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BackgroundAntimicrobial resistance is a worldwide public health emergency that requires urgent attention. Most of the effort to prevent this coming catastrophe is occurring in high income countries and we do not know the extent of the problem in low and middle-income countries, largely because of low laboratory capacity coupled with lack of effective surveillance systems. We aimed at establishing the magnitude of antimicrobial resistance among Escherichia coli and Klebsiella pneumoniae carried in the gut of out-patients from pastoralist communities of rural Western Uganda.MethodsA cross-sectional study was carried out among pastoralists living in and around the Queen Elizabeth Protected Area (QEPA). Stool samples were collected from individuals from pastoralist communities who presented to the health facilities with fever and/or diarrhea without malaria and delivered to the microbiology laboratory of College of Health Sciences-Makerere University for processing, culture and drug susceptibility testing.ResultsA total of 300 participants fulfilling the inclusion criteria were recruited into the study. Three hundred stool samples were collected, with 209 yielding organisms of interest. Out of 209 stool samples that were positive, 181 (89%) grew E. coli, 23 (11%) grew K. pneumoniae and five grew Shigella. Generally, high antibiotic resistance patterns were detected among E. coli and K. pneumoniae isolated. High resistance against cotrimoxazole 74%, ampicillin 67%, amoxicillin/clavulanate 37%, and ciprofloxacin 31% was observed among the E. coli. In K. pneumoniae, cotrimoxazole 68% and amoxicillin/clavulanate 46%, were the most resisted antimicrobials. Additionally, 57% and 82% of the E. coli and K. pneumoniae respectively were resistant to at least three classes of the antimicrobials tested. Resistance to carbapenems was not detected among K. pneumoniae and only 0.6% of the E. coli were resistant to carbapenems. Isolates producing ESBLs comprised 12% and 23% of E. coli and K. pneumoniae respectively.ConclusionWe demonstrated high antimicrobial resistance, including multidrug resistance, among E. coli and K. pneumoniae isolates from pastoralist out-patients. We recommend a One Health approach to establish the sources and drivers of this problem to inform public health.

Purpose: To describe the epidemiology of Microbial Keratitis (MK) in Uganda. Methods: We prospectively recruited patients presenting with MK at two main eye units in Southern Uganda between December 2016 and March 2018. We collected information on clinical history and presentation, microbiology and 3-month outcomes. Poor vision was defined as vision < 6/60). Results: 313 individuals were enrolled. Median age was 47 years (range 18-96) and 174 (56%) were male. Median presentation time was 17 days from onset (IQR 8-32). Trauma was reported by 29% and use of Traditional Eye Medicine by 60%. Majority presented with severe infections (median infiltrate size 5.2 mm); 47% were blind in the affected eye (vision < 3/60). Microbiology was available from 270 cases: 62% were fungal, 7% mixed (bacterial and fungal), 7% bacterial and 24% no organism detected. At 3 months, 30% of the participants were blind in the affected eye, while 9% had lost their eye from the infection. Delayed presentation (overall p = .007) and prior use of Traditional Eye Medicine (aOR 1.58 [95% CI 1.04-2.42], p = .033) were responsible for poor presentation. Predictors of poor vision at 3 months were: baseline vision (aOR 2.98 [95%CI 2.12-4.19], p < .0001), infiltrate size (aOR 1.19 [95%CI 1.03-1.36], p < .020) and perforation at presentation (aOR 9.93 [95% CI 3.70-26.6], p < .0001). Conclusion: The most important outcome predictor was the state of the eye at presentation, facilitated by prior use of Traditional Eye Medicine and delayed presentation. In order to improve outcomes, we need effective early interventions.

As population increases in urban areas, the domestic and industrial activities increase resulting in an increase in the volumes of wastewater and anthropogenic pollution, hence posing a threat to public health and environment. This study assessed the physical chemical quality of two main sewage plant effluents discharging into River Rwizi. Effluent water samples were analyzed for dissolved oxygen, colour, turbidity, total suspended solid, total iron, phosphates, alkalinity, magnesium, calcium carbonate, temperature, pH, ammonium, electrical conductivity, chloride and nitrates. Parameters were analyzed following standard methods of APHA (1985). The values obtained were compared with EPA (2001), NWSC (2015) and NEMA (1999) standards for waste water. Results showed that the mean values most of the parameters tested were higher than the recommended EPA, NWSC and NEMA standards. The mean colour was 1627.67˚C and 1414.33˚C in Kakoba and Taso sewage effluents respectively compared to EPA (20-150), NWSC (500) and NEMA (300) standards (p > 0.05). The mean alkalinity was 1390.17 mg/l and 1308.33 mg/l for Kakoba and Taso respectively compared with EPA (400) and NWSC (800) standards. DO had a mean concentration of 68.27 mg/l and 63.03 mg/l in Taso and Kakoba respectively compared to EPA and NEMA standard of 5 mg/l. Mg was 243.29 mg/l and 246.49 mg/l in Kakoba and Taso sewage effluents respectively compared to NEMA standard for waste water of 100 mg/l (p > 0.05). The mean pH was 8. 26 and 8.16 in Taso and Kakoba sewage effluents respectively compared to NWSC and NEMA standard of 6.0 -8.0. Phosphate mean concentration levels were 32.2 mg/l and 27.11 mg/l for Taso and Kakoba respectively compared to standards of EPA (0.5 -0.7 mg/l) and NEMA Journal of Water Resource and Protection sewage effluents respectively compared to NWSC maximum permissible limit of 5 mg/l. The mean NH 4 concentration was 385.33 mg/l (Kakoba) and 50.0 mg/l (Taso) compared to the EPA guideline range (0.2 -4 mg/l). Chloride (Cl) had a mean of 833.33 mg/l in Kakoba compared to EPA (250 mg/l), NWSC and NEMA (500 mg/l) standards. Therefore the study recommends for effective treatment of waste effluents from Kakoba and Taso sewage treatment plants before recycling in order to avoid pollution of river Rwizi.