World Antibiotic Awareness Week in Albania

Albania observed World Antibiotic Awareness Week (WAAW) on 14–20 November 2016 with a range of activities involving citizens, civil society organizations, health care professionals, academia and government institutions. This included the presentation of findings from an important survey on the knowledge, attitudes and practices of the Albanian population regarding the control and prevention of antimicrobial resistance (AMR), conducted in October and November 2016.

Using an evidence-informed policy-making approach, and with the aim of providing the country’s health care professionals and policy-makers with sound information, the survey focused on adult primary health care users in the urban and rural areas of 3 districts, including the capital. The survey’s overall response rate was 94%, and a total of 1223 people participated.

It used the questionnaire from WHO’s Antibiotic resistance: multi-country public awareness survey (2015). It asked participants about their use of antibiotics (in the last month, last 6 months, last year and more than a year ago), about how they obtained antibiotics in drugstores (with or without a prescription), and about their knowledge of antibiotics and AMR.

The survey found a high prevalence of antibiotic use in the last month, last 6 months and last year, especially in rural areas and among people with less education. It also found a correlation between low levels of knowledge on the proper use of antibiotics and younger age, less education and rural residence. Similarly, participants who were younger, less educated and/or living in suburban and rural areas had lower levels of understanding of AMR. Overall, results indicated a high level of misunderstanding about many aspects of AMR among Albanian adults.

Leaders of the project presented the survey’s main findings at 2 meetings during WAAW.

The first was the Antimicrobial Resistance Public Health Meeting, held on 17 November. Participants included health promotion specialists from all districts of Albania as well as professionals from the country’s Institute of Public Health. Dr Arjan Bregu, Director of the Institute of Public Health, and Dr Gazmend Bejtja of the WHO Country Office in Albania chaired the meeting.

Presenters explained that the survey constitutes one of the very first reports on the knowledge, attitudes and practices of the Albanian adult population regarding AMR. They emphasized that further studies including nationwide, population-representative samples of adults should be conducted in order to replicate and confirm the findings of the current survey.

Participants agreed that the survey could help to shape future public awareness efforts in Albania, and also to evaluate the impact of these efforts. They noted that a rigorous response to AMR requires strong leadership, advocacy and resources, and that the Albanian Government must play a central role in providing stewardship and coordination.

The survey results were also presented at the Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) network meeting on 18 November. The AMR Intersectoral Technical Committee organized the meeting in collaboration with the Albanian Ministry of Health and with support from WHO/Europe. Participants included representatives of the public health sector; infectious diseases, microbiology and pneumology departments in universities and health services; and veterinary and agricultural organizations.

Mr Ilir Beqaj, Minister of Health of Albania, Dr Nazira Artykova, WHO Representative in Albania, and Professor Anyla Bulo, Vice Rector of the University of Medicine in Tirana, gave opening remarks. Professor Perlat Kapisyzi, Chair of the AMR Intersectorial Technical Committee, chaired the meeting.

Opinion leaders from different fields, policy-makers and WHO representatives discussed a new approach to tackling AMR and formulated strategic objectives for moving forward. They agreed that the new national action plan on AMR, endorsed by the AMR Intersectoral Technical Committee, is the prerequisite for systematic action.

Participants also made reference to the study visit of a team of Albanian representatives from Human Health, Animal Health and Agriculture to the Netherlands on 18–21 September 2016. WHO/Europe supported the visit, which was organized in collaboration with the Netherlands Ministry of Health, Welfare and Sport; the Directorate of Public Health; the University of Utrecht’s Faculty of Medicine and WHO Collaborating Center for Reference and Research on Campylobacter; and the National Institute for Public Health and the Environment. This study visit highlighted 3 good practices for AMR control that can be realistically adopted in Albania:

• setting clear, government-defined targets;
• prohibiting the use of various specific antibiotics in the livestock industry, apart from therapeutic use in individual animals based on good diagnostics and according to professional guidelines; and
• empowering diagnostic microbiology laboratories in health care.

Specialists from the Institute of Public Health also explained how the new Law on the Control of Infections and Infectious Diseases in Albania is aligned with European Union legislation.

Other important talks focused on quality of laboratory diagnosis and the External Quality Assessment exercise, conducted in Albania through CAESAR for 3 consecutive years; the need for a national network of AMR reference laboratories; challenges faced by the Albanian health system in terms of infection prevention and control; reporting methods and databases; the importance of pharmacists in encouraging the proper use of antibiotics; and basic protocols for combining antibiotics. From a food safety perspective, speakers also shared the findings of a recent study on the occurrence of Salmonella and Campylobacter spp. infections in humans and broiler chickens.

Altogether, the meeting featured 4 sessions and 16 talks. Participants openly discussed each topic and shared their thoughts and experiences on how to improve the current situation.

Also during WAAW, the Ministry of Health of Albania launched its updated Guidelines on Infection Control in Communities and Health Care Institutions. The WHO Country Office supported the Ministry in developing and updating the Guidelines, pursuant to the requirements of Law No. 15/2016 “On the prevention and fighting of infections and infectious diseases in the Republic of Albania”. The Guidelines were officially approved on 21 November 2016.

The WHO Country Office also supported Albania in the development of information and promotional materials on AMR for WAAW. Posters and leaflets were distributed in pharmacies, health care institutions, universities, schools and kindergartens, encouraging health care workers and the public to become “antibiotic guardians”.