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Kisubi - Entebbe The First National Conference on Antimicrobial Resistance The First National Conference on Antimicrobial Resistance Promoting Best Antimicrobial Practices in Uganda Wash & Wills Hotel, Mbale 21st – 22nd November 2016 1 TABLE OF CONTENTS WELCOME……………………………………………………………………........... 3 PARTICIPANTS IN THE ORGANIZATION OF THE CONFERENCE…..... 4 FUNDERS………………………………………………………………………......... 5 INFORMATION ABOUT MBALE………………………………………….......... 6 MESSAGES…………………………………………………………………….....…. 7 AGENDA DAY ONE……………………………………………………………........ 12 Plenary 1………………………………………………………………………......….. 12 Plenary 2………………………………………………………………………......….. 12 Breakout Session 1……………………………………………………………...….. 13 Plenary 3……………………………………………………………………….......…. 13 Breakout Session 2……………………………………………………………...….. 13 AGENDA DAY TWO………………………………………………………….......… 14 Plenary 4…………………………………………………………………………........ 14 Plenary 5…………………………………………………………………………........ 14 Breakout Session 3………………………………………………………………..... 14 Round Table Discussion……………………………………………………………. 15 Plenary 6…………………………………………………………………………........ 15 ABSTRACTS……………………………………………………………………......... 16 COALITION AGAINST RESISTANCE TO PESTICIDES & ANTIMICROBIALS’........................................................................... 45 The First National Conference 2 on Antimicrobial Resistance The First National Conference Theon AntimicrobialFirst National Resistance Conference on Antimicrobial Resistance WELCOME Dear Participants, The Steering Committee warmly welcomes you to the First National Conference on Antimicrobial Resistance being hosted at Wash and Wills Hotel, Mbale, Eastern Uganda, from 21st – 22nd November 2016. The theme of the conference “Promoting Best Antimicrobial Practice in Uganda” resonates with the agenda of AMR Global Action Plan that Uganda has embraced. Together for the first time in Uganda, various stakeholders have come together to listen to one another and to use this platform to accelerate formation of a multisector response. The different stakeholders include players that contribute to increasing resistance, those most adversely affected by it, and those critical to the control and prevention of the problem. This conference is being held at a crucial time in this country; the Ministry of Health has setup AMR surveillance system and it is engaging the Office of the Prime Minister to constitute a multi-sectoral National AMR Committee to draft the National Action Plan; Ministry of Agriculture, Animal Industry and Fisheries has developed a National Plan to contain resistance to acaricides, which in turn will reduce the need for antimicrobials; National Drug Authority is developing guidelines towards responsible and prudent use of antibiotics in animals. The conference will synergize these and other upcoming efforts. It is our sincere hope that this conference will enrich your perspective in the efforts to mitigate antimicrobial resistance in Uganda. Sincerely 2016 National Steering Committee, AMR-Conference 3 PARTICIPANTS IN THE ORGANIZATION OF THE FIRST AMR-CONFERENCE Allen Mukhwana, Uganda Virus Research Institute Bonaventure Ahaisibwe, Seed Global Health Charles Mutabazi, Busitema University Faculty of Health Sciences Christian Acemah, from Uganda National Academy of Sciences Constance Basirika, Busitema University Faculty of Health Sciences Franklin Kizito, Infectious Diseases Institute George Mutumba, Busitema University Faculty of Health Sciences Grace Nakuku, Busitema University Faculty of Health Sciences Jacobs Iramoit, Busitema University Faculty of Health Sciences Jenifer Lasman, Busitema University Faculty of Health Sciences Jolly Akullo, Busitema University Faculty of Agriculture Joseph L. Mpagi, Busitema University Faculty of Health Sciences Kenneth Mugabi, Ministry of Agriculture, Animal Industry and Fisheries Lamorde Mohammed, Infectious Diseases Institute Paul Kyambadde, Ministry of Health Paul Oboth, Busitema University Faculty of Health Sciences Paul Waako, Busitema University Faculty of Health Sciences Pauline Byakika, Makerere University College of Health Sciences Peter Masaba, Busitema University Faculty of Health Sciences Peter Olupot-Olupot, Busitema University Faculty of Health Sciences Priscilla Kanziga, Infectious Diseases Institute Rebecca Arakit, Busitema University Faculty of Health Sciences Rebecca Nekaka, Busitema University Faculty of Health Sciences Richard Walwema, Infectious Diseases Institute Stephen Baguma, Uganda National Academy of Sciences Vincent Kayizzi, National Drug Authority William Lali Ziras, World Health Organization Winnie Wafula, Busitema University Faculty of Health Sciences Yahaya Gavamukulya, Busitema University Faculty of Health Sciences The First National