Drug-resistant infections threaten urban health

In Kibera, an impoverished area in Kenya’s capital city of Nairobi, widespread and uncontrolled antibiotic use is contributing to a significant increase in drug-resistant infections. Far from being an isolated example, Kibera is just one of a growing list of poor urban locations in developing countries where antibiotic resistance has become a deadly issue through a similar combination of factors. Dr. Guy Palmer, a professor at Washington State University who studies global health and infectious diseases, discussed this in an interview with the New York Times. 

“We can’t effectively mitigate the growing problem of antibiotic resistance without dealing with places like Kibera.There are a billion people living in similar situations,” he said.

Since their discovery, antibiotics have become an indispensable, lifesaving resource against infectious disease. However, their target, bacteria, can evolve to avoid the effects of the drugs. Furthermore, bacteria are able to share genetic material containing resistance traits, not only with their offspring but horizontally with other bacteria as well. 

Antibiotic resistance is sometimes seen as an issue primarily in developed nations, driven by over-prescription of the drugs for any minor infections, some of which cannot even be cured by antibiotics. However, resistance is also an alarming issue in developing nations, and its impacts have only become more widespread and severe as a result of practices which involve overuse and misuse of the drugs. 

In one study, researchers reported that 87 percent of households in Kibera used antibiotics in the past year, mostly for colds and the flu, coughs, and fevers, as compared to around 17 percent of American households. 

Antibiotics are comparatively accessible to residents in Kibera. Mass-produced generic drugs are available for low prices, and a prescription is not required to obtain them. Individuals can freely purchase antibiotics from vendors and pharmacy stalls, usually run by individuals without a degree or training in pharmacy or medicine. 

Often, residents in Kibera are not buying a full course of antibiotics. Instead, to save money they purchase a few individual pills. Taking less than the full regimen of antibiotics may not get rid of the infection entirely which allows for the growth of mutated, resistant bacteria. Even if individuals purchase an entire course, they rarely finish it. 

Counterfeit drugs are another problem in Kibera. While some counterfeit antibiotics don’t contain an active ingredient, the more troubling ones contain only a minute amount which is not enough to eliminate an infection. 

The widespread antibiotic usage in Kibera is due to the prevalence of infectious disease in the community, which largely originates from poor sanitation. 

Raw sewage flows through the drainage ditches and spills into the surrounding soil. Bacteria from human waste is subsequently carried into households on hands and shoes, and then gets into residents’ food and water. Typhoid and Escherichia coli are two of the many examples of bacteria which are widespread. The emergence and proliferation of resistant strains of common pathogens result in a dangerous vicious cycle: As residents fall ill they turn to ineffective antibiotics that may fail to get rid of the infection completely, which leads to the rise of more resistant strains.

Hospitals in Kenya have seen the effects of growing resistance, as they receive patients whose infections do not respond to any common antibiotics. More effective antibiotics tend to be expensive, and often must be imported.

Many of Kenya’s hospitals have established programs and committees to improve health workers’ hygiene practices and encourage vaccination, among other initiatives to prevent the spread of infection in the first place.

However, hygiene protocols have proven difficult to enforce in hospitals, and the efforts of the government, including attempts to mandate that a prescription be required before buying antibiotics, have seen only limited success.

“I don’t think our government thinks it’s a big problem,” Dr. George Otieno, a doctor in Kijabe Mission Hospital, noted in an interview with the New York Times.