Africa, a continent renowned for its rich culinary tapestry, has been quietly grappling with a culinary crisis that threatens not only its gastronomic traditions but also the health of its people.
. As the world focuses on global challenges, such as pandemics and climate change, another subtle yet menacing threat in the name of antimicrobial resistance (AMR) is emerging. The escalating misuse of antibiotics and other antimicrobial agents in agriculture, aquaculture, and veterinary practices is giving rise to antimicrobial resistance. The problem with AMR is that the drugs that were once hailed as saviors against bacterial infections are now becoming powerless, as bacteria evolve to withstand their effects.
In 2019 alone, over 5,000 individuals worldwide lost their lives due to non-Typhoidal Salmonella (NTS) infections resistant to antimicrobials, translating to a staggering burden of US$ 50 billion, according to a report by FAO on the economic catastrophe posed by foodborne AMR. This figure accounts for only one of over 30 pathogens responsible for antimicrobial-resistant foodborne diseases, illustrating the extensive and alarming scope of the problem. As a matter of fact, the World Health Organization (WHO) has declared AMR as one of the top 10 global public health threats facing humanity.
The Road from Farm to Fork: A Complex Journey
The journey from farm to fork is a labyrinthine web, where factors intertwine to shape the safety of the food consumed. In Africa, where a significant portion of the population relies on locally sourced foods, the AMR crisis manifests in multifaceted ways including;
Agriculture and Livestock: The Perilous Intersection
Agriculture forms the backbone of Africa’s economy, and it is intertwined with the food culture. Antimicrobials play a critical role in treating diseases of food-producing animals (aquatic and terrestrial) and plants, helping to ensure food security.
In some cases, antimicrobial substances are used to treat microbial diseases of plants. However, the heavy use of antibiotics to enhance animal growth and prevent infections in livestock creates a breeding ground for antibiotic-resistant bacteria. These bacteria can infiltrate the food chain, from meat and milk to vegetables, as contaminated soil and water spread the resistance. Remember, these bacteria can survive cooking if the food isn’t properly handled or cooked. From there, they can infect humans, leading to illnesses that are difficult to treat.
Research by the Kenya Medical Research Institute (KEMRI) found high levels of contamination in raw pork and poultry meat sold in leading supermarkets in Kenya. Out of the 393 samples collected from the supermarkets, 98.4% of pork and 96.6% of poultry were contaminated with high levels of bacteria. The study noted that out of the 611 bacterial isolates recovered, 38.5% were multi-drug resistant.
This resistance was noted for critically essential antimicrobials (according to the WHO) such as rifampicin (96%), ampicillin (35%), cefotaxime (9%), cefepime (6%), and ciprofloxacin (6%). Moreover, the study observed high resistance to key antimicrobials for veterinary medicine such as tetracycline (39%), sulfamethoxazole (33%), and trimethoprim (30%).
Antimicrobials and their residues can also accumulate in the environment through contamination with human or animal waste, inadequate disposal of waste products resulting from the manufacture of antimicrobials, and the use of antimicrobials as pesticides. Contact of animals with contaminated water and soil leads to transmission of resistant bacteria to and from food animals and within food chains.
Cultural Practices and Health Beliefs: A Challenge of Awareness
Traditional beliefs often influence healthcare choices in Africa, and the misuse of antibiotics is no exception. In some communities, antibiotics are perceived as powerful panaceas that can cure a range of ailments, from minor infections to viral illnesses. This deep-rooted misconception leads to self-medication and non-compliance with prescribed antibiotic courses, fostering the evolution of drug-resistant bacteria.
