Abstract
There is no doubt that antibiotics have reduced the burden of bacterial infectious diseases. Antimicrobial resistance threatens the effectiveness of successful treatment of infections and constitutes a public health concern with national and global dimensions. This problem is worrisome in war-torn areas like the Eastern Democratic Republic of the Congo. The difficulties experienced by war-torn nations in addressing antimicrobial resistance are significant for the rest of the globe as microbes do not acknowledge boundaries and do not distinguish between peace and wartime. In this paper, we describe the impact of warfare on the social determinants of health, the environment and biodiversity, and its consequences on the antibiotic use and the host-pathogen interplay. Furthermore, we describe different pillars to be taken into account, learned in a war-torn area, in combating antimicrobial resistance. These lessons are summarized in terms of tools to be used for combating antimicrobial resistance, challenges to overcome in war-torn setting and core actions to be undertaken. Surveillance is a valuable tool to combat antimicrobial resistance as it helps to detect resistant bacteria, enables correct decisions to be taken, guides policy recommendations and tracks the antibiotic use and misuse. The challenges encountered in this region include the shortage of competent laboratories, poor infrastructure and data management, lack of standard protocols, low coverage of surveillance, lack of intersectoral cooperation, and inadequate national, regional and international collaboration. Regarding this situation, the core actions to be undertaken include the establishment of ABR surveillance and monitoring systems, building laboratory capacity for rapid and reliable diagnostic testing, and engagement in national, regional and global surveillance networks. Therefore, this study showed an urgent need for establishing and implementing sentinel site surveillance laboratories and elaborating and implementing national action plans for combating antimicrobial resistance.
Highlights
There is no doubt that antibiotics have reduced the burden of bacterial infectious diseases
antimicrobial resistance (AMR) is an ongoing phenomenon observed in bacteria, and its spread and amplification is accelerated by irrational use of antibiotics, the use of fake and counterfeit drugs, poor prescribing habits and non-compliance to prescribed treatments [3]
For surveillance of antimicrobial resistance in Democratic Republic of theCongo (DRC), the essential core data might be generated by microbiology laboratories that routinely identify and determine the susceptibility or resistance of bacteria isolated from clinical specimens
Summary
There is no doubt that antibiotics have reduced the burden of bacterial infectious diseases. Nations typically divert resources in times of conflict to satisfy military requirements rather than the population's health needs These unfortunate conditions provide an atmosphere for bacteria to establish mechanisms of resistance to traditional antibiotics, as well as opportunities for the spread of emerging pathogens. Breaches of medical neutrality comprise a second social determinant specific to a conflict setting These are especially relevant for the right to health care, as combatants attempt to weaken the resistance of civilians by deliberately depriving them of access to care, especially at the times when they most need it. Since in Eastern DRC dispensing of antibiotics without appropriate prescription is common [3], such practice may lead to the spread of antimicrobial resistance among the local bacteria frequently causing both community-acquired and nosocomial infections. Human infections caused by highly drug-resistant pathogens are more prolonged, complicated, and difficult to eradicate [13]
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