Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions.

Background: Antimicrobials are crucial for animal health and food security. However, their overuse in animals can lead to the emergence of resistant microorganisms. Antimicrobial resistance (AMR) poses a global public health threat that impacts both animal and human health. The objective of this study was to estimate the antimicrobial consumption (AMC) of veterinary antimicrobials at the national level using import data from January to December 2021, available from the Uganda National Drug Authority (NDA). Methods: The World Organization for Animal Health (WOAH) methodology was applied using the Anatomical Therapeutic Chemical classification codes for veterinary medicines. Results: Approximately 88,387.37 kg (88.39 tonnes) of veterinary antimicrobials were consumed in 2021. Parenteral veterinary antimicrobials accounted for 63.8% (56,375.65 kg) and oral veterinary antibacterials accounted for 36.2% (32,011.71 kg). Tetracyclines were the single most consumed veterinary antimicrobial class, accounting for 62.7% of total consumption. Oxytetracycline was the most consumed antibacterial (58.4%), followed by sulphadiazine + trimethoprim (11.1%), penicillin g/dihydrostreptomycin (7.4%), penicillin G procaine + dihydrostreptomycin (6.8%), and tetracycline (3.5%), respectively. Out of all imported veterinary antimicrobials, 76% belonged to the World Health Organization (WHO)’s Highly Important Antimicrobials (HIA) category, 16% to the Critically Important (CIA), and 9% to the Highest Priority Critically Important (HPCIA) categories. Imported colistin accounted for 0.1% of total veterinary consumption. Conclusions: This study contributes to understanding antimicrobial consumption in Uganda’s livestock sector and, for the NDA, leaves in place a system for routine surveillance at a national level. We recommend strict regulatory oversight on the importation and use of colistin and macrolides to address AMR.

The Post-Ebola era (2017–2019) presented an opportunity for laboratory investments in Sierra Leone. US CDC supported the Ministry of Health and Sanitation to establish a microbiological unit for routine antimicrobial sensitivity testing in two referral (pediatric and maternity) hospitals in Freetown. This study describes resistance patterns among patients’ laboratory samples from 2017 to 2019 using routine data. Samples included urine, stool, cerebrospinal fluid, pus-wound, pleural fluid, and high vaginal swabs. Selected Gram-positive and Gram-negative bacterial isolates were tested for antimicrobial susceptibility. Of 200 samples received by the laboratory, 89 returned positive bacterial isolates with urine and pus-wound swabs accounting for 75% of positive isolates. The number of positive isolates increased annually from one in 2017 to 42 in 2018 and 46 in 2019. Resistance of the cultures to at least one antibiotic was high (91%), and even higher in the pediatric hospital (94%). Resistance was highest with penicillin (81%) for Gram-positive bacteria and lowest with nitrofurantoin (13%). Gram-negative bacteria were most resistant to ampicillin, gentamycin, streptomycin, tetracycline, cephalothin and penicillin (100%) and least resistant to novobiocin (0%). Antibiotic resistance for commonly prescribed antibiotics was high in two referral hospitals, highlighting the urgent need for antimicrobial stewardship and access to reserve antibiotics.