AMR Shield; Data driven community action against AMR

The initiative is designed to combat AMR in Kenya through a One-health Approach. It utilizes data to empower one-health workforce and communities in mapping resistance, advocating for policy changes, and engaging locals against AMR by promoting responsible antibiotic use, providing training, and fostering community engagement, against AMR. 

Dr. Martin Muchangi – Director Population Health and Environment 

Antimicrobial resistance (AMR) is a looming public health crisis threatening Kenya’s communities. Globally, it is estimated that around 4.95 million people died due to bacterial antimicrobial resistance in 2019 (Lancet, 2022). In Kenya, AMR directly caused 8,500 deaths in 2019 and was associated with 37,300 deaths (Metrics and Evaluation 2022) with common pathogens such as E. coli (up to 80% resistant to ampicillin) and Klebsiella pneumonia (over 50% resistant to critical antibiotics) showing high resistance in Kenya. World Bank has estimated that AMR could cost Kenya up to $3.8 billion annually by 2050, indicating a significant economic impact.

Contributing factors include:

• Inappropriate antibiotic use: Over-the-counter availability, lack of diagnostic tools, and limited access to qualified healthcare lead to misuse and overuse. Incorrect use of antibiotics can occur when health workers lack updated information, misidentify the infection, patient pressure, or benefit financially from supplying/prescribing.
• Weak surveillance systems: Limited data on AMR prevalence hinders effective interventions and policy development
• Poor sanitation and hygiene: Inadequate water, sanitation, and hygiene (WASH) facilities and infection prevention and control in hospitals facilitate the spread of resistant bacteria.
• Livestock sector practices: Antibiotic use in animal agriculture without proper controls contributes to the emergence of resistant bacteria.

AMR disproportionately affects women, children, and immunocompromised individuals. Our audience are segmented into three.

1. Community Members – These are communities residing in informal settlements and rural areas with limited access to healthcare and sanitation. There is a need for access to safe and sustainable WASH, and awareness and education about AMR and antibiotic use.

2. One Health care and service providers – These include frontline health care, Veteneray service providers as well as community health Promoters (CHPs). There is a need to training on AMR, antibiotic stewardship, data collection methods, and technology especially for CHPs for data collection.

3. Policymakers - Include Health, animals and environment including County leadership, government officials, local authorities, and community leaders who influence policies and resource allocation. There is need for data-driven insights to inform policy decisions and awareness of the social-economic impact of AMR.

To understand the needs of audiences, we will involve them in the process from the beginning through stakeholder engagement forums, community dialogues, participatory planning & action, and data analysis to understand their needs, identify high-risk populations, and tailor interventions to specific contexts. We will set up regular review meetings and dialogues for continued feedback and engagement. 

By sharing knowledge, data, and resources openly and fairly, the proposed solution contributes to a global effort in combating AMR and protecting public health. The public good is realized through;

Data and knowledge sharing: We will work with the MOH and stakeholders to ensure AMR practitioners can find, use and share data repositories and best practices as part of knowledge management. Sharing knowledge, data, and resources openly fosters global collaboration and empowers wider application of solutions crucial for tackling AMR and protecting public health.

Knowledge products: All knowledge products (publications, white papers, educational materials) produced in this project on AMR and responsible practices will be open source and practitioners will be free to use the same to raise awareness and empower communities.

Capacity building: Through our Institute of Capacity Development and Amref International University, we will make any training manuals and curriculum public / free courses to help communities build their own expertise in AMR control.

We will create tangible impact by empowering community members, health and animal care providers in underserved areas to combat AMR. We will employ community engagement, data-driven advocacy, and capacity building for health and animal care providers creating a significant impact on the lives of vulnerable communities by reducing exposure to AMR, improving access to quality healthcare, and promoting better health practices through improved hygiene practices and awareness of appropriate antibiotic use will decrease the spread of bacterial infections, protecting individuals and families.

Activities

• Community engagement: Educational campaigns on AMR, and empowering individuals to make informed decisions about hygiene, sanitation, and antibiotic use.
• Training and capacity building: We will provide training in antimicrobial stewardship, and data collection, analysis, and interpretation, equipping healthcare providers with the skills to utilize data effectively.

• Improved data infrastructure: The Mjali mobile app and data analysis tools will enhance data collection efficiency and provide real-time information on local infection trends and resistance patterns. For data analysis, machine learning and data visualization tools will analyze collected data, identify infection patterns, resistance hotspots, and high-risk areas.
• Data-driven advocacy: Project findings on AMR prevalence and community needs will inform policy changes that directly address the challenges faced by underserved communities.

We will scale in three ways;

1. Technical: Since our technology is already applicable across the country, what we will modify is standardizing the tools and materials for easy replication in other counties in matters AMR and collaborating with other organizations to integrate the project into existing systems.

2. Social: Leverage Amref’s footprint in the country to empower communities including their leaders using data to push for national policies addressing AMR. We will also share the knowledge and lessons from this project to inspire others through conferences, workshops, and publications.

