Health 28.10.21

University project saving mothers' lives in Uganda

A team from the University of Salford has returned from a trip to Uganda, which saw them make great progress in tackling antimicrobial resistance (AMR), significantly reducing death rates for new mums in hospital.

Louise Ackers, Chair in Social Policy, and Clare Liptrott, Senior Lecturer in Non-Medical Prescribing, were among those who took part in the project – which aims to promote the safe use of antibiotics, working with the Commonwealth Partnerships for Antimicrobial Stewardship Scheme (THET Partnership for Global Health) and in line with the World Health Organisation (WHO).

AMR is where bacteria becomes resistant to antibiotics, creating a ‘super strain’ of resistant bacteria which can spread and become dangerous. This can be caused by people using antibiotics when they don’t need to.

‘There are also good bacteria in our bodies to help with things, including digestion and processing vitamins. Antibiotics aren’t selective, so taking them unnecessarily can affect our own body’s health too,’ advised Clare.

It has been predicted by WHO that AMR could be the biggest cause of death by 2050 - overtaking cardiovascular disease and cancer.

Louise added, ‘AMR is a global, multifaceted issue. It’s being projected that in the next 10 years, chemotherapy will be severely compromised in the UK because of AMR.’ 

Louise has worked in Uganda for the past 10 years, having founded Knowledge for Change, a charity which focuses on research impact in healthcare. The research is mostly around maternity wards.

‘The two main killers of new mothers in Uganda are haemorrhage (bleeding) or sepsis. For some time now we’ve been working on trying to understand if there’s a way to reduce deaths from sepsis,’ she explained.

Alongside PhD students, Louise and Clare worked in a postnatal ward to reduce the number of deaths from sepsis, which are usually caused by c-section wound infections. They found that infected wounds were treated with antibiotics – not necessarily the right ones – meaning the average stay in hospital was 3 months.

Instead, infected wounds would be swabbed and sent off to be tested in a lab. A phone was installed so that the ward could easily contact the lab and find out the results. This meant that the correct antibiotics could be given to treat the infection.

‘Simple things can make a difference. The length of stay in hospital for a wound infection has gone down massively – some women were staying 30 days; now average stays are 7-10 days, which has had a massive impact on patients and the hospital itself.

‘No mother has died from maternal sepsis since we put these steps in place,’ added Clare.

The team also visited primary schools, to educate children about washing hands and taking antibiotics responsibly.

In Uganda, it is possible to buy antibiotics in a pharmacy, just as you might with paracetamol in England. They could be taken for any reason – from a headache or a cough, to depression – because people are not educated about when and how they should be used. This contributes to antimicrobial resistance, as the more antibiotics are used unnecessarily, the more resistant the bacteria become.

‘Whether in the UK or Uganda, one way of educating parents is through the children, rather than the other way around,’ Clare explained. 

She had previously worked on an AMR prevention ‘guardianship’ programme with Public Health England. This saw Clare, working as part of the group, create an activity pack - to be used by any youth leaders - to teach children about AMR in a ‘fun’ way. Children would make a pledge online, promising to take responsibility for their use of antibiotics.

As it had already been tried and tested by children in the UK, Clare took the activity pack to Uganda. There, the team educated children about germs through engaging activities, including the use of a Shrek mask. Clare used this to demonstrate the importance of washing your hands after sneezing and blowing your nose.

‘The children are taught in English at school, but they didn’t understand words like “snot,” so we had to come up with creative ways to communicate that to them,’ she said.

The children were provided with colouring-in sheets and felt-tip pens – resources which Clare brought over from England. They were also encouraged to use ‘plasticine’ constructed of salt dough and food colouring to make their own bacteria models.

Clare described the experience as ‘empowering.’

‘The children were enthusiastic and were credits to their schools. They all made a pledge to go home and tell their families about one thing they had learned – which was handwashing. That was brilliant, as handwashing is the most important thing for preventing antimicrobial resistance.’

Now, Clare and Louise are working to further prevent AMR and improve the quality of aftercare in postnatal wards in Uganda.

‘Of all the things we’ve done in Uganda, this project has been hugely effective - we’ve definitely seen change,’ Louise said. ‘These projects seemed to have brought about a real substantial and sustainable change. To see the number of women dying drop considerably has been really quite heartening.’

For the next few months, the University of Salford is hosting nurses from Uganda, while they undertake training for cervical cancer screening.