Superbug in New Delhi
Mahatma Gandhi’s wry comment that "Sanitation is more
important than independence" comes back to haunt us once again. Fifty of
171 seepage samples (water pools in streets and rivulets) and 2 of the 50
tap water samples in New Delhi tested positive for bacteria with the
infamous bla NDM-1 mutation while 100 control samples from sewage water in
Wales tested negative. Bacteria included enterobacteria and aeromonads and
11 species in which NDM-1 mutation has not previously been described such
as Shigella boydii and Vibrio cholerae. 20 strains of
bacteria were found in the samples, 12 of which carried blaNDM-1 on
plasmids while isolates of Aeromonas caviae and V cholerae
carried blaNDM-1 on chromosomes. Transfer of the plasmids carrying
the NDM-1 gene was highest at 30°C, the average peak temperature, and
within the daily temperature range of New Delhi from April to October.
This study published by Walsh, et al in The
Lancet Infectious Diseases indicates that the mutation is now circulating
in bacteria present in the environment and is no longer just hospital
derived. The ICMR has invited research proposals from scientists to
generate more evidence. An honest appraisal of the problem will be the
first step to solve this gargantuan problem. The second important
development has been the drafting of the much-needed national policy for
containment of antimicrobial resistance. The policy admits that the use of
antibiotics is inappropriate in 20 per cent to 50 per cent of cases. It
targets the indiscriminate use of antibiotics in food animals and intends
to curb the practice since it ultimately causes drug resistance in humans.
Most importantly, access to third generation antibiotics like carbapenems
is to be restricted to tertiary hospitals. The paradox is that a nation
which writes software for half of the world finds it difficult to develop
a national surveillance system for measuring antibiotic resistance. (The
Lancet Infectious Diseases, May 2011;355-62).
‘SMS for Life’ Project
Stock-outs of malaria treatments at the health facility
level in many sub-Saharan African countries have been a persistent problem
for many years. A stock-out is the unavailability of medicine at the
health facility. To solve this problem an innovative solution has been
designed by a private-public partnership between Novartis and the Ministry
of Health, Tanzania. This unique partnership developed a solution using
mobile phones, SMS messages, internet and mapping technology to visualize
weekly stock inventory of artemisinin combination therapy (ACTs) and
injectable quinine at 129 health facilities and 226 villages. The SMS for
Life pilot project was designed so that health workers in Tanzania used
their personal cell phone to send a weekly SMS stock-count message into a
centralized database. At the start of the pilot, 25% of all health
facilities did not have any ACTs in stock, but by the end, 95% had at
least one ACT dosage form in stock. In addition, 888,000 people in the
three pilot districts had access to all malaria treatments at the close of
the pilot, versus 264,000 people at the start, which helped to reduce the
number of deaths from malaria. The pilot project was launched in 2009 and
its huge success has lead to its nation wide deployment which was
announced on World Malaria day on 25 April 2011. (Malar J 2010; 9:298.)