Edinburgh Infectious Diseases
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Urbanisation and the challenges for antimicrobial resistance in Uganda

April 2022:  Fleming Fund fellow, Dr Joel Bazira discusses the impacts of rapid growth of cities on control of AMR.

City street in Kampala
Uganda is experiencing a high rate of urbanisation, currently estimated at 5.2% per annum, suggesting that the urban population will double in just 14 years.

City expansion

In a recent article for Uganda’s Daily Monitor newspaper, Prof Joel Bazira described some of the impacts on antimicrobial resistance caused by the massive growth in urban populations in Uganda:

(i) unplanned growth of cities leads to poor housing, poor drainage and poor sanitation, which all allow for the increased spread of infectious diseases;  

(ii) an inadequate public health system has allowed poorly-regulated, private provision of services, which has increased the misuse and abuse of antibiotics, a key factor in the growth of AMR; and

(iii) high urban demand for meat encourages inappropriate use of antibiotics as growth-promoters, which alongside poor waste-water management practices, results in wide exposure of consumers to low-doses of antibiotics.

Uganda’s National Action Plan for AMR

Joel Bazira
Prof Joel Bazira, Fleming Fund Fellow in Human AMR Surveillance.

In response to this silent epidemic of AMR, Uganda launched a National Action Plan (NAP) against antimicrobial resistance in 2018.  The NAP since then has been in the implementation phase. 

Prof Bazira proposes that it could be strengthened by following a few key suggestions:

First improve awareness: Knowledge is power and we need to communicate the challenge of the Common man.  we need to better understand what the public knows about drug resistance and how the very things they do contribute to the problem.

Second adopt a one-health approach to surveillance:  Significant efforts have been made quantifying AMR, but efforts have mainly on the human health sector.  Curbing AMR in Uganda requires the involvement of stakeholders from both human and animal environments. 

Third improve infection prevention efforts:  Measures should go beyond just preventing infections in hospitals, but must extend into the communities.  The message is simple - health begins at home.

Fourth prioritise the optimal use of drugs.  Enforcing regulations of the sale of drugs needs to be taken more seriously by the authorities.  We should also consider banning the use of drugs for growth promotion and we should enforce proper disposal of waste.

Fifth improve investment in research and innovation:  Research should not only focus on assessing the magnitude of the AMR problem, but also investing in pharmaceutical need for the future. Greater emphasis needs to be placed on discovering new drugs and repurposing old drugs including the development of herbal medicines. 

About the author

Professor Joel Bazira MB ChB, MMed, PhD was a Fleming Fund Fellow in Human AMR Surveillance at the University of Edinburgh in 2019-2021

He is now Associate Professor of Microbiology and Parasitology and Head of the Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, and a Fellow of the Uganda National Academy of Sciences. 

Contact Professor Bazira

Related links

Fleming Fund fellowships at the University of Edinburgh

Fleming Fund

Mbarara University of Science and Technology

Uganda National Academy of Sciences