Water, sanitation, and hygiene must be the first lines of defence against antimicrobial resistance

Water, sanitation, and hygiene must be the first lines of defence against antimicrobial resistance. The Lancet Global Health Blog, Sept 21, 2016 |

Author : Yael Velleman. Yael Velleman is a WaterAid senior policy analyst on health and hygiene


WaterAid/Anna Kari

As world leaders meet at the UN General Assembly to discuss the rise of drug-resistant micro-organisms globally, they would do well to consider the experience of the midwives at Kiomboi hospital, in the Iramba district of Tanzania.

Before a WaterAid intervention earlier this year, Kiomboi’s taps were dry for 23 hours per day, leaving medical professionals faced with a difficult choice: risk the transmission of infection during childbirth because the delivery room and instruments could not be properly cleaned, or prescribe precious antibiotics as a preventive measure, possibly contributing to the emerging problem of drug-resistant infections.

It is difficult to describe what it is like for medical professionals like these, delivering babies and caring for patients in a hospital without adequate access to clean water or proper sanitation. The water supply to the wards runs for just 1 hour per day, medical equipment is washed in the same sink that waste from the maternity ward is disposed into, and expectant mothers wash their babies’ clothes in the dirty water of a nearby river. The only toilet is fetid and dank and the shower is next to an open sewer. Dirty hands and dirty water mean that pathogens spread quickly and babies and their mothers risk infections like sepsis.

In March, when Kiomboi was without water for 3 consecutive weeks, staff told WaterAid they had to turn first to unpredictable collection of rainwater, and then had to send a car to collect water from a river. Without readily available clean water, midwives were not able to do their jobs safely. At least 12 babies developed sepsis during this period, and two of them died. Midwives were then faced with the torturous question of whether those babies’ deaths were their fault: were those infections transmitted in the delivery process?

The experience of Kiomboi is not an isolated one, and although the hospital now has access to clean water, 42% of health-care facilities across Africa do not. It is estimated that one in five deaths among newborns in sub-Saharan Africa and South Asia are caused by sepsis, meningitis, and tetanus. Of these, sepsis is the most dangerous, leading to 18-20% of neonatal deaths.

Many of these infections could have been prevented and babies’ and mothers’ lives saved, had there been clean water, proper sanitation, rigorous hand and environmental hygiene, and infection prevention and control practices – critical to delivering quality health care. Using antibiotics to do the job of clean water, good sanitation, and good hygiene runs counter to good public health practice, and contributes to the global rise in drug-resistant infections.

Antimicrobial resistance crosses all boundaries – be they geographic or socioeconomic – and is a serious threat to public health globally. According to the UK Government’s Review on Antimicrobial Resistance published earlier this year, by 2050 up to 10 million people may die every year from drug-resistant infections. This is not just a health problem, but an economic one too. It is thought that growing resistance to antibiotics could not only cost us enormously in loss of lives but could also cost the global economy up to £70 trillion by 2050.

Sustainable water and sanitation infrastructure and services and good hygiene practices that prevent infection in the first place should be part of the fight against antimicrobial resistance. This, along with prudent use of antibiotics and further development of drugs and vaccines, is essential. As an organisation, WaterAid has joined a public pledge to champion the delivery of quality health care as critical to tackling antimicrobial resistance. Along with raising public awareness, we have promised to push national governments, donors, and international organisations on the need for prevention strategies for addressing this emerging crisis.

We do so while continuing to work on the ground to ensure that midwives like those at Kiomboi now have access to clean water, the infrastructure to ensure that they are able to protect mothers and their babies from infection and care for them safely, and the awareness and training to prioritise prevention of infection and reduce reliance on antibiotics. Water, sanitation, and good hygiene are the first line of defence in combating infection and the rise of drug-resistant micro-organisms.

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