Antimicrobial medicines are essential to modern healthcare. However, once hailed as miracle drugs, the applications and purposive usefulness of these medicines are now facing a crisis. The overuse and misuse of these medications lead to bacteria and other disease-causing microorganisms developing resistance, rendering the medicines progressively less effective.
This phenomenon is scientifically termed as antimicrobial resistance (AMR). Naturally, the gradual decrease in medicine efficacy makes it harder to treat diseases. Globally, AMR contributes to nearly five million deaths every year. Last week we observed the World AMR Awareness Week (WAAW), which is a global campaign to raise awareness and understanding of AMR to promote best practices and reduce the emergence and spread of drug-resistant infections.
The peak of Covid-19 pandemic in 2020 gave us the reality check we needed -- how unchecked spread of a pathogen can have profound social and economic effects. The rise in infection means more prescription of antimicrobials -- which means more cases of negligent usage of the medicines -- ultimately leading to increased likelihood of microorganisms developing resistance.
According to the report titled “Drug-resistant infections” by the World Bank, AMR could push up to 28 million people in developing countries into poverty by 2050. This is because an increase in AMR will translate to high healthcare costs and social and economic inequalities.
A recent study of neonatal sepsis and AMR in low- and middle-income countries such as Bangladesh, Ethiopia, India, Nigeria, Pakistan, Rwanda, and South Africa found that of 390 bacteria studied, 97.2% were resistant to the common antibiotic called ampicillin, while 70.3% of the bacteria were resistant to a broad-spectrum antibiotic known as gentamicin. Another study from WaterAid Bangladesh showed that 40% of people from low-income communities do not complete prescribed antibiotic course, which results in the growth of antimicrobial resistance (AMR).
There are numerous ways for AMR to appear, persist, and spread apart from having high exposure to antibiotics. Microorganisms frequently take advantage of water-borne pathways of contagion, whether it be through utensils in the kitchen, surface of the toilets or beds in the hospitals. Poor hygiene practice at home, community, or institutional levels results in increased disease burdens and therefore increases consumption of antibiotics, which promotes AMR growth.
The sad reality is that 22% of healthcare facilities globally do not have basic water supply. The recent Joint Monitoring Program (JMP) also reports one in 10 healthcare facilities do not have sanitation services. Moreover, women bear the brunt of antibiotic resistance coupled with poor water, sanitation, and hygiene (WASH) facilities. Due to lack of water for safe births, women are routinely prescribed antibiotics to avoid infections.
Furthermore, inadequate knowledge on sexual and reproductive health rights (SRHR) may further exacerbate the challenges of AMR, especially for mothers. According to WaterAid's study commissioned by All-Party Parliamentary Group (APPG) of UK, in some countries, 90% of women consume these medicines, which makes women a more likely nexus where microorganisms can develop more resistance than men.
When all of these situations are occurring simultaneously in a densely populated country such as Bangladesh, AMR can grow and has the potential to reach the scale that rivals any epidemic or even begin another pandemic. With limited healthcare resources, the country constantly faces overcrowding in hospitals and clinics, raising the spread of resistant diseases.
Prevention is always better than cure. This is why adequate and proper WASH interventions can be the first line of defense needed to curb the growth potential of AMR in microorganisms. Appropriate WASH reduces the spread of infections, thereby reducing the need to constantly rely on antibiotics. According to the World Health Organization (WHO), 70% of healthcare associated infections can be prevented through good hand hygiene and other cost-effective WASH practices. Another intervention study demonstrates that improved hand hygiene amongst a group of children in a day-care centre can reduce the need for antibiotic use by 30%.
However, the remedy begins from raising awareness about the crisis of AMR and how effective WASH measures can prevent infections. Educating children and transforming them into advocates can enable better hygiene practices at households and communities. When individuals recognize the impact of their actions on the larger ecosystem of global health, they become active participants in the fight against AMR. WASH practices also intersect with agriculture, promoting healthier livestock and safer food production practices.
Governments, NGOs, and international stakeholders must prioritize investments in WASH infrastructure and education. This includes ensuring access to clean water and decent sanitation facilities, promoting good hygiene education at the community level, and integrating WASH into healthcare systems. WaterAid’s study report “Prevention first” estimated the cost of achieving universal access to WASH in existing healthcare facilities in the world’s 46 least developed countries is an equivalent of one trillion (1 lakh crore) Bangladeshi taka -- an average of just Tk 70 per person per year.
Without effective global action, AMR will become a significant threat to humanity, one that most threatens the lives of children, women, and those living in low- and middle-income countries like Bangladesh. It is a wake-up call we cannot ignore.
As we navigate the complexities of the modern healthcare landscape, let us recognize the pivotal role that WASH plays in shaping a healthier, more sustainable future. By investing in it, we not only protect individuals and communities from the burden of infectious diseases but also contribute significantly to the global effort to combat antimicrobial resistance.
Azman Ahmed Chowdhury, Sadhli Roomy, and Kashfia Mahfuz are Development professionals from WaterAid Bangladesh.
