Pneumonia, access and excess: Nathalie studies the correlation between pneumonia in children and their mother’s education
In low-income countries, the issue of antibiotic overuse is complicated by that many patients lack access to antibiotics even when they really need them. Nathalie Arnqvist studies Global Health at Uppsala University and is writing her master thesis in collaboration with the Foundation to Prevent Antibiotic Resistance, and her topic is pneumonia among children in Kenya.
In rich countries we are most familiar with the narrative of antibiotics as a story of excess, where we use too much antibiotics for minor conditions and thereby cause resistance. Yet while the consequences of excess are expected to cause millions of deaths in future patients, today more people die from not having access to antibiotics than from infections that have become resistant to them. It may appear to be two separate problems, but they are closely connected.
Ensuring access to antibiotics to everyone who needs it while restricting use for everyone else requires a strong and well-functioning healthcare system. A study from 2014 interviewed stakeholders in the health systems of various low- and middle-income countries, and illustrates how antibiotic stewardship in these settings becomes a difficult trade-off between present and future patients. When antibiotics are easily available to buy without prescription, this results in misuse and overuse and causes rapid development of resistant infections. On the other hand, stewardship measures modelled on high-income countries where antibiotics require a physician’s prescription may result in many patients having no access to antibiotics at all. In many rural areas there might not be any physician who could prescribe. When there is a licensed prescriber, it may still be the case that not all patients are able to afford getting the prescription – even if they could afford buying the drug itself.
Nathalie Arnqvist is writing her master thesis in Global Health at Uppsala University on pneumonia among children in Kenya. Pneumonia is one of the most common causes of death among children under five, and most of the cases could be treated with antibiotics if they were accessible.
However, pneumonia is also to a large extent a preventable disease, by vaccination and by general health-promoting habits such as healthy diets. Nathalie is doing a quantitative study of the correlation between pneumonia among children under five and the education level of the children’s mothers.
– I found my interest for antibiotic resistance during my bachelor in biomedicine. That’s why I applied for a master in global health, to be able to work with antibiotic resistance and decreasing the spread of bacterial diseases, says Nathalie.
Prevention of antibiotic resistance is a very complex issue, involving not only medicine and biotechnology but also topics such as politics and policy, behavioural change, communication and economy. The access-excess dilemma illustrates that resistance is interwoven with the functioning of the entire health system. Preventing resistance is not only an issue of stewardship, but also of addressing high infection frequencies that drive the demand for treatment in the first place.
Nathalie Arnqvist graduates in June and is looking forward to pursuing a career in the field of antibiotic resistance after finishing her thesis.
– I’m excited to see the results and see if this is something to pursue and keep doing research on, or if I might pursue a different angle within the antibiotic resistance field. I want to work with antibiotic resistance and/or communicable diseases in the future, so after my graduation I think I will look for jobs or internships that will take me one step closer to working with antibiotic resistance in a global context.
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A new study in Global Health Action, commissioned by the Foundation to Prevent Antibiotic resistance, concludes that research on preventive strategies is an under-researched field. Among the 430 000 research papers on antibiotic resistance that the study identified in an 18-year period, only 0.25% focus on preventive strategies. More cross-disciplinary research and evidence-based interventions are needed for the prevention of antibiotic resistance.
The Sustainable Development Goals (SDG’s) guide investment in sustainable development, and the lack of inclusion of antibiotic resistance has therefore been problematic. The recent review has added one indicator of resistant infections, but most of the links between resistance and the SDG’s are still implicit. Even so, rising awareness of the importance and fragility of global health can hopefully pave way for a greater recognition of the intimate connections between antibiotic resistance and sustainable development.
At first sight, a viral disease such as covid-19 has little to do with antibiotic resistance. Those who remember their biology classes will know that antibiotics work only to treat bacterial infections. However, there can be a connection between the occurrence of resistant bacteria and how bad a viral pandemic becomes.