DRUM, Drivers of Resistance in Uganda and Malawi

The challenge

The spread of antibiotic resistant bacteria is a global problem with the poorest nations likely to suffer most. The DRUM consortium, working in Uganda and Malawi, investigated which aspects of human behaviour are most important in spreading antibiotic resistance, to inform potential interventions to prevent further spread of untreatable bacteria.

The discovery and development of antibiotics is one of the great scientific achievements of the 20th Century, however it rapidly became clear that bacteria quickly become resistant to these lifesaving agents, and the spread of antibiotic-resistant bacteria is now a problem of global concern.

Low-income countries frequently have the greatest burden of severe and life-threatening infections, and these nations are likely to suffer most from the spread of untreatable bacteria. There is much that is unknown about how antibiotic resistance spreads between humans animals and the environment globally and this is particularly true of sub-Saharan Africa, where diagnostic laboratories are not commonly available, health systems are weaker and antibiotic use is not well-regulated.

About the project

The Drivers of Resistance in Uganda and Malawi (DRUM) Consortium addressed how human behaviour and antibacterial usage in the home, animals and in the wider environment in urban and rural areas of Uganda and Malawi contributes to the spread of antibiotic resistance in bacteria. The consortium had a particular interest in the common bacteria E. coli and K. pneumoniae:

• coli is an example of a bacteria that often causes infections in the community, but may also spread around hospitals
• pneumoniae is a key cause of hospital acquired infections, particularly amongst vulnerable groups such as premature babies

The project studied these bacteria together as they are from the same family and are able to share traits that make them resistant to antibiotics.

Resistance type of interest

The resistance type of interest was extended spectrum beta-lactamase resistance (ESBL) which makes bacteria resistant to antibiotics called cephalosporins, the first-line antibiotic for severe infections in Uganda and Malawi.

Our strategies and approaches

The DRUM consortium investigated which aspects of behaviour are most important in spreading antibiotic resistance by surveying human behaviour in relation to antibiotics, water, sanitation and hygiene and investigating bacterial behaviour in response to these stimuli.

The project used cutting edge computational and statistical techniques to establish which behaviours are most important. This information has provided a foundation to work with policy makers in Uganda and Malawi to identify workable interventions to prevent resistant bacteria from spreading further.

Find out more about DRUM’s work and international partners.