Opportunities and challenges for improving antimicrobial stewardship in low and middle income countries ; lessons learnt from the maternal sepsis intervention in Western Uganda

This paper presents findings from an action-research intervention designed to identify ways of improving antimicrobial stewardship in a Ugandan Regional Referral Hospital. Building on an existing health partnership and extensive action-research on maternal health, it focused on maternal sepsis. Sepsis is one of the main causes of maternal mortality in Uganda and Surgical Site Infection, a major contributing factor. Post-natal wards also consume the largest volume of antibiotics. The findings from the Maternal Sepsis Intervention demonstrate the potential for remarkable changes in health worker behaviour through multi-disciplinary engagement. Nurses and midwives create the connective tissue linking pharmacy, laboratory scientists and junior doctors to support an evidence-based response to prescribing. These multi-disciplinary ‘huddles’ form a necessary, but insufficient, grounding for active clinical pharmacy. The impact on antimicrobial stewardship and maternal mortality and morbidity is ultimately limited by very poor and inconsistent access to antibiotics and supplies. Insufficient and predictable stock-outs undermine behaviour change frustrating health workers’ ability to exercise their knowledge and skill for the benefit of their patients. This escalates healthcare costs and contributes to Anti-Microbial Resistance

Abundance and utilization of Pyrenacantha sylvestris in Budongo Forest Reserve, western Uganda

Pyrenacantha sylvestris S. Moore (Icacinaceae), locally known as Kateganende, has been extensively harvested by local people yet poorly managed. This has created a gap between its utilization and conservation. A study was therefore conducted to document its abundance and utilization in Budongo Forest Reserve. Abundance was assessed in ten systematically sampled plots of 20 × 50 m. Five of the plots were established in logged forest (compartment N2) and the other five in the nature reserve (compartment N15). Individual P. sylvestris and trellises were recorded and their respective diameter at breast height measured. Questionnaires designed to capture information on the utilization of P. sylvestris were administered to 40 systematically selected respondents adjacent to the forest reserve. Abundance was highest in logged areas of the forest (χ2 = 14.8, d.f. = 4, P \u3c 0.01). Individuals in the diameter class 0.1–0.5 cm were the most abundant. Pyrenacantha sylvestris in the forest were mostly hosted in the trellises of the diameter class 1.0–10 cm. Over-reliance and use of P. sylvestris threaten the survival of the species. There is a need to create awareness and regulate its harvesting. In addition, research needs to be conducted on the possibility of propagating and domesticating this plant