Conference 4 on Antimicrobial Resistance The First National Conference on Antimicrobial Resistance FUNDERS • Busitema University Faculty of Health Sciences (Uganda), • Epicentre (France) • Makerere University-Institute of Infectious Disease GHSP (Uganda) • Massachusetts General Hospital (US) • Medilink Lab and Surgicals (Kenya) • Peace Corps (Us) • President’s Emergency Plan for Aids Relief (US) • Seed Global Health (US) • USAID/Uganda Health Supply Chain (Uganda) 5 INFORMATION ABOUT MBALE Mt Elgon Region Mount Elgon, an extinct volcano that straddles Uganda-Kenya border, is the 8th highest mountain in Africa and has the largest base area of any freestanding volcano in the world. Total area is 2,304 km2, of which 2045 km2 is a protected and makes up the Mt Elgon National Park. The Region comprises the districts of Manafwa, Bududa, Mbale, Sironko, Bulambuli, Kapchorwa, Kween, and Bukwo. It is home to two main tribes, Bagisu and Sabinyi. Most people in Mt Elgon region live in rural areas; only 6.6 percent of the population lives in urban areas compared to the national average at 25.6 per cent. Mbale District Mbale District is named after the largest city in the district, Mbale, which also serves as the main administrative and commercial centre in the Region. It is located approximately 245 kilometres by road, northeast of Kampala, the capital of Uganda. Mbale Town Mbale town is relatively safe which makes it safe to walk the main streets at night without too much fear of getting mugged or robbed. The center of the city is relatively clean, the bars and nightclubs are fun, and there are plenty of restaurants. Most of the large banks, offices and big hotels are situated in the Town centre. Things to Do in Mbale Hiking experience on Mt Elgon Enjoy game drive in Mt Elgon National Park Enjoy Weekend at Sipi Falls Witness Traditional Male Circumcision (taking place in 2016) Tourist Attractions in Mbale Mount Elgon National Park Wanale Forest Reserve Sipi Falls Bull fighting competition Simu and Sisi Falls Bukigai Hills The First National Conference 6 on Antimicrobial Resistance The First National Conference on Antimicrobial Resistance MESSAGE FROM AMR-CONFERENCE CHAIRMAN One of the most fascinating qualities of humanity is our ability to adapt. There is no other species that has been able to sustain existence on every continent and even venture past the boundaries of this planet. Human beings have been able to adapt to different conditions through observation, persistence, reasoning and luck. It was by luck that a little less then one hundred years ago, Alexander Fleming transformed health care. It was on the morning of 3rd September, 1928 that this researcher observed that his cultures of Staphylococci had accidently become infected by a fungus, from the Penicillium genus. Dr. Fleming observed that the bacteria near the fungus were dying off but the bacteria farther away from the fungus survived. From this observation, Dr. Fleming hypothesized that the fungus was producing some agent that was toxic to the bacteria. This marked the beginning of the revolutionary age of antimicrobials. Since the discovery of Penicillin, many more antimicrobials have been found and this has led to the reduction of morbidity and mortality. Combining the effects of antimicrobial medications together with improvements in vaccinations, humanity was thought to have a found a way to adapt to the antimicrobial world. Unfortunately, we see that the tide is turning. There is growing evidence that microorganisms are developing resistance to available antimicrobial drugs. During the next two days, we will discuss researchers’ findings on resistance patterns currently being reported in Uganda. We will be hearing from a variety of stakeholders during this conference. Antimicrobial resistance is a multi-sectorial problem and will involve all of us to work together to adapt to this changing microorganism environment. Through this meeting, I call upon members to develop a unified antimicrobial stewardship program for Uganda. Dr. Joseph L. Mpagi, Head Department of Microbiology & Immunology, Busitema University Faculty of Health Sciences 7 MESSAGE FROM THE DEAN OF BUSITEMA UNIVERSITY FACULTY OF HEALTH SCEINCES I take pleasure to welcome you all to Mbale town. We are pleased that a number of distinguished scholars have joined us to share their thoughts about the emerging global challenge of resistance to antimicrobial agents and pesticides. This challenge is compounded by the ever changing trends in globalization. As a young faculty we are positioning ourselves to play a critical role in the economic and social development of Africa through the training of distinguished health professionals and establishing a distinguished research base, focused on areas in which