Beyond definitions, statistics and campaigns; addressing communication barriers to AMR prevention in local African communities – Perspectives from Ghana

The World Antimicrobial Resistance [AMR] Awareness Week (WAAW) celebrated annually has, over the past few years, done well to call much-needed attention to the menace of AMR in Africa – at least, from the Ghanaian perspective. In recent times, the annual week-long event is triggering conversations, enquiries and quests for elaboration. The relentless campaigns and plethora of picturesque material are beginning to ruffle the feathers of all about the global menace. Further, policy-makers, influencers and political actors are also joining the campaign—motivated by the pull and projected necessity.
 
During these commemorations, the messages commonly disseminated comprise vivid illustrations and simplified interpretations of antimicrobial terminology, crafted to enhance understanding of the concept among non-clinical audiences. These efforts are strengthened by statistics that highlight worrying trends in antimicrobial use and stark projections of how AMR may profoundly affect health and healthcare systems in future. One such key message, is the World Health Organization (WHO)’s projection that, by 2050, approximately 10 million lives could be lost annually to AMR-related conditions if sustained interventions are not implemented. Such figures are capturing public attention and driving engagement with AMR issues. This illustrates the effectiveness of clear definitions, evidence-based statistics, and targeted campaigns in shaping public knowledge on AMR.
 
However, in resource-limited, low/lower-middle income countries such as Ghana and majority of Africa, a priority of need and necessity exists—where, sustenance, infectious diseases and livelihood are prioritized by the people in terms of what conversations they engage with. Their often-hard circumstances thus, make it almost impossible to give ear to a ‘pandemic’ they do not see. To wit, if the option of cheap, over-the-counter concoctions of antibiotics which may have a chance of curbing infections are available, it would be likely difficult to convince locals to cease such patronage and make a switch to a more sustainable practice—especially if it involves re-rationing money they do not even have. Or, in a community of animal farmers accustomed antibiotic misuse for improved yield, the message of antimicrobial stewardship might even run the risk of being rumored as a sneaky scheme of ‘elite’ enterprises to skin their profits.With this background, it is safe to say that, there still exists a meaningful gap between the communication employed in the fight against AMR and the key condiment of change – the people. The language of many locals is ‘what they see before them or affects them’.
 
It would therefore be to our key advantage to descend to the level of the locals, and explicitly eviscerate one after the other, the negative impacts of AMR in their day-to-day lives and how it is impacting their prosperity in the long run. Explaining to locals how the delayed healing and high hospital cost of their kin’s infection was due to a causative bacterium which was hard-to-treat due to acquired resistance, would be more relatable than projecting statistics from studies which probably involved cohorts from the Americas or Europe.
 
To attain this, community engagements could be a starting point and a very powerful tool. An engaging environment where complex scientific concepts are broken down to the most basic understanding and in local dialect would very likely be better-received by locals. Also, locals may incline more to it if it emanates from a local/ group of locals who possess adequate knowledge with relevant evident-based experiences. Thus, training of a local corps as AMR ambassadors with the primary mandate of conducting AMR education, surveillance and interventions could be useful.Conducting clinical studies in local communities, abattoirs and health centers could be another crucial step toward giving relevance and practically to the theoretical data presented to locals on which advocacy strategies are often based. Such studies may get the grassroot population to understand that AMR is not imported and is evolving right before their eyes, through their actions and inactions. This suggestion also serves as a clarion call for extensive funding for local/grassroot community-based research on AMR.
 
The above-mentioned interventions can only be more impactful with an educated audience. In this light, a multilateral approach can be employed where basic formal education is prioritized in local communities. Efforts should not also be limited to just education. Capacity-building, commercial empowerment, clinical upgrading and functional, effective governance are but a few of the other aspects of societal development that would help provide a sustainable future for antimicrobial stewardship in local communities.
 
The silent pandemic of AMR is looking more intense on the African landscape. Acknowledging the present limitations of the region—which spans economic, health, social and resource-related challenges—effectively utilizing the few resources and circumventing factors as simple as communication could be the decisive next step towards sustainable AMR prevention and antimicrobial stewardship for Ghana and Africa at large. It could be a simple intervention that would safeguard the health and wellbeing of Africans for years to come.

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