Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data
Loading...
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
JMIR public health and surveillance
Abstract
Antimicrobial resistance (AMR) is an emerging public health crisis in Uganda. The World Health Organization
(WHO) Global Action Plan recommends that countries should develop and implement National Action Plans for AMR. We
describe the establishment of the national AMR program in Uganda and present the early microbial sensitivity results from the
program.
Objective: The aim of this study is to describe a national surveillance program that was developed to perform the systematic
and continuous collection, analysis, and interpretation of AMR data.
Methods: A systematic qualitative description of the process and progress made in the establishment of the national AMR
program is provided, detailing the progress made from 2015 to 2020. This is followed by a report of the findings of the isolates
that were collected from AMR surveillance sites. Identification and antimicrobial susceptibility testing (AST) of the bacterial
isolates were performed using standard methods at both the surveillance sites and the reference laboratory.
Results: Remarkable progress has been achieved in the establishment of the national AMR program, which is guided by the
WHO Global Laboratory AMR Surveillance System (GLASS) in Uganda. A functional national coordinating center for AMR
has been established with a supporting designated reference laboratory. WHONET software for AMR data management has been
installed in the surveillance sites and laboratory staff trained on data quality assurance. Uganda has progressively submitted data
to the WHO GLASS reporting system. Of the 19,216 isolates from WHO GLASS priority specimens collected from October
2015 to June 2020, 22.95% (n=4411) had community-acquired infections, 9.46% (n=1818) had hospital-acquired infections, and
68.57% (n=12,987) had infections of unknown origin. The highest proportion of the specimens was blood (12,398/19,216, 64.52%), followed by urine (5278/19,216, 27.47%) and stool (1266/19,216, 6.59%), whereas the lowest proportion was urogenital
swabs (274/19,216, 1.4%). The mean age was 19.1 (SD 19.8 years), whereas the median age was 13 years (IQR 28). Approximately
49.13% (9440/19,216) of the participants were female and 50.51% (9706/19,216) were male. Participants with community-acquired
infections were older (mean age 28, SD 18.6 years; median age 26, IQR 20.5 years) than those with hospital-acquired infections
(mean age 17.3, SD 20.9 years; median age 8, IQR 26 years). All gram-negative (Escherichia coli, Klebsiella pneumoniae, and
Neisseria gonorrhoeae) and gram-positive (Staphylococcus aureus and Enterococcus sp) bacteria with AST showed resistance
to each of the tested antibiotics.
Conclusions: Uganda is the first African country to implement a structured national AMR surveillance program in alignment
with the WHO GLASS. The reported AST data indicate very high resistance to the recommended and prescribed antibiotics for
treatment of infections. More effort is required regarding quality assurance of laboratory testing methodologies to ensure optimal
adherence to WHO GLASS–recommended pathogen-antimicrobial combinations. The current AMR data will inform the
development of treatment algorithms and clinical guidelines.
Description
Keywords
Antimicrobial resistance, Surveillance, Microbiology, Laboratory, Uganda, WHO
Citation
Nabadda, S., Kakooza, F., Kiggundu, R., Walwema, R., Bazira, J., Mayito, J., ... & Mwebasa, H. (2021). Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data. JMIR public health and surveillance, 7(10), e29954. doi: 10.2196/29954