Kenyan scientists analyze sewage for antibiotic resistance given previous success in polio aversion

KENYA – Scientists in Kenya have managed to analyze the extent and state of antimicrobial resistance (AMR) in the country from sewage samples collected in the country’s capital Nairobi.

AMR refers to the phenomenon of disease-causing microorganisms such as bacteria evolving to withstand attacks from medicine meant to eradicate them and is a deadly threat to human survival.

In 2018, the Kenyan ministry of health discovered a vaccine-derived polio outbreak when studying sewage samples in Nairobi.

They immediately launched a renewed polio campaign targeting 2.8 million children in high risk areas. Kenya had, from 1988 to 2017, reduced the number of children suffering from polio-related paralysis from 350,000 a year to 22 and is close to eradicating polio.

There is little national data on the deaths caused by AMR in Kenya, but the country’s ministry of health reported more than 600,000 drug resistance tuberculosis cases in 2016.

An exhaustive two-year study commissioned by the UK government in 2016 concluded that AMR causes 700,000 deaths each year.

Dr Sylvia Omulo, a PhD holder in the study of the immune system and infectious diseases, studies how medications for treating infections that kill hundreds of people in Kenya are slowly losing potency.

To study this, she and her colleagues at Washington State University often take tissue from wounds, blood or urine and then expose those to particular drugs.

However, she changed course and in 2016-2017, she collected sewage samples, from which sample analysis returned answers that could change how the country studies medicine use in the community.

In a paper under review for publication in the journal Pathogens, the scientists report that there are high resistance levels in antibiotics which the public can access over the counter, such as Amoxycillin, but lower for harder-to-get but more effective antibiotics.

Over the counter prescriptions for antibiotics are the norm for a majority of urban dwellers. This points to excessive use of over the counter antibiotics for treating illnesses that require different antibiotics.

The most intriguing finding from the study, however, is how close the results of the samples picked from the toilet were to those from samples collected from households.

Often, standard studies researching antimicrobial resistance pick samples from households, and until now, no researcher had demonstrated that the samples picked from the toilet could return the same results.

According to the 2019 Census, Nairobi has 4.4 million people, and 60% of them live in the slums such as Kibera, Mukuru, and Mathari. People in slums do not have social services such as healthcare.

This drives improper use of antibiotics such as taking half doses or counterfeit ones, habits that lead to resistance. They also lack proper sanitation, making them vulnerable to outbreaks of waterborne related diseases such as cholera.

Between 2008-2011, the World Health Organization got reports from certain countries that Vibrio Cholera, the bacteria that causes cholera, was resistant to Cotrimoxazole, and studies have pointed to the increasing resistance of the antibiotic in other countries too.

Cotrimoxazole, known by the generic name Septrin, is a broad-spectrum antibiotic that clinicians prescribe to people living with HIV to protect their compromised immunities.

The World Health Organization (WHO) in addressing the AMR menace, listed surveillance, what DR. Omulo and others are doing, among four other means to tackle the problem.

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