Beyond the laboratory: making antimicrobial resistance everyone´s conversation

¹Microbiology Department, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya, ²Department of Applied Health Sciences, School of Health Sciences, Kisii University, Kisii, Kenya

^&Corresponding author
Silas Onyango Awuor, Microbiology Department, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya

Commentary    

Antimicrobial resistance (AMR) is one of the most serious global public health threats of our time. It occurs when bacteria, viruses, fungi, and parasites evolve over time and no longer respond to medicines that were once effective against them, making infections harder to treat and increasing the risk of disease spread, severe illness, and death [1]. What were once easily treatable common infections, wound infections, pneumonia, and food borne diseases can now become prolonged illness or death. Yet despite its enormous consequences, we remain largely silent about AMR. That silence is especially harmful to our country, Kenya, and within our 47 counties, where rural communities often bear the brunt of its impact. Why do we speak so much on TB, HIV/AIDs and other conditions, and we are forgetting AMR? Does it mean that our people are safe from this, yet every day 5-10 patients lose their lives due to AMR among the daily total deaths we do experience in our health facilities?

Understanding the AMR threat in Kenya

Within our country, Kenya, AMR is already present in both human, environmental, and animal health systems. Resistant bacteria have been identified in common pathogens such as Escherichia coli and Staphylococcus aureus, including strains resistant to widely used antibiotics like third generation cephalosporins and penicillin. Resistance to multiple antibiotics, including carbapenems and other last line drugs, has been documented in clinical settings. This can be justified by research done by Awuor et al. [2], with the current study done in aquaculture showing an alarming threat to our market fish being contaminated with Escherichia coli, in which most of the isolates show higher resistance to commonly used antibiotics within our market. Nevertheless, due to gaps in surveillance, specifically outside major urban hospitals, the true burden of AMR remains unknown and therefore necessitates introducing culture before the administration of antibiotics to patients. There is no nationwide, systematic dataset that captures resistance across all regions, particularly in rural counties where diagnostic facilities are few and far between, with no better diagnostic equipment within these facilities.

Why aren't we talking more about it?

Antimicrobial resistance is invisible and technical

Unlike outbreaks that make headlines such as HIV/AIDS, tuberculosis, cancer, Ebola, cholera, or COVID-19, antimicrobial resistance (AMR) develops slowly and often quietly, earning it the description of a "silent pandemic" in global health discourse [3]. Resistant infections do not suddenly surge overnight; they creep up as treatment failure, prolonged illness, and repeated hospital visits. The biological processes behind resistance are technical and complex, making it harder to capture attention through simple narratives or short news reports. This technical complexity leaves many people, including policymakers, community leaders, and the public, without a clear grasp of what AMR is and why it should matter. Without vivid stories of dramatic outbreaks or immediate crisis, AMR doesn't trigger the urgency that other health threats do.

Competing health priorities

Kenya continues to battle many high-profile diseases such as malaria, HIV/AIDS, tuberculosis, maternal and child health challenges, and periodic outbreaks of vaccine-preventable diseases. These high visibility issues attract most of the public discourse, funding, and political attention, often at the expense of less visible threats like AMR, hence making it not a talk of the day.

Knowledge gaps at the community level

Many Kenyans in both rural and urban settings use antibiotics without prescriptions for humans and animals. Studies in pastoral and farming communities show that individuals often administer antibiotics based on experience, intuition, or past outcomes rather than medical guidance. This has also been confirmed in previous work, which revealed low awareness of appropriate antibiotic use among aquaculture farmers [4]. There are limited veterinary and health services, and antibiotics are frequently purchased over the counter. In one study, most livestock-owning households reported buying antibiotics from agro vet shops without veterinary prescriptions and administering them themselves, often using medication for growth promotion or disease prevention without observing proper withdrawal periods, hence introducing unsafe products for human consumption within our markets [4].

Weak surveillance and data systems

Effective public health action requires good data. In Kenya, AMR surveillance is still limited in scope and coverage. Only a small number of health facilities actively submit data on resistance patterns, and most surveillance focuses on hospital settings, leaving rural and community settings understudied. Without clear, local data on the scale of resistance and its impacts, the extent of the problem remains abstract for many stakeholders, including county leadership and local communities.

Economic incentives perpetuate misuse

Economic realities also play a role. Antibiotics are widely available in private agro vet shops and pharmacies, and they contribute significantly to the revenue of these outlets. In the absence of strict regulatory enforcement, farmers and families can access antibiotics without prescriptions, which reinforces misuse patterns.

The hidden costs of silence for AMR to our communities

Human health

In both rural and urban Kenya, AMR increases the difficulty of treating once straightforward infections. Without effective antibiotics, even simple bacterial infections like urinary tract infections, skin wounds, and pneumonia can become severe or life-threatening. Patients may require second- or third-line drugs, which are more expensive, less accessible, and sometimes unavailable in rural facilities. Resistance also translates into higher medical costs, longer hospital stays, and increased mortality burdens that families in low-income rural settings struggle to shoulder.

