Identifying &reporting antibiotic misuse among rural livestock owners

The solution involves innovatively collecting and analyzing data on antibiotic use and resistance patterns to combat antimicrobial resistance (AMR). It integrates a user-friendly mobile app, advanced technology like HPLC, and community-centric strategies. It's in the pilot phase, aiming to refine effectiveness before scaling up.

Mr. Happy Makala, Executive Director, Christian Health Association of Malawi

Antimicrobial resistance (AMR) poses a global threat, with WHO estimating 1.27 million annual deaths directly linked to bacterial AMR and 4.97 million deaths associated with it globally. In Malawi, 3,600 deaths are linked to bacterial AMR annually, ranking 23rd globally in age-standardized mortality rates per 100,000 populations. Without intervention, WHO projects a potential annual mortality of 10 million by 2050. The irrational use of antibiotics among livestock owners and brewers is a significant contributor to this problem, compounded by a lack of comprehensive data on antibiotic misuse and AMR spread in communities. The absence of such data inhibits the development of effective interventions and undermines informed decision-making. Our solution aims to address this by collecting and analyzing data on antibiotic use and resistance patterns, enabling targeted interventions and informed policy formulation. By breaking the transmission cycle of resistant microbes and mitigating environmental contamination, we seek to safeguard public health and combat AMR locally and globally.

Our solution primarily serves people in communities around Christian Health Association of Malawi (CHAM) health facilities. CHAM operates 194 church-owned health facilities and 11 training colleges, covering 27 out of 28 districts in the country. These facilities provide healthcare services to approximately 37% of the Malawian population, particularly under-served Malawians residing in hard-to-reach areas.

Our aim is to support Ministry of Health in addressing the pressing need to combat antimicrobial resistance (AMR) within communities around CHAM facilities. By collecting and analyzing data on antibiotic use and resistance patterns, our solution seeks to empower MOH with valuable insights to inform policy formulation and targeted interventions in communities around CHAM facilities.
The solution will start with communities around 25 health facilities which were under a small CHAM AMR Project. Once the results are positive, we aim to scale up to other facilities. Overall, CHAM would like to take an active role in combating AMR challenges in communities around its facilities.

This solution provides several public goods:

1. Open Data Sharing: We provide a mobile application tailored for the collection, aggregation, and analysis of data concerning antimicrobial resistance (AMR) within communities. This application will serve as a centralized platform for storing, analyzing, and visualizing data on antibiotic use and resistance patterns. By making this data accessible to stakeholders, we enable informed decision-making and policy formulation to combat AMR effectively.
2. Innovative Testing Method: We innovate and validate a simplified High-Performance Liquid Chromatography (HPLC) method for the efficient detection and quantification of antibiotics in various samples. By sharing this validated protocol, we contribute to standardized monitoring of antibiotic residues in food and environmental samples, enhancing surveillance and mitigation strategies globally.
3. Capacity Building: Through our pilot phase and subsequent scaling efforts, we equip local healthcare professionals with training and resources for testing using HPLC, surveillance using microbiology culture tests, and sampling of different samples in the One Health concept. This empowers them to conduct comprehensive monitoring of antimicrobial resistance (AMR) within communities, enhancing their capacity to identify and address AMR challenges effectively.

Our solution will create tangible impact by addressing the pressing global issue of antimicrobial resistance (AMR), which causes significant mortality worldwide. By collecting and analyzing data on antibiotic use and resistance patterns, our solution enables targeted interventions and informed policy formulation to combat AMR effectively. In Malawi alone, where bacterial AMR contributes to 3,600 deaths annually, our solution will safeguard public health by breaking the transmission cycle of resistant microbes and mitigating environmental contamination.

Specifically, our solution serves communities around Christian Health Association of Malawi (CHAM) facilities, covering approximately 37% of the Malawian population, particularly those in underserved and hard-to-reach areas. By engaging directly with community members, healthcare professionals, and CHAM stakeholders, we ensure that our interventions are contextually relevant and responsive to the needs of the communities we serve.

Through capacity building efforts, including training on HPLC testing, microbiology culture surveillance, and One Health sampling techniques, we empower local healthcare professionals to conduct comprehensive monitoring of AMR within their communities. This enhances their capacity to identify and address AMR challenges effectively, strengthening local healthcare systems and fostering community engagement in AMR prevention and control efforts.

Year 1: Pilot Expansion and Evaluation

After developing and validating the solution, CHAM will expand the pilot phase to additional communities around CHAM facilities, increasing the number of participants and data collection points. Furthermore, CHAM will evaluate the effectiveness of our solution by assessing key performance indicators, including the adoption rate of the mobile application, data accuracy, and stakeholder feedback. Key will be collaboration with MOH.

2. Year 2: Scaling Within CHAM Network

We will scale up our solution to more CHAM facilities and communities, leveraging pilot phase insights. We will train additional CHAM healthcare professionals to enhance AMR monitoring. Refine the mobile app based on feedback and technology advancements. Strengthen collaboration with MOH to integrate our solution into national AMR prevention and control strategies.

3. Year 3: Nationwide Expansion and Sustainability

Expand our solution beyond CHAM facilities to reach communities across Malawi, partnering with more healthcare providers and stakeholders. Advocate for policy changes at the national level to integrate our solution into broader AMR prevention and control efforts, ensuring lasting impact and sustainability.

To measure success against our impact goals, we have devised a comprehensive plan for monitoring and evaluating our solution's effectiveness in combating antimicrobial resistance (AMR). Key performance indicators (KPIs) will be tracked throughout the implementation process to assess progress and impact. These KPIs include:

1. Development of the App, validated HPLC assay and simplified surveillance protocol.
2. HPLC samples analysed and surveillance samples processed.
3. Adoption Rate of Mobile Application: We will measure the percentage of community members and healthcare professionals using the mobile application for data collection and reporting.
4. Data Accuracy and Quality: We will assess the accuracy and reliability of the data collected through the mobile application. This involves evaluating the consistency and completeness of the data to ensure its validity for analysis and decision-making.
5. Stakeholder Feedback: Feedback from stakeholders, including community members, healthcare professionals, and policymakers, will be gathered to gauge satisfaction and perceived usefulness of our solution.
6. Impact on Policy Formulation: We will track the utilization of data generated by our solution in informing policy formulation and targeted interventions at the community and national levels.
During the pilot phase, we will closely monitor these indicators to evaluate the feasibility and effectiveness of our approach.

Several barriers may hinder the accomplishment of our goals in the next year and the next three years:

1. Financial Constraints: Limited resources may impede the scale-up of our solution.
2. Technical Expertise: Access to skilled personnel proficient in operating HPLC equipment and conducting microbiology culture tests is crucial. Insufficient expertise may affect the accuracy and reliability of data collected and analyzed.
3. Policy Support: Lack of supportive policies or regulatory frameworks addressing antimicrobial resistance (AMR) may impede the integration of our solution into national healthcare systems.
4. Low understanding of suggested changes because of low literacy levels.
To overcome these barriers:
1. Financial Planning: We will pursue diverse funding sources, including grants, partnerships, and philanthropic support as well as leveraging existing collaborations.
2. Capacity Building: Investing in training programs to build technical capacity among healthcare professionals and laboratory personnel is essential including training institutions
3. Advocacy and Policy Engagement: Engaging policymakers and advocating for supportive policies on AMR surveillance and control will be critical including building coalitions with advocacy groups.
4. Streamline to be more effective for audience of low literacy.

By addressing these barriers proactively, we aim to strengthen the resilience of our solution and maximize its impact in combating antimicrobial resistance (AMR) in Malawi's communities.