Antimicrobial consumption surveillance in Uganda: Results from an analysis of national import data for the human health sector, 2018-2021

Background: The sureillance of antimicrobial consumption (AMC) is critical to deeloping appropriate antimicrobial stewardship interentions. It is a key component of World Health Organization's (WHO) Global Action Plan on Antimicrobial Resistance and the Uganda Antimicrobial Resistance National Action Plan 2018-2023. Our study's objectie was to determine the national consumption of all antimicrobials. Methods: Data on all imported antimicrobials were retrieed from paper-based records and entered in the web-based National Drug Authority (NDA) management information system from 2021. The import data for the year is a proxy for nationwide consumption because they account for 95% of all medical products. The NDA authorizes all imports to the country regardless of final distribution in the supply chain. The data were analyzed in accordance with WHO Anatomical Therapeutic Chemical codes and defined daily dose (DDD) methodology. We also retrieed consumption data for 2018, 2019, and 2020 that were preiously submitted by Uganda to WHO's Global Antimicrobial Resistance and Use Sureillance System. Results: In 2021, the aerage DDD per 1000 inhabitants was 29.02 for all antimicrobials; 80.7% of anti-microbials consumed were oral. Penicillins (27.6%) were the most consumed antimicrobial class, followed by sulfonamides and trimethoprim (15.5%). Based on WHO's Access, Watch, and Resere (AWaRe) antibiotic classification, 62.91% of AMC was from the access class, with watch class aeraging 14.51% in the period 2018-2021. Watch class AMC spiked in 2021 (34.2%) during COID-19 pandemic compared to 2020 (24.29%). Azithromycin and ciprofloxacin were the most consumed watch class antimicrobials in 2021. Conclusions: The relatiely high consumption of injectable antimicrobials and year oer year increase in watch class AMC requires urgent stewardship interentions. Further work is needed to establish a system for longitudinal AMC sureillance that is well resourced and funded to oercome the challenges of estimation and proide more accurate data on consumption and use patterns. (c) 2023 The Author(s). Published by Elseier Ltd on behalf of King Saud Bin Abdulaziz Uniersity for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creatiecommons.org/licenses/ by-nc-nd/4.0/).