The utilization of antimicrobials within animal and plant production is subject to a complex interplay of various factors. One pivotal aspect is the burden of diseases that could otherwise be mitigated through alterations in environmental hygiene, nutrition, husbandry practices, and other management strategies. The challenge is compounded by limited access to experts in animal and plant health, alongside insufficient training and support for these specialists. Another significant factor driving antimicrobial use is their application as growth and production enhancers in animals. The absence of stringent regulation and oversight further contributes to this phenomenon, facilitating the unmonitored administration of antimicrobial drugs. Moreover, the ready availability of these drugs through over-the-counter or internet sales exacerbates the situation. The market’s susceptibility to substandard and falsified antimicrobials adds another layer of concern. Inadequate awareness of best practices also plays a role, resulting in excessive or inappropriate use. Complex anthropological, sociocultural, political, and economic influences further erect barriers to the implementation of sound practices, creating a multifaceted challenge that necessitates comprehensive solutions.
The Ripple Effect: Unraveling the Consequences
The repercussions of AMR on Africa’s food safety are both immediate and far-reaching.
Implications on health
The rise of antibiotic-resistant infections presents a grim picture for healthcare systems across Africa. Common illnesses that were once easily treatable now pose serious challenges, leading to increased mortality rates and prolonged hospital stays. The limited availability of effective antibiotics puts a strain on healthcare resources and exacerbates healthcare inequalities, as vulnerable communities bear the brunt of the crisis.
Some of the bacteria that cause food poisoning are antimicrobial resistant These infections are already bad enough on their own, causing severe diarrhea, vomiting, and even death in severe cases. But when they become resistant to treatment, they turn into an invincible and destructive threat. Lancet records that the six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 deaths attributable to AMR and 3·57 million deaths associated with AMR in 2019.
Implications for the economy
The AMR crisis extends beyond health, permeating the socio-economic fabric. The decline in agricultural productivity due to antibiotic-resistant infections in livestock disrupts food supply chains and raises food prices. Farmers face losses as their livestock fall prey to untreatable infections, compounding the cycle of poverty in already vulnerable communities. FAO estimates that in just ten years, 24 million more people may be forced into extreme poverty as a result of AMR, many of whom are in low-income countries.
Lancet records that the six leading pathogens for deaths associated with resistance include: E.Coli, followed by S.Aures, Klebsiella Pneumoniae, Streptococcus Pneumoniae, Acinetobacter Baumannii and Pseudomonas Aeruginosa.
Crafting a Resilient Culinary Future
Addressing antimicrobial resistance in African agriculture and food production requires a multi-pronged approach that encompasses responsible antibiotic use, sustainable practices, and innovative solutions. Here are some potential solutions along with examples of successful interventions that African nations can adopt to safeguard their culinary legacy and public health;
- Multi-sectoral Collaboration: A Unified Front
AMR is a complex problem that requires a united multisectoral approach. If action is not taken, FAO predicts that the rise of AMR cumulatively may result in over US$3.4 trillion loss in the world’s annual gross domestic product (GDP) in ten years.
Governments, healthcare systems, agriculture, and the culinary industry must come together to address the AMR challenge. Coordinated efforts can lead to regulatory reforms, guidelines for responsible antibiotic use, and awareness campaigns to educate communities about the dangers of antibiotic misuse.
This can be achieved through the One Health approach. It brings together multiple sectors and stakeholders engaged in human, terrestrial, and aquatic animal and plant health, food and feed production, and the environment to communicate and work together in the design and implementation of programs, policies, legislation, and research to attain better public health outcomes.
The Third Global High-Level Ministerial Conference on Antimicrobial Resistance, hosted in Muscat, Oman, last year adopted the Muscat Ministerial Manifesto, which sets out the three global targets for managing AMR.
One of the targets aims to reduce the total amount of antimicrobials used in agri-food systems by at least 30-50% by 2030, galvanizing national and global efforts. It also aims to preserve critically important antimicrobials for human medicine, ending the use of medically important antimicrobials for growth promotion in animals.
The third target involves ensuring that ‘Access’ group antibiotics (a category of antibiotics that are affordable, safe, and have a low AMR risk) represent at least 60% of overall antibiotic consumption in humans by 2030.
