Ways to prevent drug resistance  

The World Antimicrobial Awareness Week (WAAW) is a global campaign commemorated annually between November 18 and 24. The campaign aims at improving awareness and understanding of antimicrobial resistance (AMR) and encouraging best practices among the public, health stakeholders and policymakers. This year’s campaign was held under the theme; ‘Preventing Antimicrobial Resistance Together’ and provides an opportunity to reflect on the different stakeholder groups and their role in AMR prevention. 

Antimicrobials are medicines used to prevent and treat infections in humans, animals and plants. They include antibiotics, antivirals, antifungals and antiparasitics.
The inappropriate use of antimicrobials has resulted in AMR, which occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines. 

This makes infections harder to treat and increases the risk of disease spread, severe illness and death. While AMR occurs naturally over time, usually through genetic changes, human behaviours such as poor disposal of antimicrobials increase exposure to organisms that can impact humans and animals. 
AMR is a rising challenge for food systems and public health, both globally and nationally. Misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals; infection and disease prevention and control in health-care facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation are the major drivers of AMR.
 
The impact of AMR is far-reaching, and the cost to both the global and national economies is high. AMR in animals complicates the management of infectious diseases and production, leads to the death of animals. Also, of concern is the danger of spillage of resistant organisms from animals to humans, which could have potentially devastating public health effects. 
In poultry farms in peri-urban and rural districts of Wakiso and Soroti in Uganda found high levels of human drug-use for the treatment of poultry diseases. Most of the human medications used, including pain killers, antiparasitics and antibiotics, are readily available over the counter in pharmacies.

The increase of AMR among livestock is attributed to insufficient knowledge and information on the impact of antimicrobial misuse and overuse, especially by farmers, lack of understanding of the benefits of disease prevention options like animal vaccination and poor on-farm hygiene practices, among others. 
Efforts have been made to address AMR in humans, although much more needs to be done. Unfortunately, the animal and plant sectors have received much less attention. More needs to be done to recognise and promote the One Health approach: That is, the interplay between people, animals, plants, and their shared environment. 

Not all the required interventions can be achieved at once, but some low-hanging fruits exist for the animal industry and can be implemented by both the public and private sectors. 
These include improving awareness and knowledge levels through boosting extension services and improving access to veterinary services, especially in rural areas. Farmers in rural areas purchase veterinary inputs, including drugs, from village markets. 
Those who cannot afford to buy, use leftover vaccines from their neighbours. Because they do not have adequate information on what to use, they often use whatever is available. Other interventions include improving awareness, access and affordability of disease control interventions and supporting farmers to adhere to policies that promote good husbandry practices, such as withdrawal periods following administration of antimicrobials before they can put their farm products on the market.  
 
Research to investigate the evidence of access, use and disposal of antimicrobials for humans and animals at the community level is ongoing and will provide information on the AMR challenge in the country. 
The AMR challenge is multi-sectoral and, therefore, cannot be addressed by stakeholders alone. In accordance with this year’s WAAW theme, different sector players must work collaboratively at all levels to mitigate the spread and impacts of AMR.  

The author, Ms Pamela Nabukenya Wairagala is a communications and knowledge management senior officer