Drivers of Resistance in Uganda and Malawi

The consortium is addressing how human behaviour and antibacterial usage in urban and rural Africa leads to the transmission of AMR amongst E. coli and K. pneumoniae in humans, animals and the environment.

Overview Interventions Outcomes Partners

The growing threat of drug-resistant bacteria is well recognised. Low- and middle- income countries are likely to be more severely affected due to overstretched health systems and poor access to alternative antibiotic regimes. Generating evidence on antimicrobial resistance (AMR) in low resource settings, as well as developing and implementing effective policy to tackle AMR, is vital. A meaningful response will require coordination between a range of different sectors including human health, animal health, environment and agriculture.

The DRUM Consortium sought to address how human behaviour and antibacterial usage in urban and rural Africa leads to the transmission of AMR amongst E. coli and K. pneumoniae in humans, animals and the environment and influences the clinical impact of drug-resistant bloodstream infection (DR-BSI) in humans. DRUM sought to develop agent-based models that will enable the prediction of how these transmission pathways can be interrupted. DRUM’s vision is to establish Ugandan and Malawian sites as sustainable model settings for interdisciplinary study and mitigation of AMR by embedding a One Health strategy at the heart of a consortium that will generate outputs applicable to similar communities throughout East and Southern Africa and beyond.

AFIDEP’s worked as part of the DRUM Consortium is two-fold: to investigate barriers to and facilitators of collaborative policy development in Malawi, and to coordinate efforts around policy engagement and strategic communications for the whole consortium.

The consortium’s policy study investigated key actor’s perceptions of the barriers between sectors to sustainable, collaborative development of policy in line with the Malawi antibacterial resistance strategic plan; analyse the wording and phrasing used by key stakeholders while discussing antibacterial resistance control and how these shape their approaches to policy development and implementation if at all; document gaps in the antibacterial resistance control policy across human and animal health and environmental sectors compared to countries’ national plan; and document the processes through which the antibacterial resistance control policy development and implementation evolve over time in Malawi and Uganda, over a 2 year period.

For consortium-wide policy engagement and communications, AFIDEP represented DRUM in the national Antimicrobial Resistance core group and Technical Working Group meetings and discussions. It further conducted a regional policy analysis for AMR from which a policy engagement strategy was developed that led to the development and implementation of a communications strategy for the DRUM consortium. These aided in regular and appropriate engagement of stakeholders that have an influence on policy across the One Health spectrum.

To create public awareness on AMR, AFIDEP joined Malawi Ministry of Health and Population and other key stakeholders on 20 Nov 2019, in a ‘Big Walk’ in Lilongwe, Malawi for the Antibiotic Awareness week.

To learn more about antimicrobial resistance, and the DRUM consortium’s One Health approach to understanding how water, sanitation and hygiene practices interact with antimicrobial usage to facilitate the transmission of AMR- bacteria in Uganda & Malawi, download the factsheet here, information sheet here, and the comics used to create awareness about AMR here.

AMR OUTPUTS:

The DRUM Consortium was made up of researchers from the following institutions

● Liverpool School of Tropical Medicine
● African Institute for Development Policy
● Centre for Ecology and Hydrology
● Lancaster University
● Malawi Liverpool Wellcome Centre
● University of Liverpool
● London School of Hygiene & Tropical Medicine
● Makerere University (Mak)
● Institute of Infectious Diseases (IDI)
● University of Strathclyde
● Wellcome Trust Sanger Institute

AFIDEP’s work was specifically to identify and address barriers between in-country sectors involved in AMR control for the delivery of appropriate policy.

Key Details

Dates:	March 2018 to June 2022
Aim:	DRUM was a consortium whose aim was to transform the understanding of the drivers of antimicrobial resistance (AMR) in Uganda and Malawi, and design interventions to reduce AMR spread.
Where:	Malawi , Uganda
Project Manager:	Tumaini Malenga