Table Of ContentAnti-Microbial Resistance
in Global Perspective
Louise Ackers
Gavin Ackers-Johnson
Joanne Welsh
Daniel Kibombo
Samuel Opio
Anti-Microbial Resistance in Global Perspective
· ·
Louise Ackers Gavin Ackers-Johnson
· ·
Joanne Welsh Daniel Kibombo Samuel Opio
Anti-Microbial
Resistance in Global
Perspective
Louise Ackers Gavin Ackers-Johnson
Global Social Justice University of Salford
University of Salford Salford, UK
Salford, UK
Daniel Kibombo
Joanne Welsh Infectious Disease Institute
University of Salford Kampala, Uganda
Salford, UK
Samuel Opio
Pharmaceutical Society of Uganda
Kampala, Uganda
ISBN 978-3-030-62661-7 ISBN 978-3-030-62662-4 (eBook)
https://doi.org/10.1007/978-3-030-62662-4
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We dedicate this book to the Future Generations of public health users in
Uganda and Low- and Middle-Income Countries facing the impacts of
Anti-Microbial Resistance.
Foreword
As the UK Special Envoy on AMR, I welcome Professor Louise Ackers’
book, Anti-Microbial Resistance in Global Perspective. The resistance of
bacteria to antibiotics is a growing threat to modern medicine and our
ability to treat infections. It is estimated that more than 30,000 women
die each year as a result of severe infections when giving birth and the
majority of these deaths occur in LMICs. Sepsis accounts for around 10–
15% of maternal mortality and the vast majority of these deaths could
be prevented through the appropriate use and stewardship of antibiotics.
Anti-microbial resistance is an increasingly serious threat to the gains
made in health and development and for the attainment of the Sustain-
able Development Goals (SDGs) in particular, SDG 3.1 which calls for
a reduction in preventable maternal deaths. We know that the situation
willonlygetworseif,andwhen,theantibioticsthattreattheseinfections
become less effective. We need to protect and preserve the antibiotics for
as long as possible to save the lives of millions not only for now but for
the future generations.
This book provides us with invaluable empirical evidence on how we
can promote the rationale use of antibiotics in LMICs to reduce the risk
of pregnant women dying from a fatal drug resistant infection. Through
effective infection prevention control and antibiotic prescribing based
on laboratory results, Professor Acker shows us how rates of infection
can be drastically reduced and more effectively treated. Using laboratory
vii
viii FOREWORD
results as a basis for interventions is so important and leads to sustain-
able change. This was all achieved through a health partnership between
volunteers in NHS Trusts and health institutions in the UK and their
counterparts in Uganda and demonstrates the power of peer to peer
support, in the form of mentoring and other less traditional approaches
on formal training interventions, for effective behaviour change. We
thank our health workers, in particular those involved in this partnership,
whose great working is driving amazing progress in Uganda and beyond.
With small and low-cost stewardship interventions we can make a signif-
icant impact on maternal mortality, and ultimately reduce the impact of
antimicrobial resistance.
Professor Louise Ackers’ work was funded by the Fleming Fund, a
£265 million UK aid programme, through the Commonwealth Part-
nership on Antimicrobial Stewardship programme. The Fleming Fund
supports LMICs to generate, use and share antimicrobial resistance data
so they can optimise the use of antibiotics and reduce drug resistance. It
is committed to improving understanding of antimicrobial resistance by
raisingawarenessofantimicrobialstewardshipinLMICs.Thestewardship
of antimicrobials currently available to us is vital in order to preserve the
effectivenessofdrugsforaslongaspossibleandhenceisakeycomponent
of our response to AMR.
Professor Dame Sally Davies
UK Special Envoy on AMR
London, UK
Acknowledgments
The Maternal Sepsis Intervention was very much a team activity. We
wouldliketothankallthemembersoftheProjectTeamfortheircommit-
ment and professionalism including; James Ackers-Johnson (Knowledge
for Change), Allan Ndawula (K4C), Ibrahim Mugerwa (AMR National
Taskforce), Saarah Niazi-Ali (Antibiotic Specialist Pharmacist, Tameside
General Hospital, Manchester), Clare Liptrott (Pharmacist, University of
Salford) and Allan Muwazae (Senior Pharmacist, FPRRH). Amrit Atwal
(Anthony Nolan Haematology Pharmacist at University Hospitals Birm-
ingham NHS Foundation Trust) was awarded a Chief Pharmaceutical
Officer’s Global Health Fellowship to work with the team. Chloe James
(Microbiologist,UniversityofSalford)supervisedGavinAckers-Johnson’s
doctoral research and provided training on the interpretation of labo-
ratory results in Uganda. Simon Sseguya (Pharmacist, FPRRH) worked
closelywiththeteaminsuppliesmanagementandasaclinicalpharmacist
and joined colleagues in the UK in February 2020 for 4 months on a
Commonwealth Professional Fellowship.
The Project owes special gratitude to the K4C clinical team on
the ground including Dorothy Gashuga (K4C Lead Midwife); Rachel
Namiiro (K4C Midwife), Barbra Kamara (K4C IPC Specialist Midwife)
and Joe Odur (K4C Pharmacist). Dorothy, Rachel, Barbra and Joe have
worked tirelessly on the wards for the whole project exuding profes-
sionalism and collegiality. They have also played a key role in data
collection.
ix
x ACKNOWLEDGMENTS
The work was supported by the presence of Professional Volunteers:
Elizabeth Pearson, Rob Harper, Caroline Hammond, Amy Cleese, Jan
Dubbink, Jemma Berwick and Harriet Earp.
Maaike Seekles provided support with data collation and analysis.
We would like to thank the Directors (past and present) of FPRRH,1
Dr. Florence Tugumisirize and Dr. Alex Adaku and the Hospital Admin-
istrator, Mr. Louis Muhindo, for their active support with all aspects of
the project.
We extend our gratitude to the health worker team on the Post-
natal and Gynaecology wards whose commitment and expertise have
been pivotal to project success. Special thanks go to the ward In-Charge,
Mrs. Gladys Acayo, Hannah Kemiyondo, Irene Lubambula, Bridget
Kyomuhendo and all the nurses and midwives.
This research was conducted during activities funded by the Depart-
mentofHealthandSocialCareusingUKaidfundingandismanagedby
the Fleming Fund. The views expressed in this publication are those of
the author(s) and not necessarily those of the Department of Health and
Social Care.
1Fort Portal Regional Referral Hospital is known locally as Buhinga Hospital.
Contents
1 Introduction to Antimicrobial Resistance
and the Maternal Sepsis Intervention 1
2 Autonomy, Evidence and Methods in Global Health 11
3 The Impact of the Maternal Sepsis Intervention 37
4 Infection Prevention Control (IPC) and Antimicrobial
Resistance (AMR) 53
5 The Role of Microbiology Testing in Controlling
Infection and Promoting Antimicrobial Stewardship 81
6 Task Shifting, Midwifery Empowerment
and the Nascence of Clinical Pharmacy 103
7 Change Processes: Multi-Disciplinary Teamwork 129
8 The Knowledge Creation and Transfer Mechanism 145
9 Conclusions: Capturing, Sustaining, Spreading
and Researching Change 161
xi
