Use of antibiotics to treat humans and animals in Uganda: a cross-sectional survey of households and farmers in rural, urban and peri-urban settings

Susan Nayiga,Miriam Kayendeke,Laurie Denyer Willis,Clare I R Chandler,Christine Nabirye,Sarah G Staedke

doi:10.1093/jacamr/dlaa082

Abstract

BackgroundUse of antibiotics to treat humans and animals is increasing worldwide, but evidence from low- and middle-income countries (LMICs) is limited. We conducted cross-sectional surveys in households and farms in Uganda to assess patterns of antibiotic use among humans and animals.MethodsBetween May and December 2018, a convenience sample of 100 households in Nagongera (rural), 174 households in Namuwongo (urban) and 115 poultry and piggery farms in Wakiso (peri-urban) were selected and enrolled. Using the ‘drug bag’ method, participants identified antibiotics they used frequently and the sources of these medicines. Prevalence outcomes were compared between different sites using prevalence ratios (PRs) and chi-squared tests.ResultsNearly all respondents in Nagongera and Namuwongo reported using antibiotics to treat household members, most within the past month (74.7% Nagongera versus 68.8% Namuwongo, P = 0.33). Use of metronidazole was significantly more common in Namuwongo than in Nagongera (73.6% versus 40.0%, PR 0.54, 95% CI: 0.42–0.70, P < 0.001), while the opposite was true for amoxicillin (33.3% versus 58.0%, PR 1.74, 95% CI: 1.33–2.28, P < 0.001).Veterinary use of antibiotics within the past month was much higher in Wakiso than in Nagongera (71.3% versus 15.0%, P < 0.001). At both sites, oxytetracycline hydrochloride was the most frequently used veterinary antibiotic, but it was used more commonly in Wakiso than in Nagongera (76.5% versus 31.0%, PR 0.41, 95% CI: 0.30–0.55, P < 0.001).ConclusionsAntibiotics are used differently across Uganda. Further research is needed to understand why antibiotics are relied upon in different ways in different contexts. Efforts to optimize antibiotic use should be tailored to specific settings.

Highlights

Increased use of antimicrobial medicines for treatment of humans and animals is understood to be driving the development of antimicrobial resistance (AMR) worldwide.[1,2,3] As concerns about AMR grow, global health actors have emphasized the need to reduce unnecessary use of antimicrobials.[4,5,6] The WHO Global Action Plan on AMR highlights the importance of optimal use of antimicrobial medicines in human and animal health, aiming to reduce consumption of antimicrobial agents worldwide.[4]
Considering the population evaluated for antibiotic use in humans, more respondents were female in Namuwongo than in Nagongera (79.3% versus 56.0%, respectively)
Considering the population evaluated for antibiotic use in animals, respondents in Nagongera and Wakiso were similar in gender and age (Table 1), but education, occupation and farm characteristics varied

Summary

Introduction

Increased use of antimicrobial medicines for treatment of humans and animals is understood to be driving the development of antimicrobial resistance (AMR) worldwide.[1,2,3] As concerns about AMR grow, global health actors have emphasized the need to reduce unnecessary use of antimicrobials.[4,5,6] The WHO Global Action Plan on AMR highlights the importance of optimal use of antimicrobial medicines in human and animal health, aiming to reduce consumption of antimicrobial agents worldwide.[4]. Low- and middle-income countries (LMICs) are reportedly major contributors to the global increase in antibiotic use,[7,10] but evidence from LMICs is limited.[11] Data are available from only 16 African countries[7,10] and patterns of antibiotic use in LMICs are not well understood.[11]. Use of antibiotics to treat humans and animals is increasing worldwide, but evidence from lowand middle-income countries (LMICs) is limited. We conducted cross-sectional surveys in households and farms in Uganda to assess patterns of antibiotic use among humans and animals

Methods

Results

Conclusion