In the era of ever-increasing antibiotic resistance, common diseases such as pneumonia, tuberculosis, genitourinary tract infections etc, are becoming difficult to treat.
Bacteria are becoming rapidly resistant to commonly prescribed medications, resulting in the use of expensive drugs which are leading to increased economic burden on the patient, longer hospital stays and rise in deaths. The latest infection added to the list is a strain of typhoid which recently emerged in Sindh and other parts of Pakistan, and is fast becoming an epidemic. This strain has become resistant to regular antibiotics usually prescribed for this disease.
Typhoid is an infection caused by Salmonella Typhi – a bacteria that causes infection of the intestinal tract resulting in high fever, stomach pain, weakness, headaches, chills, rashes, constipation or diarrhoea. If left untreated, typhoid can be lethal. The infection is acquired through consuming contaminated food or water and through contact with an infected individual. According to the most recent WHO estimates, approximately 20 million cases and 160,000 typhoid-related deaths occur worldwide annually. With the growing resistance of the disease we can expect the death toll to rise.
In third-world countries like Pakistan, lack of availability of clean water and proper sanitation to most of the rural and parts of the urban population makes typhoid an endemic disease. Overcrowding, lack of basic healthcare and education further aggravates the issue. With Pakistan’s population growing at a rate of two percent per annum, and reaching almost 207 million as per the census of 2017, and a literacy rate of dismal 58 percent, only 36 percent of the population use safely managed drinking water services.
Only 58 percent of Pakistanis have access to basic level sanitation, with 11.5 percent still defecating in the open, according to the WHO and Unicef’s joint monitoring programme (JMP) for water supply, sanitation and hygiene. The current infrastructure, expenditure and human resource dedicated to the basic needs of an average Pakistani cannot sustain the standard public health issues desperately needed in our country.
Another major threat, as mentioned above, is the growing antibiotic resistance among bacteria that cause common diseases; the current strain of typhoid is just the example of that. This is partly caused by the misuse and overprescribing of antibiotics by healthcare providers. Excessive use of antibiotics in livestock and agriculture is another major contributing factor. Unfortunately, the trend to overprescribe and irrationally use antibiotics does not seem to be subsiding.
According to recent studies, antibiotic consumption in Pakistan between 2000 and 2015 increased by 65 percent, from 800 million defined daily doses (DDD) to 1.3 billion DDD. Pakistan has been found to be the third highest consumer of antibiotics, after India and China, among low and middle-income countries. This trend has further accelerated the process of antibiotic resistance where experts fear that a time will come when common colds and fevers will not be treatable.
As the sweltering heat of summer approaches Pakistan, the risk of infectious and diarrhoeal diseases has increased significantly. What can we do to reduce the risk of typhoid? One of the key steps to prevent typhoid is vaccination – its importance cannot be stressed enough. On the grassroots level, we also need to educate the population on how to avoid typhoid with simple preventive steps like washing hands frequently, avoiding drinking untreated water and thoroughly washing raw fruits and vegetables.
Improved sanitation and access to clean water is key to reducing the incidence of the disease. While the situation is disconcerting and disheartening to say the least, it is imperative for the government and public health organisations to take steps to improve the basic amenities for average Pakistanis.
It is essential that medical practitioners review the use of antibiotics, and create awareness among the common public against self-medication. Antibiotic stewardship is a need of the hour. There is an urgent need for global action on the judicial use of antimicrobials in both humans and animals. If we will not take concrete and comprehensive steps to reduce the reckless use of antibiotics, we will very soon run out of options to treat infections like typhoid. Simultaneously, the need to fund the development of new drugs to treat these multidrug resistant bacteria is crucial for our future.
The writer is a pediatric infectious disease specialist at Fatima MemorialHospital, Lahore.