Health workers’ perspectives on the occurrence and management of antimicrobial resistance at the human-animal-environment interface in Uganda

Abstract

Background The role of human, animal and environmental health workers is increasingly being recognized and linked to the emergence and transmission of antimicrobial resistance (AMR). Little has been done in low and middle-income countries despite the seriousness of this public health challenge. Our study explored the perspectives of health workers on the occurrence, transmission, and management of AMR at the human-animal-environment interface. Methods We conducted a descriptive qualitative study within Wakiso district, central Uganda between August and October 2022, using focus group discussions (4) with village health teams (VHTs) and key informant interviews (12) with other cadres of health workers. Data were managed in NVivo 12 and analyzed using thematic network analysis exploiting both deductive and inductive approaches. Findings: Animal health workers had better knowledge of AMR occurrence compared to their counterparts from the human and environmental health sectors. VHTs had a limited understanding of the AMR concept, even though they believed that drug-resistant infections were a growing concern in the community. Advancement in technology was viewed as being both a facilitator and a barrier to AMR occurrence and management. Cultural norms underlying animal production and close interactions between humans and animals were reported as key drivers for AMR spillover and amplification. Laxity in policy implementation, unskilled human resource, and weak surveillance systems for AMR were reported to be the underlying gaps in its management. Most participants advocated for a One Health strategy in combatting AMR at a community level. Conclusion Culture-driven solutions, diagnosis before treatment, more sensitization of community health workers, and improved regulation of drug use as well as multi-sectoral collaborations may create a suitable environment for the implementation of one-health approaches in the management of AMR.