In the Makerere University's 74th graduation ceremony, James Muleme is set to be awarded a PhD in Public Health, specializing in the intricate dynamics of Antimicrobial Resistance (AMR) at the human-animal-environment interface within Wakiso district.
His thesis, titled "Reservoirs, transmission and antibiotic resistance profiles of Extended Spectrum Beta Lactamase-Producing Escherichia Coli at the Human-Animal-Environment interface among Farming Communities in Wakiso District, Central Uganda," probes into the reservoirs, transmission, and antibiotic resistance profiles of ESBL-Ec, a critical zoonotic pathogen.
Academic Journey
Armed with a Bachelor's degree in Environmental Health Science and a Master's degree in Veterinary Preventive Medicine, both from Makerere University, Muleme embarked on a multidisciplinary academic journey. His experiences in managing Zoonotic diseases and the concept of One Health played a pivotal role in shaping his career aspirations.
“I initially faced challenges bridging environmental health and veterinary public health. However, recognizing that some of the world's most significant health threats are zoonoses, I was motivated to integrate these two disciplines and contribute to College of Veterinary Medicine Animal Resources and Biosecurity (COVAB) 's objectives. Focusing on the interconnectedness of the human-animal-environment interface and providing clarity to my career aspirations, says Muleme.
Recognizing AMR as a silent threat to global health, Muleme directed his focus towards this crucial issue and his research on ESBL-Ec sheds light on its prevalence, multi-drug resistance, and potential transmission at the human-animal-environment interface, challenging conventional notions of antibiotic use driving AMR.
For Muleme, a Bachelor's studies in Environmental Health Science offered at MakSPH laid the foundation for understanding the intricate relationship between the environment and human health, emphasizing holistic approaches to address health challenges.
He subsequently obtained a Master's degree in Veterinary Preventive Medicine from Makerere University College of Veterinary Medicine Animal Resources and Biosecurity (COVAB). This reinforced his understanding of how human and animal health are intertwined and promoted the concept of One Health. He is well-equipped to tackle important zoonoses, thanks to this interdisciplinary basis, which has shaped his research emphasis with a broad, multidisciplinary mindset.
“I believe that comprehensive solutions require considering the interconnectedness of human, animal, and environmental systems. My research approach involves linking various determinants to understand causative pathways, informing effective interventions and policies,” he says.
About his study
Extended-spectrum beta-lactamase producing Escherichia coli shortened as ESBL-Ec, a bacteria resistant to multiple antibiotics, including critical ones, is a zoonotic pathogen transmitted between humans, animals, and environments.
Classified by the World Health Organization as a critical pathogen, it requires global antimicrobial resistance (AMR) surveillance. Muleme’s PhD research focused on these bacteria to understand AMR dynamics at the human-animal-environment interface.
It was conducted in Wakiso, Central Uganda, using a mixed methods approach, including field epidemiology, laboratory techniques and qualitative methods.
The study discovered a high prevalence of ESBL-Ec at 25 percent in apparently healthy households, indicating its presence in communities. It revealed multi-drug resistance, including resistance to carbapenems and genes linked to colistin resistance.
“Similar resistance patterns in bacteria from humans, animals, and the environment suggest potential transmission at the interface. This challenges the notion that irrational antibiotic uses alone drives AMR, emphasizing the need for a holistic approach. The findings highlight the importance of human and animal health practices and effective infection prevention and control in mitigating AMR at the household level,” observes Muleme.
Molecular analysis uncovered widespread ESBL genes and shared replicons among isolates from different sources. Cultural norms and human-animal interactions were recognized as key drivers of antimicrobial resistance spillover, resulting in widespread dissemination and unnoticed transmission of ESBL-Ec. The findings recommend culture-driven solutions, improved drug regulation, and collaborative efforts for effective One Health approaches to address AMR.
Holistic Approach to Challenges
“Collaboration with district professionals eased fieldwork, while lab partnerships ensured sample and result integrity. I connected with global scientists for feedback and training. My focus on clear communication aligned with my Public Health PhD. Results were submitted to journals, and presentations were made at multidisciplinary platforms. I plan to involve engaging stakeholders to share my study's findings. This collaborative environment expedited my PhD completion in three years,” says Muleme.
Asked about whether he experienced unexpected challenges or discoveries during his research, Muleme says whereas his focus was on human-animal interactions in a specific environment initially, the research revealed the significant influence of environmental factors.
Also, he notes there was limited evidence of primary studies at this interface, which underscored the necessity for more research like this PhD study.
“The complex interface enriched my research depth, emphasizing the need for a holistic understanding of the Human-Animal-Environment interface. It became evident that collaborative efforts across disciplines and a comprehensive perspective are essential to address the challenges posed by this intricate system,” he shares.
As a Research Associate in the Department of Disease Control and Environmental Health at Makerere University, Muleme’s mission is to apply the insights gained from his PhD research to address disease control and combat antimicrobial resistance.
“I plan to implement integrated public health interventions, considering the interconnectedness of disease transmission and resistance. Collaborating with healthcare professionals, environmental scientists, and policymakers, I aim to form a unified front against antimicrobial resistance.
My focus is on fostering interdisciplinary research and collaboration to develop effective strategies for curbing the spread of resistant pathogens. I also hope to engage with communities to raise awareness about responsible antibiotic use, promoting behavioral changes to contribute to the global efforts in combating antimicrobial resistance,” Muleme says.
Just like Dr. Nicholus Nanyeenya, Muleme has completed a PhD in a span of three years, from provisional admission in July 2021 to thesis submission in August 2023 and successful defense in November 2023. He thinks it is possible for anyone to finish right in time.
“My advice to aspiring researchers is fourfold; Choose supervisors with a track record of guiding PhD fellows, being friendly, result-oriented, and accessible even beyond formal hours; ensure funding for research; prioritize thorough preparation before field data collection, break from routine, and attend key events; and prioritize mental health and allocate time for self-care.
In terms of practical implications, Muleme’s research findings highlight the interdependence of human, animal, and environmental health, advocating for an integrated approach in farming communities.
“This could translate into creating sustainable farming guidelines, minimizing antibiotic dependence, endorsing biosecurity measures, and fostering alternative disease prevention methods,” he says.
Looking ahead, Muleme wants to promote comprehensive strategies addressing the root causes of disease emergence and antimicrobial resistance. This involves collaborating with policymakers, contributing evidence-based recommendations, and shaping policies across healthcare, veterinary, and environmental sectors.
“My focus is on advocating judicious antibiotic use, implementing surveillance systems, and encouraging alternatives. In public health, I intend to guide interventions promoting responsible antibiotic use at the community level through engagement and awareness campaigns. Educational programs emphasizing the One Health perspective can create a collective understanding of combating AMR.
He believes that God was in his favor to journey this far, and expresses gratitude support of supervisors, mentors, funding bodies, and the communities of Wakiso district. “To my supervisors, Professors JC. Ssempebwa, C. Kankya, M. Munyeme, and Dr. D. Musoke, thank you. I am also thankful for the mentorship of Prof. Frederick Makumbi and Prof. Esther Buregyeya, along with Prof. Morten Tryland. I extend my appreciation to my family, research team, and the communities of Wakiso district. I also remember my late mother, Ms. Namubiru Getrude (MHSRIP), whose courage inspired and led me to embark on this PhD journey.”
This research was supported by the Consortium for Advanced Research Training in Africa (CARTA); The Climate change and infectious diseases management: A One Health approach (CIDIMOH) – NORHED funded project, the Government of Uganda through the Makerere University Research and Innovations Fund and the Makerere University School of Public health.
Written by Davidson Ndyabahika
