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Musoke D, Namata C, Lubega GB, Kitutu FE, Mugisha L, Amir S, Brandish C, Gonza J, Ikhile D, Niyongabo F, Ng BY, O'Driscoll J, Russell-Hobbs K, Winter J, Gibson L. Access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda: a qualitative study. J Pharm Policy Pract 2021; 14:69. [PMID: 34416911 PMCID: PMC8379804 DOI: 10.1186/s40545-021-00361-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/12/2021] [Indexed: 12/01/2022] Open
Abstract
Background Inappropriate use of antimicrobials in both humans and animals is a key driver of antimicrobial resistance (AMR). In addition, human behaviours such as poor disposal of antimicrobials in the environment can increase their exposure to microbes which can impact on humans and animals. However, evidence on access, use and disposal of antimicrobials for humans and animals at community level in Uganda is limited. This study therefore explored access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda.
Methods A qualitative study was conducted that involved focus group discussions (FGDs) and key informant interviews (KIIs). Participants of the FGDs were community health workers (CHWs) and farmers involved in animal husbandry, while key informants included: officials from the Ministry of Health; Ministry of Agriculture, Animal Industry and Fisheries; human and animal health professionals; district health officials; and members of the national AMR surveillance committee. Twelve FGDs were held (8 for CHWs and 4 for farmers) while 15 KIIs were conducted. Thematic analysis in NVivo (version 12) was performed. Results Five main themes emerged from the study: access to antimicrobials in humans; access to antimicrobials in animals; use of antimicrobials in humans; use of antimicrobials in animals; and disposal of antimicrobials. Community members mainly accessed antimicrobials for humans from public health facilities such as government health centres, as well as private facilities, including drug shops and clinics. Antimicrobials for animals were obtained from veterinary practitioners and drug shops (both for humans and veterinary). Examples of inappropriate use of antimicrobials in both humans and animals was evident, such as sharing antibiotics among household members, and giving human-prescribed antimicrobials to food-producing animals as growth promoters. While some CHWs returned unused antimicrobials to public health facilities for proper disposal, community members mainly disposed of antimicrobials with general household waste including dumping in rubbish pits. Conclusions There is a need to increase awareness among the population on proper access, use and disposal of antimicrobials for both humans and animals. Development of a drug disposal system at community level would facilitate improved waste management of antimicrobials. Together, these measures would help prevent the rate of progression of AMR in communities.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Carol Namata
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Grace Biyinzika Lubega
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Lawrence Mugisha
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Saba Amir
- School of Animal, Rural and Environmental Sciences, Nottingham Trent University, Nottingham, NG25 0QF, UK
| | - Claire Brandish
- Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Joviah Gonza
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Deborah Ikhile
- Institute of Health and Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK
| | - Filimin Niyongabo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Bee Yean Ng
- Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Jean O'Driscoll
- Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | | | - Jody Winter
- Department of Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Linda Gibson
- Institute of Health and Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK
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Ndoboli D, Nganga F, Lukuyu B, Wieland B, Grace D, von Braun A, Roesel K. The misuse of antiretrovirals to boost pig and poultry productivity in Uganda and potential implications for public health. INTERNATIONAL JOURNAL OF ONE HEALTH 2021. [DOI: 10.14202/ijoh.2021.88-95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Since 2015, local newspapers reported that pig and poultry farmers in Uganda use antiretroviral drugs (ARVs) to promote growth in animals and control diseases. This study was conducted to assess farmers' knowledge, attitude and perceptions about the use of antiretroviral drugs as boosters in pigs and poultry and the possibility of detecting the antiretroviral drugs in meat using available laboratory methods.
Materials and Methods: In 2019, a cross-sectional study was conducted in ten districts in Uganda. In 20 focus group discussions with 100 pig and poultry farmers and 70 animal health service providers, we assessed the use of ARV in livestock enterprises. Subsequently, samples of chicken, pigs, and animal feeds were collected from volunteer participants, and screened for residues of saquinavir, lopinavir, nevirapine, and efavirenz using liquid chromatography-tandem mass spectrophotometer.
Results: Participants in all ten districts were predominantly smallholder farmers supplying the local markets. All groups reported the use of ARVs in pigs and broiler birds but not in layer hens. In the absence of good quality feeds, the motivation for feeding ARVs was rapid animal weight gain, as well as the control of animal diseases, for which farmers have no alternative solutions. ARVs were obtained within the community for free, against cash, or in-kind payment. Residues of lopinavir were detected in four, and saquinavir in seven districts, and all three sample matrices.
Conclusion: Our study findings confirm anecdotal news reports on ARV use in livestock. While our findings are not generalizable to the whole country, they call for a representative follow-up. As the drugs were detected in tissues destined for human consumption, the potential risk to human health warrants further investigation.
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Affiliation(s)
- Dickson Ndoboli
- Central Diagnostic Laboratory, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda; Biosciences Eastern and Central Africa Hub, International Livestock Research Institute, P.O. Box 30709, Nairobi, Kenya; Animal and Human Health Program, International Livestock Research Institute, P.O. Box 30709, Nairobi, Kenya
| | - Fredrick Nganga
- Biosciences Eastern and Central Africa Hub, International Livestock Research Institute, P.O. Box 30709, Nairobi, Kenya
| | - Ben Lukuyu
- Feed and Forage Development Program, International Livestock Research Institute, P.O. Box 24384, Kampala, Uganda
| | - Barbara Wieland
- Animal and Human Health Program, International Livestock Research Institute, P.O. Box 5689, Addis Ababa, Ethiopia
| | - Delia Grace
- Animal and Human Health Program, International Livestock Research Institute, P.O. Box 30709, Nairobi, Kenya; Natural Resources Institute, University of Greenwich, Central Avenue, Chatham Maritime, Kent ME4 4TB, UK
| | - Amrei von Braun
- Division of Infectious Diseases and Tropical Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Kristina Roesel
- Animal and Human Health Program, International Livestock Research Institute, P.O. Box 30709, Nairobi, Kenya; Institute for Tropical Veterinary Medicine and Parasitology, Freie Universität Berlin, Robert-von-Ostertag-Strasse 7-13, 14163 Berlin, Germany
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