How do human and bacterial behaviour interact in urban and rural African environments to facilitate the stable acquisition of antimicrobial resistance

Lead Research Organisation: Liverpool School of Tropical Medicine
Department Name: Clinical Sciences

Abstract

The development of antibacterials has saved millions of lives; however, the massive global usage of these agents has created huge pressure for bacteria to become resistant to these drugs and to cause infections that are difficult or impossible to treat. This, combined with the flow of drugs slowing profoundly, has made antibiotic resistance a threat to health of global importance. New approaches are necessary to reduce illness caused by resistant bacteria.
In Low and Middle Income countries (LMIC), there is a huge burden of severe illness caused by bacteria, a critical lack of clinics and hospitals to diagnose and appropriately treat bacterial infections and widespread availability of antibiotics without prescription. This situation is responsible for a huge amount of illness and is increasing the pressure on bacteria to become drug resistant. LMIC settings will be the last to benefit from new types of antibiotics and it is therefore of urgent importance to undertake research addressing antibiotic resistance in LMICs that aims to identify which are the most important causes or drivers of the development of drug resistance. This requires scientists from a variety of fields and with a variety skills, from the laboratory to policy implementation to work together.

We will therefore describe both where bacteria live when not causing infections, whether in humans, animals or the environment, and how antimicrobials are used and misused in humans animals and the environment to:

1. Determine ways of using antibiotics make resistance come at a cost rather than as a benefit to bacteria
2. Develop ways of using antibiotics across all sectors that both improves access for people that really need them, but protects medicines of last resort in a manner acceptable to governments, communities and doctors to minimise the local emergence of resistance;
3. Identify ways in which different parts of government, the health and research sectors can more effectively work together to reduce antibiotic resistance at national and district level, both within and between human and animal health and the environment.

Technical Summary

The development of antibacterials has saved millions of lives; however, the massive global usage of these agents has created huge selective pressure for the emergence of antibacterial resistant (ABR) bacteria and drug resistant infection (DRI). This, combined with the flow of new antimicrobial agents slowing profoundly, has made ABR a public health threat of global importance and new approaches are necessary to reduce morbidity and mortality from DRI.
In Low and Middle Income countries (LMIC), there is a huge burden of severe bacterial infection, a critical lack of accessible health system infrastructure to diagnose and appropriately treat bacterial infections and widespread availability of antimicrobials without prescription. This situation is responsible for a huge burden of disease, and is increasing selective pressure for ABR emergence. LMIC settings will be the last to benefit from new classes of antimicrobials and it is therefore of urgent importance to undertake research addressing ABR in LMICs that aims to identify drivers and interrupt transmission pathways of ABR pathogens. Only a truly interdisciplinary approach, from laboratory to policy implementation can impact on this problem. We will therefore describe the spatial and molecular epidemiology of ABR pathogens in the human, animal and environmental context in which antimicrobials are used, to:

1. Determine treatment strategies that leverage the fitness cost to pathogens of acquiring ABR thus minimising the emergence and persistence of resistance
2. Develop antimicrobial management and usage strategies across all sectors that both improve equity of access and restrict reserve agents in a manner acceptable to governments, communities and end users to minimise the local emergence and persistence of resistance;
3. Identify and addresses barriers to sustainable delivery of collaborative actions to address ABR at national and district level, both within and between human and animal health systems.

Planned Impact

Key impacts from the development phase award will include a strengthening of existing links with policymakers across relevant ministries from its start, and it will be used to strengthen the capacity of national and local systems to deliver coordinated ABR interventions across human, animal and environmental sectors, including building South-South cooperation. The applicants aim to secure a development award and to submit a consortium application.
Key impacts from a consortium phase application will include:
1) A South-South cooperation between College of Veterinary Medicine Makerere (COVAB) University of Malawi (UNIMA) that will enhance existing cooperation between Makerere and UNIMA.
2) A predictive model of AMR emergence to leverage fitness against pathogens, which will provide robust evidence to inform treatment policy to avoid AMR emergence.
3) A validated model of AMR transmission that will provide robust evidence to design interventions to interrupt AMR transmission.
4) An assessment of capacity, and opportunities to improve multi-sectoral policy development and community acceptability to provide an evidence base for capacity strengthening needs and evidence based, effective and feasible multi-sectoral antimicrobial stewardship and hygiene policies/guidelines.
6) A platform which allows continent-wide data input to inform AMR surveillance to support the dissemination of reliable, timely evidence to hasten mitigating actions and response.
7) Piloted interventions in urban and rural settings to interrupt transmission of AMR pathogens to reduced drug resistant infection and maintain antimicrobial effectiveness if interventions are taken to scale.
8) An economic model to estimate economic burden of AMR and returns on investment from potential interventions to minimise impact including budget impact assessment and financial planning; insights influencing the political economy of decision-making and a validated framework to estimate economic impact of future interventions.

