Drug resistance could reverse medical progress in Uganda — experts

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Uganda is facing a growing but largely invisible health crisis that experts say could undo nearly a century of medical progress.

Known as antimicrobial resistance (AMR), the phenomenon, largely owing to inappropriate prescriptions and misuse of antibiotics, threatens the effectiveness of current and future antibiotic treatments, resulting in prolonged hospitalisation and premature mortality. 

Health professionals have described AMR as a ‘silent pandemic’ already exacting a heavy global toll. According to 2019 estimates, drug-resistant infections directly caused 1.27 million deaths worldwide.

In Uganda, the threat is no longer theoretical; it is unfolding in communities, clinics, and pharmacies, driven largely by everyday practices that undermine the effectiveness of essential medicines.

Dr Lutoti Stephen, Secretary of the Pharmaceutical Society of Uganda, says the country must urgently adopt stricter accountability in how medicines are used and dispensed.

He emphasises antimicrobial stewardship as a critical line of defence, arguing that safeguarding the effectiveness of drugs is both a professional and moral obligation.

“We must ensure every pill dispensed is accounted for through proper oversight,” he notes, warning that failure to act now could leave future generations without effective treatments.

While policy frameworks are crucial, much of the battle is being fought at the community level, where misuse of medicines remains widespread.

In Kampala’s busy pharmacies, Dr Ruth M. Namyalo, a clinical pharmacist, encounters patients seeking quick fixes based on informal advice.

Many request antibiotics using vague descriptions such as “red and black capsules”, a common reference to drugs like amoxicillin, believing them to be universal cures.

She cautions that this culture of self-medication is accelerating resistance. “Patients frequently demand antibiotics for conditions like flu and cough, which are viral and do not respond to these medicines. This misuse only weakens the drugs’ future effectiveness,” she explains.

Medical evidence supports her concern. Experts estimate that up to 80 percent of common infections are caused by viruses, meaning antibiotics offer no benefit. However, their widespread misuse continues, often compounded by patients failing to complete prescribed doses.

Dr Joshua Oseku, a community pharmacy practitioner, highlights another layer of the problem: the tension between business pressures and ethical medical practice.

He notes that some drug outlets dispense antibiotics without prescriptions in a bid to retain customers, a practice that fuels resistance.

“There is a moral obligation to prioritise patient care over short-term business interests,” he says, stressing that sustainable healthcare depends on responsible dispensing practices.

Use of Antibiotics in Livestock 

The problem extends beyond human medicine. Experts warn that the use of antibiotics in livestock farming is contributing to the crisis.

When animals are exposed to low doses of antibiotics, they say resistant bacteria can develop and later be transmitted to humans through food consumption, compounding the public health risk.

They said the implications are profound, noting that “If current trends continue, modern medicine itself could be compromised. Additionally, routine surgeries, treatment of premature babies, and even cancer therapies like chemotherapy, which rely on effective antibiotics, could become significantly more dangerous.”

Health experts also warn of a worst-case scenario known as pan-drug resistance, where infections become untreatable. In such cases, doctors would be left with no curative options, only palliative care.

Self-Medication

The scale of the challenge is underscored by recent research in northern Uganda. A 2024 study by Denis Diko Adoko and Rebecca Nakaziba found that 67.79 percent of residents in Otuke District engage in antibiotic self-medication, effectively seven in every ten people.

The study links this behaviour to factors such as previous successful treatments, advice from friends and relatives, long waiting times at health facilities, and financial constraints that lead to incomplete dosing.

These practices, experts say, create ideal conditions for resistance to thrive. “When patients stop treatment early, the strongest microbes survive and multiply, eventually becoming harder, or impossible to treat,” they said.

Economic Consequences

Beyond the health risks, the economic consequences could be severe. Globally, AMR is projected to push up to 24 million people into extreme poverty by 2050.

In Uganda, prolonged illness, higher treatment costs, and lost productivity could deepen financial strain on households.

A 2025 study by Elly Nuwamanya and other colleagues titled ‘Societal Economic Burden of Antibiotic Resistance in Uganda: A Cost of Illness Study’, found that the annual societal cost of ABR in nine regional referral hospitals (RRHs) was estimated at $1.43 million (about sh5,152,290,000), representing 0.003% of Uganda’s gross domestic product.

Lost productivity costs accounted for 82% of the total, while informal care and direct healthcare costs represented 10% and 8%, respectively.

Premature mortality associated with ABR accounted for 62% of the total cost of productivity loss; accommodation, food, and out-of-pocket costs represented 55% of the informal care costs; and recurrent costs accounted for 89% of direct healthcare costs.

The overall annual societal, health system, and patient costs per ABR-patient were $4983 (about sh17,953,749), $423 (about sh1,524,069), and $4560 (about sh16,429,680), respectively.

ABR health system costs were 3% higher ($61,293) (about sh220,838,679) versus ($59,646) (about sh214,904,538) among females than among males.

Patient costs associated with ABR were higher among females than males, with informal care costs being 4% higher ($70,657) (about sh254,577,171) versus $67,886 (about sh244,593,258), and lost productivity costs 34% higher ($622,510) (about sh2,242,903,530) versus ($410,354) (about sh1,478,505,462).

Overall, societal total costs and per-patient costs of ABR were 29% ($754,461) (about sh2,718,322,983) versus ($537,886) (about sh1,938,003,258) and 21% ($5063) (about sh18,241,989) versus ($4014) (about sh14,462,442) higher in females than in males, respectively.

According to Nuwamanya, the one-way sensitivity analysis revealed that the societal economic burden of ABR estimates were most influenced by uncertainties in construction cost per square meter of space utilised by ABR patients, reduced hospital capacity, and the discount rate.

In response, experts are calling for a coordinated national effort involving the public, healthcare providers, and policymakers.

Dr Lutoti urges Ugandans to take simple but critical steps: complete prescribed medication doses, avoid self-medication, and seek proper diagnosis before taking antibiotics.

Healthcare professionals, he adds, must adhere strictly to clinical guidelines and prioritise patient education.