Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.

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.

Antimicrobial resistance (AMR) is one of the greatest threats to public health, and it is spreading across the human health, animal health, and environmental sectors. Sole reliance on desk reviews and national-level stakeholder engagement carries a risk of overestimating the country’s health security and AMR capacity. For a genuine evaluation, engaging frontline and last-mile implementers such as health care facilities and workers, farmers, and district local governments ensures a more accurate assessment of existing capabilities and implementation progress. Uganda utilized a bottom-up approach to assess the implementation status of the National Action Plan on AMR (NAP-AMR) to ensure the engagement of key stakeholders at the subnational level, who are often overlooked in NAP-AMR evaluation initiatives. This review revealed poor engagement of subnational stakeholders in the development, validation, dissemination, and implementation of the NAP-AMR as well as various issues at the national level—including gaps in government One Health policy, insufficient funding, and ineffective coordination—that resulted in the inadequate implementation of the NAP-AMR. Addressing these challenges should involve establishing a One Health policy and identifying sustainable funding sources for AMR activities. We recommend the legislation of dedicated policy to formally incorporate the National One Health Platform into government structures at the national and subnational levels. In our experience, a bottom-up approach to evaluating NAP-AMR implementation enhances the effectiveness of the review process and could be utilized by the WHO during the joint external evaluation of health security capacity.

Background/Objectives: Antimicrobial resistance (AMR) is a global public health concern exacerbated by inappropriate antimicrobial prescribing practices, particularly in low-resource settings such as Uganda. The research aimed to develop a culturally sensitive behavioral intervention, leveraging a “nudge” strategy, to improve healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016) in five Ugandan hospitals. This intervention formed part of broader antimicrobial stewardship initiatives led by the United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program. Methods: This study employed a mixed-methods approach, combining formative research and behavioral intervention. Guided by the Deloitte Behavioral Insights Framework, the research team conducted key informant interviews to identify prescribing barriers and motivators and developed three suitable behavioral interventions: perceived monitoring, ward leaderboards, and educational workshops. The study evaluated the interventions’ impact through point prevalence surveys (PPS), using the World Health Organization PPS methodology at three stages: pre-intervention, immediate post-intervention, and one-month post-intervention. Results: Key behavioral themes across individual, social, environmental, and organizational elements informed the intervention design and implementation. The behavioral intervention package increased antimicrobial prescription compliance with the UCG 2016 from 27% at baseline to 50% immediately post-intervention, though these effects diminished at one-month post-intervention. Conclusions: Our study addresses an existing gap in behavioral nudges-based operational research on antimicrobial prescribing in low- and middle-income countries. These results showed an immediate improvement in adherence to the UCG 2016 among healthcare providers in Ugandan hospitals, though the effect was attenuated at one-month follow-up. Despite the attenuation, behavior change presents a feasible, cost-effective, and sustainable approach to improving antimicrobial prescribing practices and addressing AMR.

The Journal of Public Health in Africa (JPHiA) is a peer-reviewed, academic journal that focuses on health issues in the African continent. The journal editors seek high quality original articles on public health related issues, reviews, comments and more. The aim of the journal is to move public health discourse from the background to the forefront. The success of Africa’s struggle against disease depends on public health approaches.

Background/Objectives: Effective antimicrobial stewardship (AMS) is vital for containing antimicrobial resistance (AMR), yet evidence regarding existing regulatory frameworks in low- and middle-income countries (LMICs) remains scarce. This study conducted a landscape analysis of policies, laws, and regulations governing AMS across human and animal health sectors in ten LMICs to identify gaps and inform national action plans. Methods: Between October 2019 and September 2022, data were collected through desk reviews of national documents and a standardized, structured questionnaire administered to key national informants in ten countries: Bangladesh, Burkina Faso, Cameroon, Côte d’Ivoire, Mali, Mozambique, Nigeria, Senegal, Tanzania, and Uganda. Results: Findings were analyzed across five core regulatory domains. While all countries maintained national medicine policies and regulatory authorities, antimicrobial-specific measures were often insufficient, particularly in the animal health sector. Human health frameworks were generally more advanced; however, overarching regulations for marketing authorization, post-marketing surveillance, and pharmacovigilance frequently lacked the necessary specificity for antimicrobials. Conclusions: Addressing these gaps requires strengthening One Health legal frameworks, particularly through targeted animal health policies and multisectoral coordination. Enhanced investments in capacity-building and systematic enforcement are essential to optimize antimicrobial use and strengthen the AMR response.