UGANDA NATIONAL ACADEMY OF SCIENCES Antibiotic Resistance in Uganda: Situation Analysis and Recommendations Antibiotic Resistance in Uganda: Situation Analysis and Recommendations a Uganda National Academy of Sciences A4 Lincoln House Makerere University P.O. Box 23911, Kampala, Uganda Tel: +256-414-53 30 44 Fax: +256-414-53 30 44 E-mail: [email protected] www.ugandanationalacademy.org This is a report of the Uganda National Academy of Sciences (UNAS). UNAS works to achieve improved prosperity and welfare for the people of Uganda by generating, SURPRWLQJVKDULQJDQGXVLQJVFLHQWL¿FNQRZOHGJHDQGE\JLYLQJHYLGHQFHEDVHGDGYLFH to government and civil society. UNAS was founded in 2000 and was granted a Charter E\+LV([FHOOHQF\WKH3UHVLGHQWRI8JDQGDLQ,WLVDQKRQRUL¿FDQGVHUYLFHRULHQWHG RUJDQL]DWLRQ IRXQGHG RQ SULQFLSOHV RI REMHFWLYLW\ VFLHQWL¿F ULJRU WUDQVSDUHQF\ PXWXDO respect, linkages and partnerships, independence, and the celebration of excellence. All rights reserved. Except as otherwise permitted by written agreement, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the prior permission of the copyright owner, the Uganda National Academy of Sciences. Suggested citation: UNAS, CDDEP, GARP-Uganda, Mpairwe, Y., & Wamala, S. (2015). Antibiotic Resistance in Uganda: Situation Analysis and Recommendations (pp. 107). Kampala, Uganda: Uganda National Academy of Sciences; Center for Disease Dynamics, Economics & Policy. ISBN: 978-9970-424-10-8 © Uganda National Academy of Sciences, August 2015 Antibiotic Resistance in Uganda: Situation Analysis and Recommendations i ACKNOWLEDGEMENTS $QWLPLFURELDOUHVLVWDQFH $05 KDVEHHQFODVVL¿HGDVDJOREDOKHDOWKWKUHDWWKDWWKUHDWHQV the gains achieved by anti-infectives. The world is therefore coming together to mobilize efforts to combat the problem. In May 2015, the WHO member countries passed a resolution and approved a Global Action Plan for combating that clearly outlines actions member countries should take to combat the problem (WHO, 2015). The Global Health Security Agenda (GSHA) further subscribes mechanisms to contain the same with leadership from the USA CDC (CDC, 2014). The country assessment by GHSA, done in early 2014, reported absence of coordinated actions in the country addressing the problem. The country had no national plan that brings together all stakeholders to take action. The Uganda National $FDGHP\RI6FLHQFHV 81$6 LVWKHUHIRUHSOHDVHGIRUWKHWLPHO\¿QDQFLDOVXSSRUWIURPWKH Center for Disease Dynamics, Economics & Policy (CDDEP) under the Global Antibiotic Resistance Partnership (GARP) to undertake the baseline information required to inform the next actions to combat the problem. CDDEP supported UNAS to put in place a standing committee on Antimicrobial resistance that constituted itself into GARP-Uganda Working Group to oversee the collection analysis and make recommendations for further actions We heartily acknowledge the two consultants: Dr. Yusuf Mpairwe and Dr. Samuel Wamala who collected analyzed and compiled this report. We thank the reviewers and editors who volunteered their time to provide candid and critical comments to ensure that the report is accurate, effective and credible. We acknowledge serious gaps in the quality of data that was available. Nevertheless it is our sincere hope that this report provides a starting point and will be serve as a baseline and stimulate various stakeholders to come together to take actions aimed at containing the problem. Prof.Prof Denis K.K ByarugabaByarugabab Prof.Prof Nelson K. K Sewankambo Chair, GARP-Uganda Working Group President UNAS ii Antibiotic Resistance in Uganda: Situation Analysis and Recommendations PREFACE Antibiotic resistance was initially viewed as only being a human medical problem in hospital-acquired infections, and usually only in critically ill and immunosuppressed patients. Today, the antibiotic resistance (ABR) phenomena has spread to the point that the general population is considered to be at risk, bringing about an era where many common EDFWHULDOLQIHFWLRQVDUHEHFRPLQJLQFUHDVLQJO\GLI¿FXOWWRWUHDW2IFRQFHUQLQDGGLWLRQWR the use in human beings, is the expanding use of antibiotics in poultry and livestock not only for treating disease, but to promote growth and prevent disease. The ABR phenomenon has become a global concern as geographic borders among countries and continents have become less distinct due to increasing global trade, expanding human and animal populations, societal advances and technological developments. Because of this increasing global connectivity, we now see rapid transport of infectious agents and their ABR genes. This means that ABR, in any obscure microscopic niche anywhere in the world, may consequently exert an impact on the rest of the world. UNAS, with support from the Center for Disease Dynamics, Economics & Policy (CDDEP), has formed a multi-disciplinary committee to study antibiotic resistance and access in Uganda and to participate in an evidence-based policymaking process. This report covers the efforts made by UNAS and CDDEP in constituting an independent expert Global Antibiotic Resistance Partnership (GARP-Uganda) committee, and the production of the situational analysis report on antibiotic resistance and access in Uganda. This report will guide interventions that will be put in place to tackle the problem of antibiotic resistance in Uganda. Dr Mpairwe Yusuf and Dr Wamala Samuel. Antibiotic Resistance in Uganda: Situation Analysis and Recommendations iii TABLE OF CONTENTS ACKNOWLEDGEMENTS....................................................................................................iii PREFACE.................................................................................................................................iv TABLE OF CONTENTS........................................................................................................v Executive Summary.................................................................................................................1 I: INTRODUCTION...............................................................................................................3 Formation of the GARP-Uganda committee.........................................................................4 II: METHODOLOGY............................................................................................................5 III: POPULATION AND HEALTH BACKGROUND (HUMAN AND ANIMAL).........6 3.1 Human demographics...................................................................................................6 3.2 Uganda economic indices............................................................................................HHHHH7 3.3 National health policy................................................................................................HHHHHHH8 3.3.1 Human health budgetary expenditure......................................................................H9 +HDOWK¿QDQFLQJWUHQGV.............................................................................................9 3.3.3 Infrastructure...........................................................................................................HHK0 6WDI¿QJ....................................................................................................................HH11 3.4 The animal sector........................................................................................................HHHHHH11 3.4.1 Animal demographics - livestock and pets.............................................................HH11 3.4.3 Financing in the animal sector................................................................................HH13 4.1 Burden of human disease in Uganda...............................................................................14 4.1.1 Inpatient mortality........................................................................................................HH14 4.1.2 Hospital inpatient morbidity..........................................................................................K5 4.1.3 Leading bacterial infections..........................................................................................H16 4.1.3.1 Pneumonias............................................................................................................16 4.1.3.2 Bacterial meningitis................................................................................................16 4.1.3.3 Septicaemia.............................................................................................................17 4.1.3.4 Acute diarrhoea.......................................................................................................18 4.1.3.5 Respiratory infections.............................................................................................19 4.1.3.6 Urinary tract infections (UTIs)...............................................................................19 4.2 Burden of disease in animals......................................................................20 4.2.1 Contagious bovine pleuralpneumonia (CBPP)..............................................................20 4.2.3 Theileriosis (East Coast fever)........................................................................................21 4.2.4 Poultry diseases in Uganda.............................................................................................21 4.2.5 Pig diseases in Uganda...................................................................................................22