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

22 August 2022

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 CwPAMS (1.0, extension and 1.5). Other key stakeholders involved in this project include Wakiso district local government, Ministry of Health, other policymakers, 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 (community 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.  

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 among others which all contribute to AMS in the community. In addition, the mode of AMS/AMR/IPC training became blended, with the UK team joining and facilitating virtually. The UK team also supported ERRH remotely in drafting the hospital’s AMS Action Plan through online platforms such as Zoom for meetings and email for review of documents.
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.

We have also trained 168 health practitioners, and 472 community health workers 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 work plans and carrying out community education among many others. 

 A quote following AMS mentorship sessions 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. Before 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 spread 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 

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

This post was written by:

Suzan Nakalawa, Project Volunteer and Grace Lubega - Uganda Project Coordinator - with contribution from the entire partnership members - Nottingham Trent University - Makerere University School of Public Health partnership


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