Implementation of microbiology capacity
Study period:Ongoing.
Antimicrobial resistance (AMR) is of growing concern in Uganda, as elsewhere around the world, and the Fleming Fund and others have committed early investments to address this challenge. A key priority is surveillance of AMR, but there are several challenges involved in establishing good-quality microbiology capacity and data streams in countries like Uganda where laboratory infrastructure is not yet well developed.
Concerns about antimicrobial resistance (AMR) in Uganda were well summarized in a 2015 report compiled by the Uganda National Academy of Sciences, titled “Antibiotic Resistance in Uganda: Situational Analysis and Recommendations” pdf found here. Since then, researchers, public health specialists, and funders have directed more resources toward understanding and addressing the threat of AMR in Uganda. Indeed, Uganda is the first Fleming Fund investment country in the East African region.
Uganda has established a National Strategy for AMR and an AMR Surveillance Plan (2018-2023) download pdf. and with support from the Fleming Fund has finalized its AMR National Action Plan (released 14 Jan 2019). The National Action Plan specifically proposes to “support the implementation of a national AMR surveillance program to generate actionable data.” Currently, the potential for AMR surveillance in Uganda is very limited: microbiology capacity in the public health system is found only at the 14 regional referral hospitals, which can perform blood culture and antibiotic susceptibility testing (when reagents are available). An acute febrile illness surveillance program, coordinated through the Infectious Diseases Research Collaboration (IDRC); and partners with international funding, began in 2016 in pediatric inpatient wards at six reference hospitals around Uganda. This program, which aims to identify the causes of febrile illness in hospitalized children, includes the performance of blood culture. In the acute febrile illness program, blood samples are transported from the clinical site to a central reference laboratory in Kampala for culture and susceptibility testing. However, samples typically reach Kampala >24-48 hours after collection, reducing the sensitivity of microbiological culture, and limiting the accuracy of the data. Despite these limitations, these data are the only systematically collected information available to inform future AMR policies and strategies in Uganda.
This project seeks to address this gap. The overall aim of the project is to establish a microbiology laboratory at the IDRC clinical and research laboratory at the Tororo General Hospital in south-east Uganda.
The key objectives for this laboratory include:
- To provide real-time, on-site culture and susceptibility data for clinical samples obtained from Tororo District Hospital patients, and from community members participating in research studies (e.g. the birth cohort studies in Busia), to guide patient care and antibiotic prescribing;
- To directly address the need for good-quality AMR surveillance data in Uganda, from a site with geographical and epidemiological importance, to inform Uganda’s AMR National Action Plan;
- To provide a sustainable foundation for future clinical, research, and surveillance work on AMR-related topics in the Tororo area by leveraging well-established links among IDRC, regional and district health facilities, local communities including urban and rural/agricultural populations, other research scientists, and policymakers.
Study site:
IDRC Tororo Laboratory at Tororo General Hospital.
Principal Investigators:
Moses Kamya, Heidi Hopkins, Catherine Ludden, Sarah Staedke and Ben Amos
Project Coordinator: Peter Olwoch
The study is conducted by Collaborators from the University of Oxford, London School of Tropical Medicine and Hygiene and Infectious Diseases Research Collaboration(IDRC)
