Edna Mutua: Antimicrobial resistance surveillance and governance

I'm Dr Edna Mutua. I'm a social scientist working at the KEMRI Welcome Trust in Nairobi, Kenya. My area of research is on antimicrobial resistance. Essentially, when you see antimicrobial resistance, we're looking at a status where bugs that used to respond to medicine are no longer doing that, and making infections difficult to treat.

For this interview, I'll talk about two projects on antimicrobial resistance that I'm currently working on. The first one focuses on antimicrobial resistance surveillance. So how we're doing this project is: a patient who is eligible for a blood culture when they present to a health facility that does not have capacity for doing such tests, has their sample taken, and then the sample is ferried to a high-capacity laboratory that can process the samples and do the analysis. The results are then fed back to the health facility for patient management.  We are piloting this approach because we'd like to see its feasibility in the Kenyan context. We'd like to understand in practical terms what does it mean to run such an approach? What are the handoffs that you're likely to experience, and how should you mitigate them? And this is useful for helping to plan if this is an approach that should be taken to scale.

This body of work has benefits in two ways. The first and the most immediate way is, when you give the feedback to the hospitals about the results of the sample that was taken, the doctor can be able to use that to inform the treatment plan. But when it comes to policy, once we are able to know what bugs are circulating, then we can be able to plan better for what medicines we should be having in our health facilities. We should also be in a position to determine whether the mitigation strategies we have for antimicrobial resistance are actually working, or we need to improve, or we need to think in different ways.

The benefit this project had for the patients that we interacted with was that the results, once relayed to the clinicians, were used to determine their treatment plans. At policy level, this type of work is useful because it informs the kind of bugs that are circulating, and it puts us in a place where we can be able to determine if the mitigation measures we have are adequate or not. In health facilities, it can help us identify whether we have the right medicines for the kind of medical challenges that we're facing, and therefore, being able to prepare well.

It matters because antimicrobial resistance can be expensive. It can be expensive in the sense that it can cost lives. It can be expensive in the sense that it can result in long hospital stays for patients, and, of course, lowering the quality of life. And it is expensive in the sense that once you have somebody who has stayed too long in hospitals, it means also that people have to sacrifice livelihood activities for caregiving, and therefore, worsening the outcomes for families.

My vision for the future is to see a world where we are able to mitigate antimicrobial resistance in an equitable and a just way, so that we don't cause harm as we try to contain AMR, and we don't weaken our health systems as we try to also mitigate AMR. For mitigation to be just, it means that we're looking at both the positive and the negative consequences that could emerge by implementing a certain measure. And asking ourselves, how can we maximise the gain while we are lowering the pain or the harm that comes out of it?

This interview was recorded in January 2024