WORKSHOP ANALYZES THE REAL BURDEN AND MORTALITY ASSOCIATED WITH ANTIBIOTIC RESISTANCE IN THE COUNTRY

Antimicrobial Resistance (AMR) poses a significant public health threat, accounting for approximately 1.14 million deaths in 2021, with the highest burden in sub-Saharan Africa. In Mozambique, it is estimated that around 31,100 deaths were associated with antibiotic resistance, of which 7,800 deaths were directly attributable to antibiotic-resistant infections. In many African countries, including Mozambique, a major challenge lies in the availability of data on antimicrobial resistance due to the lack of adequate microbiology laboratory infrastructure and qualified technical staff, making it difficult to accurately quantify the real burden and mortality associated with antibiotic resistance.

To mark the World Antibiotic Awareness Week (18–24 November), the Manhiça Health Research Center (CISM), through the Child Health and Mortality Prevention Surveillance (CHAMPS) program, held a workshop on Antimicrobial Resistance (AMR) surveillance on 28 November in the city of Quelimane, Zambézia Province. The workshop targeted microbiology laboratory technicians, microbiologists, medical students from Licungo University, and students from the Laboratory course at the Institute of Health Sciences and Medicine.

“Antimicrobial Resistance is one of the major public health concerns. There is a need to analyze the various factors contributing to AMR, so that it can be addressed and guided by scientific evidence for decision-making regarding the importation of appropriate medicines, as well as the rational use of antibiotics,” said Dr. Tomé Charles, Director of the District Services of Health, Women and Social Action in Quelimane (SDSMASQ), in his opening speech.

According to Dr. Marcelino Garrine, Microbiologist and Researcher at CISM, the available data on antibiotic resistance in Mozambique mostly come from studies conducted in the southern region, with data from the central and northern regions still scarce. However, he notes that there are ongoing efforts between the health sector and the community to reduce antibiotic use throughout the country. “Studies vary from region to region and are still conducted sporadically. There is a lack of continuous surveillance to obtain robust data on AMR in Mozambique. For example, studies carried out in the city of Beira, Sofala Province, show that certain strains are more common and are associated with increased hospital admissions. Therefore, gathering information on which pathogens (diseases in humans caused by infectious agents) are most prevalent in Mozambique and which are associated with resistance leading to death should be a priority,” Garrine commented, adding that preliminary data from the ongoing CHAMPS study at Quelimane Central Hospital report the circulation of bacterial pathogens such as K. pneumoniae, S. aureus, and E. coli resistant to multiple antibiotics, associated with high mortality rates in children under five years of age. These findings highlight the existing challenge in the country regarding the proper clinical management of patients with infections caused by antibiotic-resistant strains, likely contributing to mortality.

Meanwhile, Aureliana Chambal Chilengue, Young Ambassador of the American Society for Microbiology (ASM) in Mozambique, who participated virtually, presented the organization’s objectives and vision, as well as the main activities carried out by ASM in the country. “We have already visited the Central Hospitals in Maputo, Beira, and Nampula, as well as some schools and universities, to strengthen microbiology science and demonstrate the possibility of leveraging local resources. In 2023, we launched the Children’s Microbiology Club, an initiative aimed at stimulating interest in science among children aged 5 to 15 through creative, visual, and interactive activities. Additionally, we organized a health fair at ISCISA (training institution) and a workshop targeted at students in the final stage of their courses, focusing on career guidance and developing strategies for professional growth,” explained Aureliana, highlighting the opportunity for interested individuals to become members of the society.

As Ambassador of the American Society for Microbiologists in Mozambique, Dr. Inácio Mandomando highlighted the organization’s role in seeking solutions to strengthen member countries and in providing opportunities to train the next generation of researchers to help countries make informed decisions (there are over 114 ambassadors globally).

Mandomando, who is also the Principal Investigator of the CHAMPS program in Mozambique, explained that CISM, through the Demographic and Health Surveillance System (HDSS) in the community, has been monitoring trends in antibiotic resistance and the main pathogenic agents since 2000 in the Manhiça district. Currently, the aim is to collect the same information in Quelimane so that clinical staff can recommend the appropriate antibiotics and reduce unnecessary usage.

The CHAMPS researcher also emphasized the One Health context, in which humans, animals, and agriculture all contribute to antimicrobial resistance. He further highlighted the role of the CHAMPS program in understanding and analyzing AMR’s contribution to the causes of death in children under five years of age.

The Senior Director of Impact and Engagement at the CHAMPS Central Office, Dr. Portia Mutevedzi, who was visiting the Mozambique site, attended the event and spoke about the program’s interest in further investigating AMR. For several causes of stillbirths, CHAMPS has identified AMR as a major risk factor. “Many causes of child mortality are related to maternal issues, which means that projects addressing these maternal problems can reduce child mortality. CHAMPS has also investigated why newborns are infected with antibiotic-resistant pathogens and found that these infections occur during and after delivery. However, a high number of community-acquired infections were identified, unusually occurring three days after discharge, suggesting possible hospital-acquired infections as well. Malnutrition, HIV, and malaria are also found in children older than one year,” stated Portia.

However, following the discussions, it was concluded that the limited data on AMR in Mozambique point to a problematic situation regarding antimicrobial resistance in the country. To effectively combat this silent pandemic, it is crucial to generate knowledge and evidence that can support prevention and control activities against antibiotic resistance.