Antimicrobial resistance in Africa: Communication strategies for improving public awareness of antibiotic misuse

Antimicrobial resistance (AMR) has emerged as one of the most difficult public health issues of the 21st century and is threatening to offset all our achievements in controlling communicable diseases.

Available data reveal that the African continent shares the global trend of increasing AMR resistance. Significant resistance has been reported for diseases such as cholera, typhoid, meningitis, tuberculosis, malaria, and AIDS.

Since antimicrobials were first discovered, AMR has been a naturally occurring process. However, in recent times, AMR has become a major global crisis because of the inappropriate use of antibiotics, which has significantly increased the rate of development and spread of drug-resistant microorganisms. Unfortunately, the rate of resistance development has not been matched by the discovery of new antimicrobials.

As antibiotic misuse is the primary driver of AMR, there is an acute need to create awareness among the general public regarding antibiotic misuse. As Africa accelerates its AMR interventions, communication must play a key role in the agenda. This calls for comprehensive communication strategies that better communicate the risks of excessive or inappropriate use of antimicrobials and the importance of proactive participation from all levels of stakeholders.

The misuse of antibiotics in the community may be a direct indicator of the poor regulatory framework and the level of awareness among the general public

Misuse of antibiotics: A primary driver of AMR

The excessive and often irrational use of antibiotics provides a selection pressure for the emergence of drug resistant strains of microorganisms. In many African countries, antibiotics are freely sold over the counter without any medical advice or prescriptions. Antibiotics are often prescribed for trivial infections such as viral upper respiratory tract infections or uncomplicated diarrhoea. Also, the absence of effective diagnostic and culture facilities in many African contexts means that the right choice of antibiotics may not be prescribed to patients.

The misuse of antibiotics in the community may be a direct indicator of the poor regulatory framework and the level of awareness among the general public. Many doctors say that the pressure to prescribe antibiotics actually comes from their clients, as there is an erroneous perception among the general public about the utility of antibiotics for faster relief of health issues. Hence, apart from having a more responsive regulatory system, there is an acute need to create awareness among the general public regarding antibiotic misuse and AMR.

Designing communication strategies for improving public awareness of antibiotic misuse

Public awareness messaging is a resource-intensive process if we have to engage all the stakeholders. Given the resource limitations in many African countries, the focus of communication strategies can be on raising awareness among specific interest groups. This can help channel limited resources to achieve specific objectives for raising awareness among these groups, thereby improving the chances of behaviour change.

Communication professionals with previous experience in health issues should ideally be leading the activity, and there should be an attempt to tailor it to the sociocultural sensitivities of each region or country. The focus should be on three to four key messages relevant to the country setting rather than bombarding the recipients with a huge volume of information.

The messaging can possibly be directed at areas such as the use of antibiotics for simple ailments like upper respiratory tract infections, diarrhoea, and simple wounds; antibiotic use in food and animal production; and environmental contamination from hospitals and pharmaceutical factories.

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Important factors to consider in designing a communication strategy include:

1. Deciding target groups for messaging: Users of antibiotics such as informal healthcare providers, nurse practitioners, and small-scale farmers should also be targeted in awareness campaigns about antibiotic misuse and AMR, as these groups generally outnumber the qualified medical practitioners or large-scale farmers. Civil society groups may have a better reach and experience in advocacy-related domains and may help complement the efforts of governmental agencies. Raising awareness among school and college students should also be a priority.

2. Leadership in communication and raising awareness: Health ministries or departments should take the lead in this activity as antibiotics are still perceived by the general public to be a domain related to human health. However, having a one health approach and adopting a multi-stakeholder approach is essential to dealing with the issue.

3. Designing the messaging approach: When approaching specific interest groups with the aim of increasing awareness, a targeted approach should be taken rather than using general media tools. The existing communication channels between the government and these groups should be explored and utilized to their full potential rather than investing in new communication channels.

4. Stakeholders of the messaging strategy: For any messaging strategy or intervention to succeed in the healthcare sector, it needs to be integrated into the routines of primary care, which is possible only with the support of primary care practitioners, family physicians, and the local health system administrators.

In conclusion

Effective communication plays a remarkable role in improving the level of community awareness about important healthcare issues. But increasing awareness alone does not result in significant behaviour change unless the issues are addressed holistically. Hence, creating a discernible change in behaviour in terms of antibiotic use will not only require adequate awareness but also a robust regulatory environment, emotional or material incentives, and an enabling social structure.