Partnership for a cross-disciplinary approach to the ecology of antimicrobial drug resistance in Kenya

抗菌素耐药性(ABR)是对未来有效的医疗保健和兽医护理的重大威胁。在全球范围内，我们依赖抗生素来治疗常见和严重的感染，但我们滥用这些化合物的价值，不合理地使用它们。在肯尼亚，就像在许多其他国家一样，在没有正确识别目标微有机物的情况下，不必要地开抗生素，这一事实往往导致治疗失败。在农业中，抗生素通常由农民直接使用，因为它们在市场上随时可以买到，而不需要处方。肯尼亚是一个正在向城市化转型的国家，到本世纪中叶，预计将有超过一半的人口居住在城市地区。这些人中的许多人可能生活在低收入住区(例如，首都内罗毕60%的居民生活在低收入住区=贫民窟)。这些地方缺乏高质量的卫生保健服务。此外，随着越来越多的人居住在城镇，农民将面临更高效率地生产更多粮食的压力，而其中的一个关键部分--就像更发达的经济体一样--将是使用抗生素药物。这些因素加在一起，给高度耐药的微生物的出现带来了巨大的风险。预防这种情况的关键是在医院和农场收集高质量的数据，了解目前存在什么水平的抗药性，以及这些生物体如何共享它们的基因，这一过程可能导致抗药性特征的快速传播。这方面的一个关键方面也是了解抗菌药物在实践中是如何使用的，它们是如何获得的，以及是什么推动了个人和集体对其使用的决定。我们的方案将调查这些不同的方面，并与肯尼亚和国际上的合作伙伴合作，以便制定长期监测工具，计划限制耐药性的传播，并向公众提供保存这些重要药物的建议。

Antibacterial resistance (ABR) is a significant threat to the future of effective healthcare and veterinary care. Globally, we are dependent on antibiotics for treating common as well as severe infections, but we abuse the value of these compounds by using them irrationally. In Kenya, as in many other countries, antibiotics are prescribed un-necessarily and without properly identifying the micro-organims being targeted, a fact that often leads to treatment failures. In agriculture, antibiotics are often used directly by farmers, as they are readily available on the market without prescription. Kenya is a country undergoing a demographic transition towards urbanisation, with over half the population expected to be in urban zones by the middle of this century. Many of these people are likely to live in low income settlements (eg 60% of residents of Nairobi, the capital, live in low income settlements = slums). Provision of high quality heath care is lacking in such sites. Further, with more people living in towns and cities, the pressure will be on farmers to produce more food more efficiently, and a key part of this - as has been the case in more developed economies - will be to use antibiotic drugs. These factors combine to produce a great deal of risk for highly drug resistant micro-organisms to emerge. Essential in preventing this will be to collect high quality data in hospitals and on farms, to understand what levels of resistance are present now, and how the organisms share their genes, a process that can result in rapid spread of resistant traits. A key aspects of this is also to understand how antibacterial drugs are used in practice, how they are procured and what drives individual and collective decision making about their use. Our programme will investigate these different aspects and work with partners in Kenya and internationally who make policy, in order to develop long term surveillance tools, plans to limit the spread of resistance and advice to the public to conserve these important drugs.