KARACHI: A comprehensive analysis of sewage collected from 74 cities in 60 countries — including Pakistan, India, Afgh­anistan and Bangl­adesh — has yielded the first comparable global data on antimicrobial resistance (AMR) in healthy population in these countries.

It’s for the first time that scientists analysed genetic material in raw sewage samples to asses AMR levels.

Titled ‘Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage’, the paper is published in the Nature Commu­nications journal.

The research is led by the National Food Institute at the Technical University of Denmark and conducted by an international team of scientists including Drs Rumina Hasan and Sadia Shakoor from the department of pathology and laboratory medicine at the Aga Khan University (AKU).

The researchers found the countries participating in sampling in two groups; North America, Western Europe, Australia and New Zealand, which generally have the lowest AMR levels whereas Asia, Africa and South America have the highest levels.

The researchers, taking help from the World Bank population density data, have also estimated the AMR levels in 259 countries and territories and drawn up a world map of resistance in healthy populations.

According to their estimates, the Netherlands, New Zealand and Sweden have the lowest levels of resistance, whereas Tanzania, Vietnam and Nigeria have the highest levels.

Other countries with highest estimated AMR levels include Pakistan, Afghanistan and Bangladesh in South Asia, and Kenya and Uganda in East Africa.

For standardisation, all genetic analysis of samples, including those of Karachi, was carried out at the Dutch partner university.

The analysis also found that high AMR gene abundance was related to poor sanitation and health in many of these countries.

“Findings of this study suggest that impr­o­ving sanitation, health and education as part of the Sustainable Development Goals would be effective strategies for limiting the global burden of AMR,” Dr Hasan said.

Sharing her concerns over the increasing levels of antimicrobial resistance all over the world especially from developing countries, she said that this situation was threatening experts’ ability to treat common infectious diseases, aggravating sufferings of patients due to prolonged illnesses, disability and, in some cases, causing death.

“We need to take immediate actions to manage it. Governments, policymakers and other stakeholders have to come forward with country-specific plans to address the challenge of antimicrobial resistance. Those who have already developed them on paper need to put them into practice,” she said.

Dr Hasan, Dr Shakoor and their team had identified Pakistan’s first outbreak of extensively-drug resistant typhoid in 2016 and led the efforts to manage it with the government and other stakeholders.

“Now we know that poor quality drinking water and an inadequate sewage infrastructure contributed to the spread of a drug-resistant strain of typhoid fever in Pakistan. A functioning infrastructure and investment in civic facilities is essential to prevent such outbreaks in future,” Dr Shakoor said.

Urban sewage, according to the study, was used for analysis because it provides sampling material from a large and mostly healthy population.

“Analysing sewage samples does not require informed consent, thus limiting ethical concerns and has limited practical and logistical barriers for sampling. Addit­ionally, sewage has proven useful for surveillance in the global polio eradication programme,” it says.

The researchers will use the experience gained from the project to develop a worldwide surveillance system that can continuously monitor the occurrence and spread of disease-causing microorganisms and antimicrobial resistance.

Published in Dawn, March 15th, 2019