Nakuru County becomes the 23rd county in Kenya to inaugurate its County Antimicrobial Stewardship and Inter-Sectoral Coordination (CASIC) structure.

The county has also institutionalize a framework for tackling antimicrobial resistance (AMR), which officials say the timing could not be more critical.

By doing so, the county now has this framework to guide the operationalization and bring stakeholders, intergovernmental bodies, and other actors together to address AMR.

But first what is AMR?

AMR refers to a scenario where the antimicrobials that we use - the microorganisms, that is, the parasites, the bacteria, and the viruses – become resistant to the medicines that we have, making them ineffective.

Dr Lydia Momanyi, a clinical pharmacist at the Nakuru County Teaching and Referral Hospital and the county's AMR focal person for human health, explains that the causes include patients skipping antibiotics doses, self- medicate without a diagnosis, fail to complete the prescription, or share medication with family members, they are contributing to resistance.

The consequences, she warns, are severe, noting that the long-term effects of AMR in the worst cases are often death.

“It reaches a scenario where the individual and the microorganism within them have resisted all the antibiotics that we have in practice,” she notes, adding that infections most vulnerable to resistance include respiratory tract infections like pneumonia, urinary tract infections, sexually transmitted infections, gastrointestinal infections, and increasingly, fungal infections.

Dr Lydia Momanyi, a clinical pharmacist at the Nakuru County Teaching and Referral Hospital and the county's AMR focal person for human health, during the official launch of the CASIC alongside its framework for tackling antimicrobial resistance (AMR) on April 14

Photo credit: LELETI JASSOR/MTAA WANGU

It is precisely the gaps in the county’s human, animal, and environmental health that the CASIC is designed to close.

According to Dr Momanyi, with the structure now officially inaugurated, the county has a formal mandate and a work plan to implement activities across all sectors under one coordinated framework.

Dr Michael Cheruiyot, who is the Chairman of the Nakuru CASIC and County Chief Officer for Livestock, Fisheries, and Veterinary Services, notes that too often human health, animal health, and environmental health have been treated as separate issues.

“We cannot have healthy people if the environment is affected. We also cannot have healthy people if animals are sick, because 75 per cent of diseases affecting both humans and animals come from animals (zoonotic diseases),” he says.

Dr. Michael Cheruiyot, who is the Chairman of the Nakuru CASIC and County Chief Officer for Livestock, Fisheries, and Veterinary Services during the official launch of the CASIC alongside its framework for tackling antimicrobial resistance (AMR) on April 14.

Photo credit: LELETI JASSOR / MTAA WANGU

Hence, the essence of the One Health approach is recognizing that the health of people, animals, and the environment is inseparable.

Dr Cheruiyot says the plans include training farmers on proper chemical handling and disposal, ensuring animals are treated and inspected by qualified personnel, and cracking down on chemists selling prescription drugs without prescriptions.

Importantly, the county also plans to take AMR education into schools, starting with children.

His call to action to farmers is to follow the manufacturer's instructions, to always have their meat inspected before slaughter, and not to spray crops and consume them the same day.

Solomon Mwaniki, the Project Manager at AMREF Health Africa, refers to AMR as a silent pandemic with a core challenge, he argues, is one of amplification.

He notes that the contextualization of AMR and the CASIC framework is also key in addressing the specific needs of the county, and so that actions and mitigation measures are tailored accordingly.

Solomon Mwaniki, the Project Manager at AMREF Health Africa during the official launch of the CASIC alongside its framework for tackling antimicrobial resistance (AMR) on April 14.

Photo credit: LELETI JASSOR/ MTAA WANGU

“AMR originates from the household, the farm, and the livestock that we keep,” he says. “So it is an edge-to-edge approach - from governance at the top, all the way to where the rubber meets the road, at the community level.”

Boost for health services in Nakuru as county forms team to tackle anti-microbial resistance

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Leleti Jassor