Looking rather frail is a lean, tall young man who has been sailing for over 45 minutes in the deep waters of Lake Victoria under the scotching sun just to reach the Buvuma Health Center IV. He sails aboard his small engine boat which also serves as his only source of livelihood.
Isaac Mukungu, a 30-year-old fisher man, visits the main island of the Buvuma Islands from a detached island of Kyanamu every two weeks to seek professional medical assistance at the Buvuma Health Centre IV, the biggest health facility on the islands for a refill of his TB treatment.
Despite being very committed to receiving and taking his treatment, Mukungu seems not to be getting better, and this worries his doctors. “Mukungu has been a very committed patient, who always honors his appointments and adheres to all his treatment. I think we are facing another case of drug resistance,” observes Dr. Kasozi Frank, the clinical officer, Buvuma Health Center IV, Buvuma District.
A follow up on Mukungu’s case reveals that he would share some of his prescriptions with his family members and would at times improvise with over the counter medicines that are easily accessed at drug shops.
Buvuma district is comprised of various detached islands; it is composed of two town councils, 87 subcouties and a population of 145,300 people. There are 52 inihibited islands with only 11 health facilities on just seven lslands which include Buvuma main Island, Bugaya, Namatale, Lwaaje, Nkata, Lubya and Lingira. The main diseases or infections include Malaria, Cough or colds (no pneumonia), pneumonia, Billihazia (dysentery), elimithiosis (worms), HIV/TB and Sexually Transmitted diseases.
According to Dr. Kasozi, Buvuma District is facing not only a multi-drug resistant TB (susceptible TB) outbreak but a general multi-drug resistant problem for almost all the recurring infections on the island. So far, three cases have been identified from Lyabaana, Namutale and Nairambi sub-counties
Study shows that the factors favoring the emergence and spread of antimicrobial resistance (AMR) in Uganda include: overuse of antibiotics associated with self-medication, over-prescription of antibiotics, and patients not finishing the entire course of antibiotics prescribed.
According to the Uganda National Action Plan on AMR 2018-2023 resistance to the most commonly-used antimicrobials (e.g. penicillins, tetracyclines and cotrimoxazole) was in some cases above 80 percent. The challenge with multi-drug resistant infections is that it restricts treatment options to fewer and often more expensive drugs, explains Dr Kasozi.
However, Uganda is making progress in implementing an AMR surveillance strategy to tackle the AMR health burden. Although numerous challenges still exist, upon further investigations, Dr. Kasozi says, they discovered that understanding of antimicrobial use, resistance prevention and containment could only be achieved by creating public awareness on the dangers of AMR and how to prevent them through effective information, education and behavior change communication.
He explained that the implementation of the AMR Action Plan and awareness campaigns are being coordinated by the Uganda National Antimicrobials Resistance Committee under the Ministry of Health. Dr Kasozi adds that social engagement is very crucial in ensuring a critical change in behavior in the way antimicrobials are used.
The AMR Plan highlights the fact that most Ugandans, including health professionals, are not aware of the growing problem of AMR. Thus, the plan emphasizes awareness and prevention since they are the most effective, affordable way to reduce risk for and severity of resistant infections. This entails disease prevention and health promotion in general to reduce the use of antimicrobial agents—the single most important driver of resistance.
It further emphasizes access to effective antimicrobial agents which are essential in slowing down development of resistant infections. This requires not only equitable access but also optimal use of antimicrobial agents, which also requires adequate access to health care facilities and services.
The Buvuma Health Center IV’s AMR prevention and control program, dubbed the Catch-up Campaign is underpinned by the provisions and recommendations of the National AMR Action Plan 2018-2023. The campaign, which is funded by the Ministry of Health, and the Global Fund, was launched in May 2021.
The campaign focuses on promoting public awareness and understanding on antimicrobial use, resistance prevention, and containment through effective communication and training, improving infection prevention and containment of resistant microorganisms in human health care, community and animal health through individual and environmental sanitation, hygiene and infection prevention and biosecurity measures.
It further emphasized the optimization of the use of antimicrobial drugs in human and animal health-care settings through effective stewardship practices and strengthening the knowledge and evidence base of antimicrobial use and antimicrobial resistance through One Health surveillance to inform policy.
The campaign uses Village Health Teams (VHT) to carry out heath seminars at community centers, where residents were rallied with the help of local leaders, especially the LC 1 chairpersons, to take part. The VHTs were adopted in Uganda as a strategy in the early 2000s to bridge health service delivery between community and health facilities.They have greatly improved service delivery in the health sector in terms of accessibility of health care as well as awareness of various health campaigns by the health ministry.
Fredrick Kasumba, the Lingira village LC 1 chairperson, says they faced a challenge of adamant residents in the beginning but with the vigorous campaigns, the exercise picked up leading to more residents getting on board.
Rachael Nassali, is a grandmother of five-year-old Gavin who is currently on ART. She admits that she was very ignorant and against treatment until the community health facilitators visited her island Lwaaje to sensitize the residents about the dangers of misusing antibiotics.
“The boy almost died but when the health workers came and referred us here (Buvuma health center IV), my grandson’s health has improved tremendously. He no longer suffers from rampant infections. I thank God and the health workers who ensured that we now follow proper drug usage and on Doctor’s prescription,” she says beaming with happiness.
The Buvuma Health Center IV is working with the Makerere University’s Walter Reed Project set to end in May 2022. Through the project, medical center engages communities on sanitation, importance of immunization and proper drug usage through proper prescriptions and diagnosis.
Dr. Kasozi says the response has been overwhelming as they have so far enrolled over 20,000 residents from the islands of Lingira, Lwaaje and Nkata. The enrolled residents are sensitized on disease prevention and health promotion in general through handwashing campaigns, safe sexual practices, immunizations as well regular checkups and screenings for proper diagnosis and follow up.
According to Nakazibwe Immaculate, the leader of the Lingira Village Health Team comprising of eight health workers, they found an alarming number of over 800 residents at Lingira island suffering the AMR problem but that has tremendously reduced to just about 200 people, thanks to the on-going campaigns and control efforts.
She observes that most of those infected are children below the age of five, people living with HIV/AIDs and Tuberculosis.
Felista Mutesi, 28, a beneficiary, is grateful to the program as her medical bills have drastically reduced due to an improvement in her ways of using drugs that has led to a reduction in reoccurrence of infections.
“People at my village of Nkata-A used to be very careless with their sanitation, some would still practice open defecation while others never ever took washing their hands seriously but when health workers, and teachers from the health center came and taught us about proper hygiene, infections have reduced tremendously,” Mutesi explains.
At Nkata Village, over 5000 residents were able to engage in these awareness sessions, where they learnt the importance of proper hygiene, how best to prevent infections according to Ms. Nakazibwe. “About a third of these have managed to mitigating infections through proper sanitation and good toilet practices.”
According to Dr. Kasozi, the main concern are the difficulties faced by the health workers in accessing the detached Islands where most residents live due to transportation challenges caused by the fact that water is the only medium of transport. This also makes access to health facilities a challenge for the residents, he adds.
By Hasifah Namuli and Namiganda Jael