The Quadripartite organizations made up of the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), the World Health Organization (WHO), and the World Organisation for Animal Health (WOAH), have recently established the Quadripartite Technical Group on the Economics of Antimicrobial Resistance (QTG-EA).
The Technical Group will advise the Quadripartite Organizations and the Global Leaders Group on AMR on the selection of optimal antimicrobial resistance (AMR) interventions, the costs imposed by AMR and the benefits reaped in tackling it across each of the One Health settings – human health, animal health, environmental health, agri-food, and plant health.
- Alternative Disease Prevention Methods
Instead of relying solely on antibiotics, farmers can adopt alternative methods to prevent and manage diseases. Implementing vaccination programs for livestock can significantly reduce the need for antibiotics. For instance, in Denmark, a successful vaccination campaign reduced antibiotic use in pig farming by targeting specific diseases. The use of probiotics and prebiotics can promote healthy gut flora in animals, enhancing their immune systems and reducing the need for antibiotics. In Thailand, probiotics were used to successfully manage disease in shrimp farming.
Traditional herbal remedies and natural products can also be explored as alternatives to antibiotics. In India, herbal extracts have been used effectively in poultry farming to boost immunity and reduce antibiotic use.
Integrated Pest Management
Embracing integrated pest management practices can reduce the need for chemical pesticides in crop production. By using natural predators, crop rotation, and resistant plant varieties, farmers can mitigate pest and disease pressures without resorting to antibiotics. Perhaps Africa could take some notes from Norway’s salmon farming industry which has managed to reduce antibiotic use by implementing strict regulations, adopting cleaner fish to control parasites, and focusing on preventative measures. According to annual studies by the Institute of Marine Research in Norway, no residues of antibiotics have ever been found in Norwegian salmon.
Dutch dairy farmers have also managed to drastically cut antibiotic use in treating animal diseases. In 2008, a memorandum of understanding was drafted and signed by farmers, veterinarians, and dairy representatives that committed the industry to a multi-stage effort to reduce antibiotic use while increasing transparency on dairy farms.
Technology and Innovation
Rapid diagnostic tests can identify bacterial infections and determine their antibiotic resistance profile, allowing for targeted treatments. The use of such tests has proven successful in the Netherlands in optimizing antibiotic use in animal farming. Implementing precision agriculture techniques can help optimize resource use, reducing the risk of disease outbreaks and the need for antibiotics. This approach has gained traction in various parts of the world, improving both productivity and sustainability.
In addition, strengthening AMR surveillance and research within but also across sectors can lead to a better understanding of the burden of resistance and enable the implementation of setting-specific measures to prevent further spread.
Similarly, reliable data on AMR in animals are needed to inform policy and plan educational interventions for effecting behavior change and reducing AMR. Last year, FAO created a platform dubbed the “International Antimicrobial Resistance Monitoring (InFARM) platform” to gather data on AMR in food and agriculture that may help to manage the risks. The InFARM data platform offers a standardized method for gathering, analyzing, interpreting, and sharing AMR data about livestock and food.
Developing new antimicrobial classes and systems (e.g. plasmids, phages), that are used only in food production, would also make the emergence of resistance to these antimicrobials less problematic to human health.
Education and Outreach
Empowering farmers, consumers, and healthcare professionals with knowledge is pivotal in combating AMR. Educational initiatives can debunk myths surrounding antibiotics, encouraging responsible antibiotic use and raising awareness about the risks of AMR-laden foods. Organizations like the FAO are involved in capacity-building initiatives in Africa. Educating consumers about the risks of antibiotic-resistant bacteria in food can drive demand for responsibly sourced products and encourage behavioral change.
Addressing the mute but potentially catastrophic enemy of antimicrobial resistance, Africa finds itself on a challenging battlefield. However, through sheer determination and concerted efforts at every level, we can tip the scales in our favor ensuring that the legacy of diverse flavors lives on for generations to come. Are you ready to join the fight against antimicrobial resistance?
This feature appeared in the October 2023 issue of Food Safety Africa. You can read the magazine HERE