Access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda: a qualitative study

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.

Knowledge, Attitudes, and Practices of Community Pharmacy Professionals on Poultry Antibiotic Dispensing, Use, and Bacterial Antimicrobial Resistance in Zambia: Implications on Antibiotic Stewardship and WHO AWaRe Classification of Antibiotics

“…Unfortunately, many poultry microorganisms have developed resistance to these antibiotics [ 3 , 45 , 48 ]. Similar information has been reported among African countries [ 3 , 29 , 48 , 49 , 50 ] and this generally calls for more prudent use of antibiotics.…”

Knowledge, attitudes and practices on antimicrobial resistance among pharmacy personnel and nurses at a tertiary hospital in Ndola, Zambia: implications for antimicrobial stewardship programmes

“…Other studies have reported similar findings. 40 , 41 This phenomenon is worrying because of the increasing global trends of cross-over use of human and livestock antibiotics often obtained from hospitals and community pharmacies. 7 , 42 …”

Gaps and opportunities in sustainable medicines use in resource limited settings: A situational analysis of Uganda

“…32,33 Furthermore, sharing of prescribed antibiotics amongst household members is common, as is the unauthorized practice of using antibiotics for animal treatment and growth promotion. 34,35 Studies of antimicrobial drug quality in Uganda have largely focused on antimalarials, reporting a high burden of poor-quality and nonquality-assured antimalarials. 36,37 Meanwhile inappropriate pharmaceutical waste disposal and environmental contamination are emerging as neglected risks to sustainable medicines use in Uganda.…”

“…Active pharmaceutical ingredients have been found in both surface waters and waste treatment facilities 38 . Households in Uganda dispose of unused medications into general waste dumpsters and rubbish pits, 34 contributing to environmental pollution.…”

“…In Uganda and resource‐limited settings generally, the rural poor lack access to effective, formal healthcare and fulfil many healthcare needs through informal providers and self‐medication 32,33 . Furthermore, sharing of prescribed antibiotics amongst household members is common, as is the unauthorized practice of using antibiotics for animal treatment and growth promotion 34,35 …”