3. Institutional: we will work with county health,  veterinary departments, the Council of Governors, and other technical working groups to strengthen Health systems for effective AMR control.

To ensure successful scaling we will garner support from stakeholders, ensure the tools and technological adaptability to local contexts, and continuous monitoring and evaluation to ensure the solution continues to address the evolving needs of the communities it serves. We will also ensure that the health community/practitioners can find, use and share critical AMR knowledge through established knowledge management platforms. 

We will utilize a robust monitoring and evaluation Framework including;

• A logic model outlining the links between activities, outputs, outcomes, and the overall impact on reducing AMR and improving health.
• Data Collection Tools that will be used in Mjali. We will develop standardized questionnaires, surveys, and templates for ongoing data collection
• Regular Review to analyze and communicate progress to stakeholders across animal, health and environmental settings
• Evaluation of before and after through Baseline, and endterm evaluations to track progress.

Some select indicators include;

• % of antibiotic prescriptions 
• % of confirmed resistant bacterial infections 
• % use of sanitation facilities 
• % of community members demonstrating knowledge of AMR and proper antibiotic use 
• % of community members aware of risks associated with antibiotic overuse/misuse 
• % of health workers reporting improved antibiotic stewardship practices   
• % of healthcare providers who follow antibiotic prescribing guidelines
• % decrease in antibiotic purchases without a prescription
• # of health facilities utilizing data for decision-making
• # of personnel trained in One Health principles and practices in different sectors.
• # of integrated surveillance report for monitoring AMR trends across human, animal, and environmental settings
• # of Households practicing responsible antibiotic use in humans and animals 

Potential barriers include;

• Data Privacy concerns where Community members might be hesitant to share personal information due to concerns about data privacy and misuse.

• Technical Barriers especially on Limited internet connectivity: Access to a reliable internet connection is necessary to transmit data effectively from rural areas. Fortunately, Mjali has offline functionality for data collection and syncing when connectivity improves.

• Cultural barriers: Addressing potential mistrust in data collection and conflicting traditional practices with culturally-sensitive approaches and community engagement.
• Financial Barriers on Cost of devices: Smartphones and tablets may be expensive for CHPs hence will leverage of this project as well as the governments community health strategy kit that provides phones for CHPs.
• Slow government responses especially on policy enactment: Bureaucracy and complex decision-making processes may hinder policy change even with compelling data.

To ensure the feasibility of our project, we have considered some Minimum Requirements for viability including Community Buy-In, Flexible Technology and Sustainable Funding to secure ongoing project operation, potential hardware costs, and staff support.

Kenya has 177th highest age-standardized mortality rate per 100,000 population associated with AMR across 204 countries (Institute of Health Metrics and Evaluation 2022). With this fund we will develop a multifaceted approach to address:

Gaps in surveillance systems: Limited data in AMR hinders effective interventions on policy development. Work with the disease surveillance team to identify sustainable measures to address the gaps. Further, engage the agricultural sector, and other agencies in developing a regulatory policy on antimicrobial use in both human healthcare and agriculture.

Inappropriate antibiotic use:  General lack of awareness on prudent use of antibiotics. Data derived from the surveillance systems will enable us monitor resistance patterns and antimicrobial use which will inform our targeted interventions.

Poor sanitation and hygiene at the health facilities:  Poor infection prevention and control measures at the health facilities, facilitating the spread of resistant bacteria at the health facilities. We will conduct IPC needs assessment at the facilities, the results will be used to develop effective interventions.

Livestock sector practices: Frequent antibiotic use in animal agriculture without proper controls. Apply the one health approach which looks at the interconnectedness between human, animal and environmental health bringing together all the stakeholders to address AMR.

We will collaborate with government Agencies, Private sector, and university.

Government agencies; Ministry of Health, Ministry of Livestock and Agriculture and Ministry of Environment

University/Research Institutions: Amref (NGO and Amref Health innovations) will collaborate with Amref International University for research agenda, advanced data analysis, joint research, and exploring innovative solutions through research and development.

Private Sector: We will collaborate with Pharmacies/chemists who dispense medicines and are very common in Kenya. They are instrumental in promoting responsible antibiotic dispensation, marketing and distribution.

We will also collaborate with TRiM (Translate into meaning) to explore technological advancements and utilise machine learning to aid Mjali capabilities. Trim is a private enterprise that provides solutions to a variety of end-users who have to deal with data and tools coming from the scientific world. TriM's multidisciplinary team includes geography, meteorology, climatology, social anthropology and computer science experts. Trim’s strong applied research background allows the production of innovative analysis and tools on smart use of existing open-source data and technologies. Amref has been working with Trim in a One Health for Humans, Environment, Animals and Livelihoods project which applies One Health approach to enhance the well-being and resilience of pastoralist communities of Ethiopia, Somalia and Kenya.