Livestock and food security

Livestock are central to rural livelihoods. Chickens, fish, cattle, goats, and sheep provide food, income, and security for families. But when bacteria in animals or aquaculture products become resistant due to misuse of antibiotics, the consequences ripple through the whole community. Among rural communities in Kenya, AMR increases the difficulty of treating once straightforward infections. Without effective antibiotics, even simple bacterial infections-like urinary tract infections, skin wounds, and pneumonia can become severe or life-threatening. Patients may require second or third line drugs, which are more expensive, less accessible, and sometimes unavailable in rural facilities. Resistance also translates into higher medical costs, longer hospital stays, and increased mortality burdens that families in low income rural settings struggle to shoulder.

Livestock and food security

Livestock are central to rural livelihoods. Chickens, cattle, goats, and sheep provide food, income, and security for families. But when bacteria in animals become resistant due to misuse of antibiotics, the consequences ripple through the whole community. Antibiotics and their residues often enter soil and water through animal manure and waste. This environmental contamination creates reservoirs where resistant bacteria can thrive and spread. For rural communities relying on shared water sources, this represents another pathway for AMR transmission.

Economic losses

Beyond healthcare costs, AMR affects productivity. Animals that fall ill and fail to recover due to resistant infections cannot provide milk, meat, or labor. Farmers may face losses that threaten household food security. These economic strains deepen poverty and limit opportunities for rural families to invest in education, nutrition, and better farming practices.

Kenya's policy response: a start, not enough?

Kenya has recognized the growing threat of AMR and taken important steps: the country developed a National Policy on Prevention and Containment of AMR, aligning with global strategies to improve awareness, strengthen surveillance, reduce infections, optimize antimicrobial use, and invest in new diagnostics, vaccines, and treatments. A second National Action Plan on antimicrobial resistance (2023-2027) builds on earlier efforts and expands multisectoral coordination, including the scaling up of surveillance sites and antimicrobial stewardship actions across human and animal health sectors [5]. County governments, such as Kisumu County, Nairobi County, Nakuru County, and Nandi County among others, have launched local AMR policies and work plans, bringing education and farmer engagement to the grassroots, hence promoting One Health issues. But despite these steps, challenges remain: surveillance is still uneven, enforcement of antibiotic prescription laws is weak, and community education is limited in scale and reach.

Speaking out: why it matters

Awareness empowers change

Knowledge is the foundation for behavior change. Community education campaigns can help rural families understand when antibiotics are necessary, the dangers of misuse, and the importance of completing prescriptions. Local leaders, health workers, and farmers' groups must be empowered to spread clear, practical messages.

Data drives policy

Investing in wider surveillance, especially in rural health facilities and community settings, will produce locally relevant data that can inform policy decisions and guide stewardship programs. When counties see evidence of resistance patterns in their own villages, they are more likely to act with urgency.

One health requires collaboration

Antimicrobial resistance cannot be addressed in isolation. A One Health approach integrating human, animal, and environmental health is essential. Strengthened coordination between health officials, veterinarians, agricultural extension services, and environmental managers can ensure that interventions are holistic and effective [6].

Grassroots engagement multiplies impact

Antimicrobial resistance action must move beyond national policymaking into the daily lives of rural people. Grassroots organizations such as the One Health AMR Coalition work with communities to raise literacy, advocate for better practices, and promote infection prevention and control.

Call to action

Antimicrobial Resistance (AMR) is no longer a problem confined to laboratories, hospitals, or scientific journals; it is a growing threat affecting families, communities, food systems, and the future of healthcare itself. The fight against AMR cannot be left to scientists and clinicians alone. It demands collective awareness, responsible action, and public engagement at every level of society. We must promote responsible antibiotic use, strengthen infection prevention practices, invest in research and diagnostics, and support public education that empowers communities to understand the dangers of misuse and overuse of antimicrobials. Every unnecessary antibiotic taken today risks weakening treatment options for tomorrow.

Healthcare facilities must strengthen antimicrobial stewardship programs. Communities must embrace hygiene, vaccination, and preventive healthcare. Educational institutions must integrate AMR awareness into learning spaces. Policymakers must prioritize sustainable investments in surveillance, laboratory systems, and innovation. Most importantly, conversations about AMR must move beyond scientific circles and become part of everyday public dialogue. Awareness creates responsibility, and responsibility drives change. The future effectiveness of antibiotics depends on the decisions we make today. If we remain silent, resistance will continue to grow unnoticed. But if we act together through awareness, collaboration, and responsible practice, we can protect one of medicine's greatest achievements for future generations.

Conclusion     

Antimicrobial resistance is not a distant or abstract threat; it is already affecting health, livelihoods, and economic stability in both Kenya's urban and rural communities. The silence that surrounds it allows misuse to continue unchecked, slows policy action, and leaves vulnerable populations at risk. Breaking that silence is not just possible; it is essential. Awareness and education must spread beyond urban centers into villages. Surveillance must expand, and communities should be partners, not spectators, in the fight against AMR. Antimicrobial resistance is a threat to our families, our farms, and our future. Speaking out, sharing knowledge, and acting collectively can ensure that life saving medicines remain effective for generations to come.

Competing interests     

The author declares no competing interests.

Authors' contributions     

The author has read and approved the final version of this manuscript.

References