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Abstract
BackgroundInappropriate use of antimicrobials in both humans and animals is a key driver of antimicrobial resistance (AMR). In addition, human behaviours such as poor disposal of antimicrobials in the environment can increase their exposure to microbes which can impact on humans and animals. However, evidence on access, use and disposal of antimicrobials for humans and animals at community level in Uganda is limited. This study therefore explored access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda.MethodsA qualitative study was conducted that involved focus group discussions (FGDs) and key informant interviews (KIIs). Participants of the FGDs were community health workers (CHWs) and farmers involved in animal husbandry, while key informants included: officials from the Ministry of Health; Ministry of Agriculture, Animal Industry and Fisheries; human and animal health professionals; district health officials; and members of the national AMR surveillance committee. Twelve FGDs were held (8 for CHWs and 4 for farmers) while 15 KIIs were conducted. Thematic analysis in NVivo (version 12) was performed.ResultsFive main themes emerged from the study: access to antimicrobials in humans; access to antimicrobials in animals; use of antimicrobials in humans; use of antimicrobials in animals; and disposal of antimicrobials. Community members mainly accessed antimicrobials for humans from public health facilities such as government health centres, as well as private facilities, including drug shops and clinics. Antimicrobials for animals were obtained from veterinary practitioners and drug shops (both for humans and veterinary). Examples of inappropriate use of antimicrobials in both humans and animals was evident, such as sharing antibiotics among household members, and giving human-prescribed antimicrobials to food-producing animals as growth promoters. While some CHWs returned unused antimicrobials to public health facilities for proper disposal, community members mainly disposed of antimicrobials with general household waste including dumping in rubbish pits.ConclusionsThere is a need to increase awareness among the population on proper access, use and disposal of antimicrobials for both humans and animals. Development of a drug disposal system at community level would facilitate improved waste management of antimicrobials. Together, these measures would help prevent the rate of progression of AMR in communities.
Highlights
Access to antimicrobials has generated impressive improvements in global health in recent years especially in low- and middle-income countries (LMICs)
Participants of the Focus group discussion (FGD) were community health workers (CHWs) and farmers involved in animal husbandry who were purposively selected in consultation with village leaders and community mobilisers in the study area
The results of this study are presented under 5 main themes that emerged from the FGDs and Key informant interview (KII): access to antimicrobials in humans; access to antimicrobials in animals; use of antimicrobials in humans; use of antimicrobials in animals; and disposal of antimicrobials
Summary
Access to antimicrobials has generated impressive improvements in global health in recent years especially in low- and middle-income countries (LMICs). Inappropriate use and exposure of antimicrobials in humans, animals and the environment is thought to be one of the key drivers of antimicrobial resistance (AMR). AMR is a global challenge, its effects are likely to be felt most acutely in LMICs constrained with insufficient health infrastructure, challenges with infection prevention and control, insufficient access to alternative treatment options, as well as inadequate human and financial resources to counter drugresistant infections [11]. Inappropriate use of antimicrobials in both humans and animals is a key driver of antimicrobial resist‐ ance (AMR). Evidence on access, use and disposal of antimicrobials for humans and animals at community level in Uganda is limited. This study explored access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda
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