One Health Togo - Project to reinforce antimicrobial resistance control in human and animal health in Togo

Antimicrobial resistance (AMR) is the ability of micro-organisms (bacteria, parasites or fungi) to inhibit the action of an antimicrobial agent. AMR compromises the effective treatment of a growing number of infections that persist and can spread. It is one of the main causes of mortality worldwide and is increasing at an alarming rate.

Antibiotic resistance can be due to:

• An excessive and inappropriate use of antibiotics in human and animal health
• The routes of transmission of multi drug-resistant bacteria (DRB) between human and animal health, in particular through food
• An improper use of medication: use of poor-quality medicines, wrong prescriptions, patients sharing treatments
• A lack of access to bacteriological tests and susceptibility testing, leading to inadequate microbiological analyses and excessive or inappropriate treatments being given
• A lack of prevention measures.

This phenomenon has serious socioeconomic consequences, as an ineffective antibiotic treatment often results in the need to prolong a hospitalisation, or use a longer and more expensive treatment, with a heavy financial burden for both patients and society. 

To address this situation, in 2015, WHO adopted a Global Action Plan on Antimicrobial Resistance, as part of the One Health approach. It has five strategic objectives:

• Improve awareness and understanding of the problem of antimicrobial resistance
• Strengthen the knowledge and evidence base through surveillance and research
• Reduce the incidence of infection
• Optimise the use of antimicrobial medicines
• Secure sustainable investments to combat antimicrobial resistance.

In 2019, a study on the prescription of antibiotics at Sylvanus Olympio University Hospital Centre in Lomé showed that 43.9% of the 399 patients hospitalised in 23 services surveyed received at least one antibiotic.

The joint external evaluation of the International Health Regulations (IHR) conducted in Togo in April 2018, with the participation of Expertise France, took stock of the challenges concerning the ability to detect and manage antimicrobial resistance.

Togo expressed its desire to have a strategic plan integrating infections associated with healthcare, as well as guidelines on the proper use of antibiotics. The Togolese Minister of Health, Public Hygiene and Universal Access to Health Care expressed the wish to set up a project to reinforce antimicrobial resistance in hospitals.

The Togo One Health project aims to contribute to measuring and preventing the transmission of multi drug-resistant bacteria in hospital and community settings, in human and animal health, in Togo. It is financed by the French Ministry of Health and Prevention and implemented by Expertise France, the Paris Public Hospitals Authority (AP-HP) and CIRAD.

Sylvanus Olympio University Hospital Centre in Lomé has been identified as a pilot site to measure and prevent antimicrobial resistance in hospitals. The objective is to feed into reflection and work on the development of national guidelines on the proper use of antibiotics and the revision of the national infection surveillance system, including for infections associated with healthcare. Sylvanus Olympio University Hospital Centre will be assisted by AP-HP.

Potential phenomena of cross-transmission between humans and animals will also be assessed at the veterinary services laboratory with support from CIRAD, because antibiotic resistance affects all sectors and can only be addressed through a One Health approach.

The project is based on three lines of action:

• Research/knowledge production: assessment of the prevalence and transmission of multi drug-resistant bacteria (DRB), in particular human-animal transmissions
• Training: strengthening of the prevention framework and the treatment capacity related to DRB of Sylvanus Olympio University Hospital Centre in Lomé
• Governance: assistance for the revision of the action plan of the national policy document for infection prevention and control (IPC), integrating a component on infections associated with healthcare and the proper use of antibiotics, and formulation of recommendations for the use of antibiotics in animal health.