A One Health Approach to Strengthening Antimicrobial Stewardship in Wakiso District, Uganda

Abstract

Antimicrobial stewardship (AMS), as one of the global strategies to promote responsible use of antimicrobials to prevent antimicrobial resistance (AMR), remains poor in many low-and middle-income countries (LMICs). We implemented a project aimed at strengthening AMS in Wakiso district, Uganda using a One Health approach. A total of 86 health practitioners (HPs), including animal health workers, and 227 community health workers (CHWs) participated in training workshops, and over 300 pupils from primary schools were sensitized on AMR, AMS, and infection prevention and control (IPC). We further established two multidisciplinary online communities of practice (CoPs) for health professionals and students, with a current membership of 321 and 162, respectively. In addition, a Medicine and Therapeutics Committee (MTC) was set up at Entebbe Regional Referral Hospital. The project evaluation, conducted three months after training, revealed that the majority of the HPs (92.2%) and CHWs (90.3%) reported enhanced practices, including improved hand washing (57.3% and 81.0%, respectively). In addition, 51.5% of the HPs reported a reduction in the quantity of unnecessary antibiotics given per patient. This project demonstrates that AMS interventions using a One Health approach can promote understanding of the prudent use of antimicrobials and improve practices at health facilities and in communities.

Access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda: a qualitative study

“…These findings provide evidence on antimicrobial use as recommended by the Uganda AMR NAP and demonstrate the need for a One Health approach in ensuring effective access and use of antimicrobials in both humans and animals. This recognition of the need for a One Health approach in addressing the misuse of antimicrobials in the fight against AMR has been previously articulated by Musoke et al [ 33 ] and Pokharel et al [ 34 ]. In addition, our findings emphasize the importance of implementing the World Health Organization (WHO) global recommendations for containment of AMR such as improving use of antimicrobials, reducing the use of antimicrobials in food-animal production, and improving access to appropriate antimicrobials [ 35 ].…”

Antimicrobial stewardship: Attitudes and practices of healthcare providers in selected health facilities in Uganda

“…Adopting AMS interventions in health facilities is critical in supporting healthcare providers with tools and systems in optimising antibacterial use, reducing the transmission and colonisation of multidrug-resistant bacteria, and lowering the incidence of antimicrobial-related adverse events [ 12 ]. Additionally, the principles of AMS are extensively applied throughout the One-health approach in optimising antibacterial use in both animal and agriculture sectors, where the emphasis is put on judicious and prudent antibacterial use to avoid the spread and development of antibacterial resistance [ 10 , 13 ]. Furthermore, following the approval of the Global Action Plan (GAP) on AMR, member states of the WHO committed themselves to the development and implementation of National Action Plans (NAPs) on AMR [ 3 , 14 , 15 ].…”

“…Several one-health initiatives have trained healthcare providers in health facilities and communities on implementing antimicrobial stewardship in both the human and animal sectors in Uganda [ 13 ]. Additionally, when Uganda drafted its National Action Plan (NAP) on AMR for 2018 to 2023, it placed a greater emphasis on a bottom-up approach that included healthcare providers in regional referral centres, general hospitals, and private not-for-profit (PNFP) organisations, as well as other stakeholders to promote AMS [ 20 ].…”

“…Additionally, when Uganda drafted its National Action Plan (NAP) on AMR for 2018 to 2023, it placed a greater emphasis on a bottom-up approach that included healthcare providers in regional referral centres, general hospitals, and private not-for-profit (PNFP) organisations, as well as other stakeholders to promote AMS [ 20 ]. Despite the Ministry of Health’s continued engagement with heads of health institutions in strengthening existing medicine and therapeutic committees and antimicrobial stewardship programmes, the attitudes and practices of healthcare providers towards AMS remain unknown in Uganda [ 13 , 20 ]. Therefore, the current study investigated healthcare providers’ attitudes and practices towards AMS and associated factors in Uganda’s regional referral hospitals, general hospitals, and private-not-for-profit (PNFPs) health facilities.…”

Comparison of the Logical Use of Parenteral Antibiotics Before and After the Implementation of the Stewardship Program

“…However, antibiotic overuse has had debilitating effects on every aspect of the healthcare system; such examples are increased medication costs, poor patient management, and bacterial resistance (1). The misuse and overuse of antibiotics, which undermines a century of advancement in the discovery of antibiotics and the contribution of antibiotics to health improvement in developing countries (2), is a major influential factor in antibiotic resistance in humans and animals (3).…”