By Pamela Nabukenya Wairagala

The World Antimicrobial Awareness Week (WAAW) is a global campaign commemorated annually held starting 18^th to 24^th November.

The campaign aims to improve awareness and understanding of antimicrobial resistance (AMR) and encourage best practices among the public, health stakeholders and policymakers. This year’s campaign was held under the theme ‘Preventing Antimicrobial Resistance Together’ and provides an opportunity to reflect on the different stakeholder groups and their role in AMR prevention.

Antimicrobials are medicines used to prevent and treat infections in humans, animals and plants. They include antibiotics, antivirals, antifungals and antiparasitics. In humans, antimicrobials have contributed significantly to treating diseases like urinary tract infections, sexually transmitted infections, sepsis, diarrhoea, post-surgery patient management and many others in modern-day medical practice. Equally in animals, antimicrobials have been used to improve animal production, animal health and welfare, and increase animal growth rates and productivity.

Antimicrobial-resistant organisms are found in people, animals, food, plants and the environment (in water, soil and air) and can spread from person to person or between people and animals, including from food of animal origin such as beef and poultry.

The inappropriate use of antimicrobials in both humans and animals has resulted in antimicrobial resistance (AMR), which occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines.

This makes infections harder to treat and increases the risk of disease spread, severe illness and death. While AMR occurs naturally over time, usually through genetic changes, human behaviours such as poor disposal of antimicrobials in the environment increase exposure to organisms that can impact humans and animals. Researchers estimate that AMR in bacteria caused an estimated 1.27 million deaths in 2019.

AMR is a rising challenge for food systems and public health, both globally and nationally. Misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals; infection and disease prevention and control in healthcare facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation are the major drivers of AMR in humans and animals.

The impact of AMR is far-reaching, and the cost to both the global and national economies is high. AMR in animals complicates the management of infectious diseases, endangers animal health and production, leads to the death of animals and threatens food security and food safety. Also, of concern is the danger of spillage of resistant organisms from animals to humans, which could have potentially devastating public health effects.

A 2022 study conducted by the International Livestock Research Institute and the Ministry of Agriculture, Animal Industry and Fisheries to understand the drivers of antimicrobial use and practices among poultry keepers and to determine the prevalence of drug-resistant Salmonella spp., Escherichia coli (E.coli) and Enterococcus spp. in poultry farms in peri-urban and rural districts of Wakiso and Soroti in Uganda found high levels of human drug-use for the treatment of poultry diseases. Most of the human medications used, including pain killers, antiparasitics and antibiotics, are readily available over the counter in pharmacies. Feacal samples collected from farms that kept free-range chickens were found to have microorganisms resistant to tetracycline, colistin and cefotaxime, some of the most common antimicrobials used to treat human infections. This points to the gravity of the issue at hand, considering that the use of antimicrobials has in the past been linked to intensive poultry systems. Poor disposal of medicine residues and packaging was evident on most of the farms visited by the researchers.  

The increase of AMR among livestock is attributed to insufficient knowledge and information on the impact of antimicrobial misuse and overuse, especially by farmers, lack of understanding of the benefits of disease prevention options like animal vaccination and poor on-farm hygiene practices, among others. Efforts have been made to address AMR in humans, though much more needs to be done. Unfortunately, the animal and plant sectors have received much less attention. Much more needs to be done to recognize and promote the One Health approach: That is, the interplay between people, animals, plants, and their shared environment.

Not all the required interventions can be achieved at once, but some low-hanging fruits exist for the animal industry and can be implemented by both the public and private sectors. These include improving awareness and knowledge levels through boosting extension services and improving access to veterinary services, especially in rural areas. Farmers in rural areas purchase veterinary inputs, including drugs, from village markets. Those who cannot afford to buy, use leftover vaccines from their neighbours. Because they do not have adequate information on what to use, they often use whatever is available. Other interventions include improving awareness, access and affordability of disease control interventions and supporting farmers to adhere to policies and guidelines that promote good husbandry practices, such as withdrawal periods following administration of antimicrobials before they can put their farm products on the market.   

Research to investigate the evidence of access, use and disposal of antimicrobials for humans and animals at the community level is ongoing and will provide much-needed information on the extent of the AMR challenge in the country.

The AMR challenge is multi-sectoral and, therefore, cannot be addressed by either human, animal or plant health stakeholders alone. In accordance with this year’s WAAW theme, ‘Preventing Antimicrobial Resistance Together”, different sector players must work collaboratively at all levels to mitigate the spread and impacts of AMR.  

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Pamela Nabukenya Wairagala

Communications and Knowledge Management Senior Officer

International Livestock Research Institute (ILRI)