By Elisha Singira and Mary Hearty

Bungoma, Trans Nzoia, Nyeri, Kiambu, Kisumu, Kilifi and Muranga are among the counties making tremendous progress in the implementation of the objectives of the National Action Plan (NAP) on Antimicrobial Resistance (AMR).

Some of the indicators considered include establishment of Counties Antimicrobial Steering Inter-Agency Committee (CASIC), antimicrobial stewardship (AMS), diagnostic stewardships, Infection Prevention and Control (IPC) and the AMR surveillance.

Speaking during the National AMR forum held in Nairobi, Dr. Emma Nyaboke, the CASIC focal person for Bungoma County said that they came up with a work plan which is aligned to the objectives of the NAP.

She said that the plan was launched in Bungoma County in January 2021 by the United States Agency for International Development (USAID) and the Food and Agriculture Organization of the United Nations (FAO) in conjunction with the National Antimicrobial Steering Interagency Committee (NASIC) together with the county.

“We decided to take an implementation approach, where we first started putting up AMR structures and appointing AMR champions at the County referral hospital before moving to sub county hospitals,” Dr Nyaboke explained, adding that the county now has strong laboratory capacity hence, fair microbiology utilization which has been done for the last three years.

In terms of creating awareness and understanding of AMR, she noted that they had distributed Information Education and Communication materials (IEC) which were developed by CASIC to public and private facilities. They had also sensitized animal health workers and health care workers on prudent use of antibiotics among other measures taken.

“Currently we are working on a study which will assess the knowledge and attitude and practices (KAP) of the agrovets, private pharmacies, farmers and the general population on antimicrobial use (AMU); and disposal of the medications that are used especially for animal health under WAP are ongoing,” Dr Nyaboke stated.

Dr. Emma Nyaboke, the CASIC focal person for Bungoma County

In terms of surveillance and research, the technical working group under one health have been appointed; there is continuous clinical and laboratory interface meetings; laboratory strengthening with support from the USAID through the Infectious Disease Detection and Surveillance initiative (IDDS) and existing data collected in labs is being analyzed.

“We are currently working on sample referral mechanism where we are riding on an existing sample referral mechanism for HIV and Tuberculosis program with support from DUMISHA AFYA and IDDS from sub-county health facilities to county referral hospital where there is a machine,” she stated. “We have analyzed the existing data and realized that majority are from the in-patients, so more data is being collected in order to come up with an anti-biogram for the county.”

Also, the County has uninterrupted bacteriology services as they have an automated identification and antimicrobial susceptibility testing (AST) machine which was a challenge before when there was a manual machine.

According to Dr Nyaboke, this has made work easier and reduced the span around time, as a result, there is an increased demand for bacteriology testing. She notes that most of the private facilities and level 4 facilities are able to refer their samples to the Bungoma County referral hospital for culture testing.

In 2020, Bungoma County tested a total of 1215 culture samples and 1035 samples in 2021 using a manual microbiology machine. Dr Nyaboke said that they hope the numbers will increase in 2022 as the county has acquired an automated machine.

Through the IDDS and NASICs, Bungoma County was able to get bacteriology test accreditation and adequate supplies which are supplemented by USAID.

Despite the tremendous achievement made so far, Dr Nyaboke highlighted some of the challenges that need to be addressed. These include: lack of consistent support for AMR activities especially in animal health; low uptake of microbiology testing both animal and human health; low uptake of microbiology at the outpatient due to cost implication; poor waste handling due to poor maintenance of burning chambers in 10 sub county hospitals; and lack of support for infection, prevention and control activities.

In Trans Nzoia, Dr. Zaietun Mulaa, the AMR focal person for the county said that they started with the training of the health care workers on AMS courtesy of Infection Prevention and Control Network, Kenya (IPNET). They utilized the radio and TV platforms to conduct the sensitization program on the rational use of antibiotics among members of the county.

Dr. Zaietun Mulaa, the AMR focal person in Trans Nzoia county

The IDDS has helped in several ways in the race to achieve the NAP objectives for AMR. Dr. Zaietun posited that it had helped them in the procurement of equipment for AMR surveillance, capacity building by equipping the county staff with the requisite knowledge in microbiology through benchmarking among others.

The focal persons for AMR from other counties echoed the same sentiments from Dr. Nyaboke and Dr. Zaietun from Bungoma and Trans Nzoia Counties respectively.

Similar initiatives have been implemented in other counties, however the AMR focal persons across the counties called on the government to fund the AMR program in specific counties to ensure its success.