THE ROLE OF ENVIRONMENTAL HEALTH IN PREVENTING ANTIMICROBIAL RESISTANCE IN LOW- AND MIDDLE-INCOME COUNTRIES
Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health. AMR leads to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased death due to treatable diseases. Some of the major causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. In addition to these concerns, Environmental Health has a crucial role to play in preventing AMR including reducing transmission of resistant microorganisms particularly in low- and middle-income countries (LMICs). The Environmental Health measures that contribute to preventing AMR include: adequate water, sanitation and hygiene (WASH); proper disposal of solid waste particularly antimicrobials; proper wastewater management; and ensuring food hygiene and safety. Achieving proper WASH through consumption of safe water, suitable disposal of human excreta, and good personal hygiene practices such as washing hands with soap at critical times for example after toilet use and before eating food are crucial to prevent the spread of resistant microorganisms. Proper disposal of unused and expired antimicrobials is important to prevent their unnecessary exposure to microorganisms in the environment hence contributing to preventing emergence of resistant organisms. Sufficient management of wastewater including from homes, communities and health facilities (which many times contain resistant microorganisms as well as antimicrobial residues) including proper treatment is important to prevent transmission of resistant organisms hence proliferation of AMR. Ensuring adequate food hygiene and safety practices such as consumption of products from animals in which adequate antimicrobial withdrawal periods have been observed, and vegetables from unpolluted fields reduces the consumption of antimicrobial residues. The reduction in occurrence of Environmental Health related diseases such as diarrhoea, cholera and typhoid particularly in LMICs also minimises the need for antimicrobials hence contributing to safeguarding them. Environmental Health, specifically WASH, solid and wastewater management, as well as food hygiene and safety, are key in preventing the spread of antimicrobial-resistant microorganisms and ingestion of antimicrobial residues especially in LMICs hence contributing to reduction in AMR.
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