resistance (AMR) is actually not new, as it has continued to be present, relevant and impact negatively in the general healthcare delivery of human beings, animals and the environment.

You know, infectious agents are older than human beings on this planet. So they were around even before animals, including humans. When those microorganisms become pathogenic to humans, it was a major battle from which mankind was looking for a way out. At that time, people got infected with microorganisms, and in some instances, they died helplessly without intervention.

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So the discovery of antibiotics or antimicrobials was greeted with a lot of happiness and glamour. The entire world felt that after the discovery of antibiotics, we had no problem again with infections, but not long after the discovery, it was identified and proposed that microorganisms had become resistant to the antibiotics that we have been using.

Since then, we have continued to witness newer microorganisms that are developing resistance to almost every antibiotic that has been discovered, and that has made everything a major threat to the entire world.

Antimicrobial resistance is something that cuts across human, animal, and environmental health. The drivers that push for the development of antimicrobial resistance are likely human activities between themselves, their animals, and their environments. 

What is your assessment of the AMR in Nigeria?

We still have deficiencies in the appropriate data to genuinely show you the true reflection of everything in Nigeria. That is still a factor in the overall weakness of the system.

But there are a lot of efforts that have recently been made, particularly by the Nigerian Centre for Disease Control and Prevention (NCDC) and other relevant agencies in the country to improve the situation. But overall, the level is relatively high. For example in Gombe, that, on the average, most of the microorganisms that are responsible for the infections tend to be resistant to the commonly used antimicrobials, such that in almost all situations, it is a 50% chance. This means 50% will respond, and 50% are likely not to respond.

The burden is higher than what we see because many of them go unnoticed, so the information is incomplete. Not only in Nigeria, but it is a major global problem. It has led to the deaths of patients around the world.

What are the major factors fueling AMR in Nigeria?

 The most important one is the weak and poor regulation when it comes to the purchase, prescription, and consumption of antibiotics. In some countries, it is impossible to get antibiotics or antimicrobials over the counter without a properly verifiable prescription.

So the misuse and abuse of antibiotics as a result of poor regulation or weak restrictions is a factor. It means anybody can buy and take it and that will alter his flora and make his microorganisms resistant. We have weak and sometimes absent guidelines and regulations.

Even in hospitals, doctors, physicians and healthcare workers are not properly guided, and the regulations are relatively weak, which makes the situation worse. The problem is multifaceted, and from different angles or perspectives, you can see the development of antimicrobial resistance.

Unfortunately, that is not just restricted to humans but is extended to animals. People use antibiotics on animals even when they are healthy just to support their growth, and in some instances, they ignorantly think about other benefits. In addition, sometimes the environment is not spared because when you abuse antibiotics in humans and animals, the end products go to the community.

The way we dispose waste exposes the environment to some microorganisms and chemical compounds. By changing the pattern of microorganisms in the environment to become predominantly resistant, if by chance anybody, either human or animal, comes into contact with these microorganisms, it becomes difficult to combat.

Therefore, it is a complex issue that requires not just doctors or health workers but also journalists and people from other disciplines to come together and educate the community about this problem so that we can save ourselves from the menace of antimicrobial resistance.

Tell us briefly what your inaugural lecture was all about.

The lecture summarises my life. I chose that topic to give me an avenue to paint the correct picture of my life from a personal to a professional and academic point of view. If you reflect on the title, “A Privileged Nomadic Microbial Warrior Noticed in Health and Medical Education,” the word “privileged” was carefully chosen to appreciate Almighty Allah for the opportunity He has given to me right from my biological position in my family and also the opportunities I have enjoyed, which to me are very rare.

Most importantly, the privilege of being the first in so many things. I am the first Gombe State indigene to come back to practice in the hospital as a clinical microbiologist. When the clinical aspect of the College of Medical Sciences of the University came on board, I had the privilege of being a pioneer in many aspects of the college. I was the first head of the department in my department.

When the faculty of clinical sciences was started, which was previously combined with the faculty of basic clinical sciences, I was the first dean. I was later appointed the deputy provost and subsequently appointed the provost of medical sciences, and I had many other privileges, like the opportunity to go around the world and meet people.

How can the AMR menace in Nigeria be tackled?

 I usually classify the actions to be taken by the authorities into three categories. Actions that have to do with enforcing laws, and regulations and ensuring that the right thing is done and people are properly enlightened and educated. Education on its own and fighting poverty will have a lot of effects on reducing this menace.

The government should make sure that the healthcare delivery system in the context of the purchase, sale, and prescription of antibiotics is regulated and properly guided. Also, ensure that people are a bit more informed, education is provided, and poverty is attacked.

The next group are the healthcare workers, who need to be properly educated, lightened, guided, and monitored. Even though you have the guidelines and regulations, you still have to make sure that you abide by those rules and regulations.

 

This report is published for the Media-EIS Fellowship Program, a collaborative partnership among Breakthrough Action-Nigeria, Nigeria Centre for Disease Control (NCDC), and Africa Field Epidemiology Network (AFENET).