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School of Public Health
College of Health Sciences, Makerere University

Scaling-up interventions for strengthening antimicrobial stewardship using a One Health approach in Wakiso district, Uganda

Posted on : Monday, December 5, 2022

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The partnership between Nottingham Trent University, Makerere University, Buckinghamshire NHS Health Trust (BHT), and Entebbe Regional Referral Hospital (ERRH) has been promoting Antimicrobial Stewardship (AMS) in Wakiso District since 2019. This collaboration uses a One Health approach and has received funding from the Commonwealth Partnerships for Antimicrobial Stewardship Scheme. Other key stakeholders involved in this project include Wakiso District Local Government, Ministry of Health, other policy makers, media, health practitioners, local leaders, and professionals ranging from pharmacists, microbiologists, environmental health scientists, and animal health experts.

Our most recent funding under CwPAMS 1.5 was aimed at scaling-up AMS interventions in Wakiso district. This phase of the project had several activities mainly at ERRH including training pharmacy staff on conducting Global Point Prevalence Survey (GPPS); conducting a GPPS; carrying out an AMS workshop for members of the medicines and therapeutics committee (MTC); holding a workshop for laboratory staff on AMS / Antimicrobial Resistance (AMR) / microbiology; developing an AMS plan; providing mentorship support on AMS to lower-level health facilities; training health practitioners (private pharmacy staff, other human health and animal health practitioners) and community health workers (CHWs) on AMS / AMR / Infection Prevention and Control (IPC); and increase membership / continue to engage members of the earlier established Communities of Practice (COPs) on AMS. Both the Uganda and UK teams were involved in co-designing and implementing the interventions.

Mr. Filimin Niyongabo from MakSPH (standing) and Dr. Jody Winter from Nottingham Trent University (on screen) facilitating a blended AMR / AMS / IPC workshop for private pharmacy staff, lower-level health facility workers, and veterinary officers in Entebbe.
Mr. Filimin Niyongabo from MakSPH (standing) and Dr. Jody Winter from Nottingham Trent University (on screen) facilitating a blended AMR / AMS / IPC workshop for private pharmacy staff, lower-level health facility workers, and veterinary officers in Entebbe.

Despite the disruption and delay in commencement of project activities because of the COVID-19 pandemic, the project team used this setback to educate CHWs about COVID-19 prevention which also comprised good hand hygiene practices and avoidance of self-medication which all contribute to AMS practices in the community. In addition, the mode of AMS / AMR / IPC training of health practitioners became blended, with the UK team facilitating virtually. The UK team also supported ERRH remotely in drafting the hospital’s AMS Action Plan. During this phase of the project, our partnership supported 3 ERRH MTC meetings and conducted 1 GPPS where 4 ERRH staff and 4 pharmacy interns were trained in GPPS data collection. The project also trained 52 health practitioners, and 151 CHWs on AMR / AMS / IPC. In addition, membership of the two multidisciplinary online Communities of Practice (CoPs) for health professionals and students grew to over 540 and 250 respectively. Most of our post-training assessments showed that participants had gained knowledge about AMR and AMS. The capacity built within ERRH pharmacy staff was used to support mentorship of five lower-level health facilities neighbouring ERRH. By the end of this mentorship, the health workers at these health facilities had prioritized AMS through drafting AMS workplans and carrying out community education among many others.

A group photo taken after an AMR / AMS / IPC workshop for the Medicines and Therapeutics committee at Entebbe Regional Referral Hospital.
A group photo taken after an AMR / AMS / IPC workshop for the Medicines and Therapeutics committee at Entebbe Regional Referral Hospital.

 A quote following an AMS mentorship session of a lower-level health facility:

 “The interventions suggested during the mentorship have been feasible. Among which was the creation of an AMS committee. We have also been guided how we can stop antimicrobial resistance. Previously, we did not know how to talk to patients but now with the different education materials we have, it is easier. We now have posters that increase awareness, and platforms from which we get information about AMS. We are very thankful for this mentorship.” Officer in-charge of a lower-level health facility, Wakiso District 

Some community health workers pose with their certificates for a group photo with Dr. David Musoke (in blue shirt and tie) following a training on AMR / AMS / IPC.
Some community health workers pose with their certificates for a group photo with Dr. David Musoke (in blue shirt and tie) following a training on AMR / AMS / IPC.

 

In conclusion, we thank our funders for enabling us to contribute to the various strategic objectives of Uganda’s AMR National Action Plan (2018- 2023). The human and animal health workers as well as CHWs trained, and communities reached during the project are change agents in their respective settings regarding proper access and use of antimicrobials.

Human and animal health practitioners poses for a photo after a training on antimicrobial stewardship in Entebbe.
Human and animal health practitioners poses for a photo after a training on antimicrobial stewardship in Entebbe.

This project, led by Dr. David Musoke from Makerere University School of Public Health and Prof. Linda Gibson from Nottingham Trent University, was funded by the Commonwealth Partnerships for Antimicrobial Stewardship Scheme (CwPAMS), an initiative of Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET) under the Fleming Fund of the UK Department of Health and Social Care (DHSC).

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