Implementing the Anti-Microbial Resistance (AMR) National Action Plan in Hospital Settings in Western Uganda

With the potential to reverse decades of medical progress, AMR is one of the biggest threats to global health, food security and development in the world today. Low- and Middle-Income Countries are particularly hard hit; infectious diseases still cause a high proportion of deaths and, as many of the most commonly used antibiotics fail to work, they struggle to procure newer and more expensive antibiotics. Sepsis is a major cause of maternal mortality in Uganda and is often caused by poor infection control during c-sections, leading to surgical site infections.

This action research project sought to reduce rates of maternal sepsis by reducing the incidence of infections, especially those acquired from hospitals, and improve the use of antibiotics to fight any infections that do occur. It focused primarily on improving infection prevention and control measures and wound management skills of staff, along with increasing the swabbing of wounds and laboratory analysis of the results to identify the bacteria responsible and target the most effective antibiotic. It also involved teaching school children about antibiotics, the importance of hand hygiene and how bacteria can spread.

The project has already been extremely successful, leading to major improvements in all of the above areas. Laboratory testing rates increased by 95% and IPC infrastructure improved by 38%, resulting in improved patient outcomes, reduced mortality, reduced length of stay on the wards and major financial savings to the hospital. The full results of the project are published in:

Ackers, H.L., Ackers-Johnson, G., Seekles, M. and Opio, S. (2020) Opportunities and Challenges for Improving Anti-Microbial Stewardship in Low- and Middle-Income Countries; Lessons learnt from the Maternal Sepsis Intervention in Western Uganda. Antibiotics 2020, 9, 315; doi:10.3390/antibiotics9060315

Ackers, H.L., Ackers-Johnson, G., Welsh, J., Kibombo, D. and Opio, S. (2020) Anti-Microbial Resistance and Maternal Sepsis in Low- and Middle-Income Countries; Ethnographic Insights on Intervention Opportunities in Ugandan Public Hospitals; Palgrave.

Funder: The Department of Health and Social Care (DHSC); the Commonwealth Pharmacists Association (CwPAMS) and the Tropical Health Education Trust (THET)

Team: Prof Louise Ackers, Dr James Ackers-Johnson, Clare Liptrott (University of Salford); Allan Ndawula, Rachel Namiiro, Dorothy Gashuga, Barbara Kamara (Knowledge for Change); Sam Opio, Ibrahim Mugerwa (Pharmaceutical Society of Uganda); Saarah Niazi-Ali (NHS Tameside and Glossop CCG)