Poverty and Root Causes of Resistance in Developing Countries
Antimicrobial use provides selective pressure for resistant strains but there are other factors that combine with use to promote the emergence and spread of resistant bacteria, mobile elements, and genes. Many of these factors are only superficially understood, if at all, and are complicated to study. Comparative antimicrobial resistance data from populations with different risk factors for resistance are hard to come by and inevitably suffer from bias. Nonetheless, a few studies document regional variations in resistance and some provide clues about factors that might exacerbate resistance. Data from these studies appear to suggest that antimicrobial misuse, prophylactic use, diagnostic imprecision, and interpersonal spread are key factors in the selection and dissemination of resistant strains. All these factors are promoted by poverty at the individual patient, health system, and national levels.
KeywordsPoor Country Poor People Refugee Camp Secure Supply Chain Resistance Containment
INO is a Branco Weiss Fellow of the Society-in-Science, ETHZ, Zürich, Switzerland.
- Berkley, J. A., Lowe, B. S., Mwangi, I., Williams, T., Bauni, E., Mwarumba, S., Ngetsa, C., Slack, M. P., Njenga, S., Hart, C. A., Maitland, K., English, M., Marsh, K., and Scott, J. A. 2005. Bacteremia among children admitted to a rural hospital in Kenya. N. Engl. J. Med. 352:39–47.CrossRefPubMedGoogle Scholar
- Lamikanra, A. and Okeke, I. N. 1997. A study of the effect of the urban/rural divide on the incidence of antibiotic resistance in Escherichia coli. Biomed. Lett. 55:91–97.Google Scholar
- Lee, N. Y., Song, J. H., Kim, S., Peck, K. R., Ahn, K. M., Lee, S. I., Yang, Y., Li, J., Chongthaleong, A., Tiengrim, S., Aswapokee, N., Lin, T. Y., Wu, J. L., Chiu, C. H., Lalitha, M. K., Thomas, K., Cherian, T., Perera, J., Yee, T. T., Jamal, F., Warsa, U. C., Van, P. H., Carlos, C.C., Shibl, A. M., Jacobs, M. R., and Appelbaum, P. C. 2001. Carriage of antibiotic-resistant pneumococci among Asian children: a multinational surveillance by the Asian Network for Surveillance of Resistant Pathogens (ANSORP). Clin. Infect. Dis. 32:1463–1469.CrossRefGoogle Scholar
- Okeke, I. 2003. Antibiotic use and resistance in developing countries. In the resistance phenomenon in microbes and infectious disease vectors: implications for human health and strategies for containment – Workshop Summary, ed. S. Knobler, S. Lemon, M. Najafi, and T. Burroughs, pp. 132–139. Washington DC: Institute of Medicine, National Academy of Science.Google Scholar
- Okeke, I. N., Fayinka, S. T., and Lamikanra, A. 2000. Antibiotic resistance in Escherichia coli from Nigerian students, 1986 1998. Emerg. Infect. Dis. 6:393–396.Google Scholar
- Schapira, A. 1994. A standard protocol for assessing the proportion of children presenting with febrile disease who suffer from malarial disease. Geneva: World Health Organization.Google Scholar
- Songsore, J. 2004. Urbanization and health in Africa: exploring the interconnections between poverty, inequality and the burden of disease. Heath Clark Lecture delivered on June 2002 at the London School of Tropical Medicine and Hygiene. Accra: Ghana Universities Press.Google Scholar
- Tsegaye, G. 1998. Assessment of knowledge and practice in urban and rural communities in Jimma zone. J. Health Sci. 8:92–93.Google Scholar
- Victora, C. G., Huicho, L., Amaral, J. J., Armstrong-Schellenberg, J., Manzi, F., Mason, E., and Scherpbier, R. 2006. Are health interventions implemented where they are most needed? District uptake of the integrated management of childhood illness strategy in Brazil, Peru and the United Republic of Tanzania. Bull. World Health Organ. 84:792–801.CrossRefPubMedGoogle Scholar
- Whyte, S. R., Geest, S. V. D., and Hardon, A. 2002. Social lives of medicines. Cambridge: Cambridge University PressGoogle Scholar
- Worku, S. and Abebe, G. 2003. Practice of self medication in Jimma town. Ethiop J. Health Dev. 17:111–116.Google Scholar