Mali’s children are dying from overexposure to antibiotics

Mali's children are dying from overexposure to antibiotics

A special wing of the MSF-run paediatric unit at Koutiala Hospital is dedicated to children carrying antibiotic-resistant bacteria, a measure aimed at limiting its spread and transmission.

(Morgane Pellennec)

Abdoulaye’s mother, sitting on one of 12 hospital beds in the building reserved for children carrying multi-resistant bacteria, watches anxiously over her son. He’s barely three and a half years old, and he’s on respiratory support, between life and death. Just a few days ago, Abdoulaye was admitted to the hospital in Koutiala, Mali’s fourth largest city, 300 kilometres from the capital city, Bamako. He is under the care of Médecins Sans Frontières (MSF, or Doctors Without Borders), which has been running the paediatric unit since 2009.

Abdoulaye has been infected with Escherichia coli, a type of intestinal bacteria that is quite easy to treat, under normal circumstances. But the strain affecting Abdoulaye is a multi-resistant one. Ongoing exposure to antibiotics administered by his parents led the bacteria to mutate, developing drug-resistant genes.

“We have prescribed him a last resort treatment,” explains Dr Flora Kuate, who has been working for MSF for three months. “But if his bacteria were to develop a new type of resistance, making it unresponsive to this medication, we will have no more solutions.”

Abdoulaye is a victim of antibiotic-resistance, the ability of bacteria to resist antibiotics. It is a phenomenon found across the world, although to varying degrees, affecting children and adults alike, and the causes are complex. Overexposure to antibiotics – in certain cases due to the consumption of meat treated with antibiotics or antibiotic-contaminated water – and failure to respect the appropriate dose and treatment period, for example, can result in the development of resistant strains of bacteria.

A lack of hygiene and infection control can then lead to their spread. Whereas bacteria have always ‘adapted’, the development of new antibiotics has stagnated. Dr Kuate explains the risks this poses: “If we were to be left without drugs for treating bacterial infections, we would revert to the pre-antibiotic era, during which people died from minor infections.”

Too many unprescribed antibiotics

In 2014, MSF set up a bacteriological laboratory at Koutiala Hospital that works alongside the paediatric unit. The aim is to improve the diagnosis of pathologies affecting children in order to provide them with the appropriate treatment. Housed in one of the smaller buildings comprising the hospital complex, seven technicians perform painstakingly detailed tasks, surrounded by incubators, microscopes and freezers: reading the media, transferring and incubating strains, etc.

These operations allow them to isolate bacteria, identify them and find the appropriate antibiotic to combat them. Over the last three months, the laboratory registered 53 cases of children infected with multi-resistant bacteria. More than half of them have since died. As of 2016, the laboratory started calculating the exact percentage of multi-resistant bacteria discovered during all their tests. The result was around 20 per cent a year.

Improved laboratory diagnosis, although a key tool, is not enough according to MSF experts. Efforts also need to be focused upstream, on the actual consumption of antibiotics. Doctors prescribing them automatically, patients using them without a prescription and the intake of drugs that are too strong or ill-adapted, make the task all the more difficult.

Just a few kilometres from the hospital, ‘roadside pharmacies’ are lined up one after the other at the local market. Planks of wood are nailed together to form makeshift stands selling boxes of anti-inflammatory pills, painkillers and antibiotics, a plastic tarp vaguely shielding them from the blazing sun.

“People come here when they have a stomach ache or a cut,” explains Moussa, the owner of one of these impromptu pharmacies. “The drugs come from Bamako, I don’t know if they’re good or not, but selling them at least allows me to provide for my family.” A few hundred metres down the road, an “official” dispensary also sells antibiotics without a prescription.

700,000 deaths a year

For want of widescale research, it is hard to estimate the extent of the phenomenon, nationwide, but Dr Ibrahim Guindo is “worried”. He heads the Antimicrobial Resistance Programme at the INRSP, the national public health research institute based in Bamako. “It was the clinicians contacting us about complicated cases, the treatment failures and routine data that alerted us to the problem,” he explains.

“We only have access to sporadic data, but one thing is for sure, reducing the consumption of antibiotics is a priority.” In late 2017, the INRSP and the Ministry of Health decided to launch a National Plan aimed at amending the law governing the sale of drugs. The INRSP has also set up bacteriological laboratories in five hospitals, which have been tasked with collecting exact data.

The Institute plans to take part in the GLASS programme, a Global Antimicrobial Resistance Surveillance System, covering 42 countries. It was launched in 2015 by the World Health Organisation (WHO), following the adoption, that same year, of a Global Action Plan on Antimicrobial Resistance.

Antibiotic-resistance reportedly claims 700,000 lives each year. A figure that could soar to 10 million by 2050.

In 2016, MSF, faced with this problem in its work across the board, embarked on the development of a bacteriological ‘mini lab’, with the support of the MSF foundation. The Mini Lab has been designed as a transportable unit, for use in countries with limited resources and in emergency situations.

“The Mini Lab is rationality writ large,” sums up Jean-Baptiste Ronat, scientific and technical head of the project. “It is about adapting the techniques, the lab equipment and the user manuals, to develop an all-in-one laboratory that can be used by non-experts. In developing countries, laboratory technicians often don’t have training in bacteriology.” A prototype will be tested in 2019 in a country that the NGO does not yet wish to disclose.

The launch is planned for June 2020. “We are only the tip of the iceberg,” insists Jean-Baptiste Ronat. “As with the fight against climate change, the fight against antibiotic resistance must involve all sectors of society. Educating people about an invisible phenomenon, however, can prove challenging, and all the more so when they are faced with other priorities, such as putting food on the table. My fear is that, as with the tale of the frog in boiling water, [it jumps out immediately when dropped into boiling water, but when placed in tepid water that is progressively brought to the boil, it gets used to it and dies], people don’t realise how grave the situation is until it’s too late.”

This story has been translated from French.