Antimicrobial Resistance (AMR) is a global challenge but disproportionally affects the poor, women and children and developing countries. AMR is a situation where bacteria develop resistance against antibiotics intended to destroy them. AMR in animals threatens the sustainability & security of food production and the livelihood of farmers. It reduces effectiveness of antibiotics, leading to higher cost of treatment, severe illnesses, and deaths. Globally, about 1.2 million people died in 2019 due to complications of AMR; Sub-Saharan African region alone had 255,000 deaths (The Lancet, https://doi.org/10.1016/S0140-6736(21)02724-0).
The challenge of AMR is further escalated by the continued dispersal of antibiotic resistance and antibiotics into the environment, especially water sources shared by both humans and livestock. Antibiotics in the environment may induce AMR in bacteria, hence the risk of transfer to humans and wildlife. The Food and Agricultural Organization (FAO), World Health Organization (WHO), and the World Organization for Animal Health (OIE) recognize the problem of Antimicrobial Resistance (AMR), and thus recommend: Prudent use of antimicrobials; and a “One Health Approach” to mitigate the problem.
The Strategic Research Agenda by the Joint Programming Initiatives (JPI) calls for transnational studies on AMR in both terrestrial and aquatic environments. Indeed, the role of livestock, wildlife and migratory birds in the spread of AMR has previously been under-emphasized, yet they are major reservoirs of ARB and ARG.
PAIRWISE Project implementation
Under a project titled, Dispersal of Antibiotic Resistance and Antibiotics in Water ecosystems and Influence on livestock and aquatic wildlife (PAIRWISE), researchers from three countries in Europe, and two in Africa are investigating the dispersal of Antibiotics (ATBs), Antibiotic Resistant Bacteria (ARB), and Antibiotic Resistance (ARGs) downstream Wastewater Treatment Plants (WWTPs) by comparing different geographical/climatic regions, wastewater management practices and types of water bodies. ATBs, ARB, and ARGs have spread in almost all habitats globally. The researchers are also investigating the risks posed to human health and the environment by pollutants and pathogens present in water resources.
Project partners include; National Veterinary Institute (SVA), Sweden; Norwegian Institute for Water Research (NIVA), Norway; Linköping University (LiU), Sweden; Doñana Biological Station, Higher Council for Scientific Research, Spain; National Research Institute for Rural Engineering, Water, and Forestry, Tunisia; Faculty of Medicine Ibn Al-Jazzar Sousse, Tunisia; and the College of Natural Sciences, Makerere University, Uganda.
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 869178-AquaticPollutants, Joint Programming Initiative on Anti-microbial Resistance (JPIAMR), www.waterjpi.eu; and JPI Oceans, www.jpi-oceans.eu. For Uganda, the three-year project is funded by the Swedish International Development Agency (Sida). The African Population and Health Research Center, Nairobi, www.aphrc.org coordinates the funding in Uganda.
In Uganda, the project is being implemented by researchers from the College of Natural Sciences, Makerere University led by Prof. Charles Masembe. Other team members are Dr. Robinson Odong, Dr. Peter Akoll, and Mr. Mayega Johnson from the Department of Zoology, Entomology and Fisheries Sciences) and Mr. John Omara from the Department of Biochemistry and Sports Science. The study area in Uganda includes the catchment of River Rwizi, Lake Mburo National Park, and River Aswa.
The research will contribute towards better understanding of the factors which influence the occurrence and spread of AMR in water systems, livestock farms, and birds. It will also contribute towards the Government of Uganda’s framework to combat the threat of AMR, through the National AMR Action Plan; design policies to reduce the risks of AMR, and the costs incurred for animal and human disease management.
Capacity building under the project
As part of the PAIRWISE capacity building component, the project is supporting research activities of two graduate students: Ms. Ndinawe Ruth Pamela (Master of Science in Molecular Biology) studying “The dispersal of antimicrobial resistance bacteria and genes through aquatic birds under different climatic and geographical conditions”; and Mr. George Katende (Master of Science in Immunology and Clinical Microbiology), studying “Characterization of clinically important antibiotic resistant bacteria and genes in river waters upstream and downstream of WWTPs and hospital effluent”.
Consultative meeting in Mbarara City
In May 2022, the Makerere team held a consultative meeting to get buy-in and introduce the PAIRWISE Project to the key stakeholders in Greater Mbarara and River Rwizi catchment. The meeting also aimed to receive input from key stakeholders regarding the use of antibiotics in Greater Mbarara district and River Rwizi catchment, to document challenges of Antimicrobial Resistance and identify potential sites for fieldwork.
Gulu City Stakeholders engagement
On 21st-25th November 2022, the research team held a similar meeting to get buy-in and introduce the project to stakeholders in Gulu City. The meeting held at Churchill Courts Hotel in Gulu City was attended by the City administrators and representatives from National Water and Sewerage Corporation, Gulu University, Gulu Regional Referral Hospital, Veterinary Officers, extension workers, and farmers including;
- Dr Aliro Tonny – Veterinary Officer, Gulu University
- Dr O. John – Veterinary Officer, Gulu District Local Government
- Mr. Moses Butele – Principal Quality Officer, National Water and Sewerage Corporation, Gulu City
- Mr. Ogweng Peter – Field Assistant, Gulu University
- Mr. Okello Richard – Extension Officer
- Mr. Opwonya Sunday Francis – Cattle Farmer, Gulu City
- Ms. Piloya Kevin – Production Officer, Gulu City Council
- Mr. Isaac Kigaje – SRO, Gulu Regional Referral Hospital
- Mr. Ogwang Quinto – MLT, Gulu Regional Referral Hospital
During the meeting, Dr Robinson Odong on behalf of Prof. Charles Masembe shared the project overview with participants, outlining the challenges of AMR, and expectations from the research. Stakeholders brainstormed and listed the commonly used antibiotics and the potential sites for sample collection. The research will take the One Health Approach, encompassing aspects of human, animal and environmental health.
According to stakeholders who participated in the meeting, Antimicrobial Resistance (AMR) remains a major challenge and dealing with it requires, among other interventions, proper waste management.
The medical and veterinary practitioners at the meeting underscored the importance of proper disposal of expired drugs in addressing the challenge of AMR. “60% of farmers in Gulu do not seek services of professional veterinary officers leading to misuse of antibiotics. This poses a risk to the environment as well as livestock and human health. There is need to strengthen regional capacity in the disposal of expired drugs,” they noted.
As part of the project activities, the research team collected samples from River Aswa, Gulu Wastewater Treatment Plant, Gulu Abattoir, dumping sites, hospital effluent and cattle farms in the catchment of River Aswa.
Mbarara Stakeholders Engagement: https://news.mak.ac.ug/2022/06/pairwise-project-engages-mbarara-stakeholders-on-antibiotic-resistance/