The Fleming Fund is working with Uganda’s health care system to break down the barriers to disease surveillance by strengthening laboratory and diagnostic capacity in antimicrobial resistance (AMR) - leveraging in-country infrastructure and sustainability - for global health security.
Case Study: AMR training to improve patient treatment in Uganda
As part of World AMR Awareness Week (WAAW) − with the theme for 2024 ‘Educate. Advocate. Act now.’ − we hear from Fleming Fund Fellows on the importance of building AMR expertise in the health workforce and the impact of studying drug-resistance.
From 2020 to 2022, Christopher Harold Amandu, a Senior Medical Laboratory Technologist, participated in the Fleming Fund Fellowship Scheme as a Professional Laboratory Surveillance Fellow in Human Health. Mentored at the University of Edinburgh, Christopher learnt a wealth of antimicrobial stewardship skills at the Arua Regional Referral Hospital (ARRH) in Uganda’s West Nile region. This led to the training of around fifty of his colleagues on AMR diagnostics to improve patient care and outcomes.
Christopher was trained by the University of Edinburgh in AMR surveillance at the human-animal interface, veterinary medicine, and point-of-care diagnostics. This covered advanced statistics, laboratory diagnostic techniques, microbiology, data use, antimicrobial use, and scientific communications. He also attended courses on AMR, antimicrobial use/consumption (AMU/C) surveillance and the One Health approach offered by Fleming Fund grantee the Open University.
As part of his training, Christopher attended the Veterinary Microbiology Laboratory at the Roslin Institute where he observed introductions to new advanced laboratory diagnostic methods in microbiology for accelerated AMR bacterial isolation and susceptibility testing.
He also attended the Royal Infirmary Hospital and Western General Hospital in Edinburgh, where Christopher learnt practical skills on antimicrobial stewardship (AMS) from the clinician Antimicrobial Management Team (AMT). He was trained in AMR data quality methods for patient information management to monitor antimicrobial prescription patterns and trends. This included the AMT developing an app with the clinical teams and primary care prescribing leads/committees for safe antimicrobial prescribing and local policy guidelines.
Fleming Fund Fellow, Christopher Amandu in microbiology training at the University of Edinburgh.
Christopher in laboratory technician training at Arua RRH in Uganda.
As above.
The ripple effect: positive outcomes
From his fellowship training, Christopher became the Chairperson of the ARRH’s AMS subcommittee, teaching what he learnt from his training on resistance bacteria identification and antibiotic sensitivity testing to hospital laboratory technicians, and AMR diagnostic stewardship to hospital staff. This led to positive outcomes and improvements in the AARH laboratory’s ability to tackle AMR effectively:
- Improved standard operating procedures for internal quality management systems on bacteria microorganism isolation and identification.
- Enhanced data management for AMS and infection prevention and control monitoring.
- Strengthened collaboration between laboratory teams and healthcare workers.
- Developed a comprehensive AMS work plan to optimise antibiotic use, improve patient care and build healthcare professional capacity on rational AMU.
- Promoted diagnostic stewardship for timely and accurate diagnostic testing to guide patient treatment.
- Increased awareness and confidence among laboratory staff in performing bacteria culture and sensitivity tests.
- Improved data management in the microbiology laboratory and a better understanding of AMR and surveillance issues among hospital staff.
- WHONET software tracks and analyses bacterial resistance trends, working with the pharmacy department.
- Effective biorepository management of patient and study samples.
Christopher, as chair of the Medicines and Therapeutic Committee at AARH, leading the AMS activities during WAAW 2023 - 'Preventing antimicrobial resistance together'.
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One Health – effective collaboration
The fellowship promoted a One Health approach, integrating human, animal, and environmental health sectors. Christopher applied this integrated approach by preparing and storing human and animal samples, positioning the laboratory as a regional hub for managing and shipping samples to specialised and reference laboratories.
Locally, he collaborated with animal health professionals to investigate anthrax outbreaks using a One Health approach in the West Nile region alongside district veterinary officers, epidemiologists, public health nurses, village health team members, and local government councillors.
Multisectoral collaboration is crucial for managing infectious diseases and AMR. This approach led to Christopher working with the Infectious Diseases Institute at Makerere University in Uganda and the Fleming Fund to establish a functional AMS sub-committee at ARRH, promoting prudent AMU across One Health sectors. These efforts significantly improved the microbiology laboratory’s capacity for quality cultures, sensitivity testing, data collection, and local data use to address AMR issues.
Working with various stakeholders has built my confidence and ability to collaborate effectively. Integrating data from human and animal health sectors is essential for combating infectious diseases and AMR. Governments and partners should allocate resources to support unified efforts.
Amandu Christopher Harold, Professional Laboratory Surveillance Fellow, Human Health.
Christopher investigating Anthrax in Uganda, with a One Health Approach.
Chrsitopher leading laboratory technician training at AARH.
Crucial progress in the AMR fight
Christopher shared the AMR data he and the trainees produced on diagnostic stewardship and resistance patterns with the hospital’s medicines and therapeutic committee at the quarterly AMRCC Meetings. His fellowship enabled him to develop the skills to contribute health data to Uganda’s National Action Plan (NAP) on AMR and the World Health Organization (WHO).
The fellowship has truly enhanced AMR diagnostics and stewardship at ARRH. My efforts in training and collaboration have led to improved laboratory practices, better data management, and a stronger focus on antimicrobial resistance and surveillance. These advancements are crucial in the fight against AMR and in supporting Uganda’s National Action Plan on AMR.
Amandu Christopher Harold, Professional Laboratory Surveillance Fellow, Human Health.
Despite these achievements, challenges remain, including limited funding for collaborative projects and AMR activities. “Building human resource capacity to fight AMR will take time. Sustainability can be achieved through collaborations across human health, animal health, environment, and agriculture sectors, supported by adequate funding.
Christopher, as chair of the Medicines and Therapeutic Committee at AARH, leading the Antimicrobial Resistance Stewardship (AMS) activities during WAAW 2023.
More Like This
Programme Update
From Programme Update, Case Study: Breaking down AMR barriers in Uganda , Date: 05/08/2022
AMR Surveillance Fellow Mabel Aworh focused her research on understanding and tracking antimicrobial resistance (AMR) in animals, providing valuable insights into how drug-resistant bacteria spread in animals and humans in slaughterhouse environments in Abuja and Lagos, Nigeria. The study 'Rare serovars of non-typhoidal Salmonella enterica isolated from humans, beef cattle and abattoir environments in Nigeria' was published in [PLOS ONE](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0296971).