Publications

10 25 50
 
Title DRUM Comic Strip English and Chichewa 
Description Comic about Antimicrobial Resistance in English and Chichewa languages 
Type Of Art Artwork 
Year Produced 2019 
Impact A comic strip in English and Chichewa. It makes understanding antimicrobial resistance accessible to Chichewa speakers 
URL https://www.drumconsortium.org/sites/drum/files/content/attachments/2020-03-06/DRUM%20Comic%20Strip%...
 
Description This was an MRC development award and the primary objective was to bring together a larger consortium of investigators to apply for the second stage award. This was done at a workshop in Malawi in December 2017 during which the Drivers of resistance in Uganda and Malawi Consortium was conceived and the scope of work agreed upon. The DRUM consortium was one of the succesful applicants to the second stage and its outputs appear in researchfish
Exploitation Route The main research outputs of the development ward have formed the basis of the ongoing work of DRUM
Sectors Communities and Social Services/Policy,Environment,Healthcare

 
Description Identifying Barriers to collaborative action on AMR in Malawi
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description BMGF/African Academy of Sciences (AAS)-Alliance for Accelerating Excellence in Science in Africa (AESA)
Amount $100,000 (USD)
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 01/2019 
End 07/2020
 
Description Drivers of Resistance in Uganda and Malawi: The DRUM Consortium
Amount £3,046,155 (GBP)
Funding ID MR/S004793/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 05/2018 
End 01/2021
 
Description JPIAMR Network of European and African Researchers on AMR (NEAR-AMR)
Amount £44,000 (GBP)
Funding ID MR/S037640/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 01/2019 
End 02/2019
 
Description MRC Doctoral Training Programme x 3 studentships
Amount £57,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 11/2018 
End 11/2022
 
Description AFIDEP 
Organisation African Institute for Development Policy
Country Kenya 
Sector Charity/Non Profit 
PI Contribution The partnership has been confirmed contractually, with a consortium agreement containing workplans and agreed budget. Partners have attended monthly Programme Management Meetings and a kick off meeting in Liverpool in June 2018 to devise these workplans, agree trans-disciplinary working practices and approve publications strategies. Organised and hosted a strategic planning and series of stakeholder engagement meetings in Kampala in January 2019
Collaborator Contribution Lead on workstrand 8 - Identifying and addressing barriers between in-country sectors involved in AMR control for the delivery of appropriate policy. AFIDEP has contributed widely to programme management meetings, development of the WS8 workplan and budget and in design and progress of a policy engagement strategy. AFIDEP also attended a Workstrand 2 strategic planning meeting in Kampala, and associated stakeholder engagement meetings in January 2019 AFIDEP have taken a lead in supporting the external communications in the consortium, creating outputs such as leaflets and our comic (reported under creative outputs) and providiung assistance with the DRUM website.
Impact Signed consortium agreement, and contribution to a multi-disciplinary workplan creation, incorporating a one-health approach. Standard Operating procedures written. Ethical approval obtained for all DRUM in Liverpool and Malawi, Uganda under revision. Expert review group appointed and approved, with draft terms of reference.
Start Year 2018
 
Description CEH 
Organisation Centre for Ecology & Hydrology (CEH)
Country United Kingdom 
Sector Public 
PI Contribution The partnership has been confirmed contractually, with a consortium agreement containing workplans and agreed budget. Partners have attended monthly Programme Management Meetings and a kick off meeting in Liverpool in June 2018 to devise these workplans, agree trans-disciplinary working practices and approve publications strategies.
Collaborator Contribution Attendance at monthly PMC meetings. Inputs to workstrand 2 - Detailed, longitudinal, microbiological surveillance of humans, animals and the environment to describe the dynamics of ESBL-E and ESBL-K and their ecological niche - specific contribution to environmental microbiology.
Impact Signed consortium agreement, contribution to a multi-disciplinary workstrand incorporating a One-Health approach (human microbiology, environment and animal/veterinarian health)
Start Year 2018
 
Description IDI 
Organisation Makerere University
Department Infectious Diseases Institute
Country Uganda 
Sector Academic/University 
PI Contribution The partnership has been confirmed contractually, with a consortium agreement containing workplans and agreed budget. Partners have attended monthly Programme Management Meetings and a kick off meeting in Liverpool in June 2018 to devise these workplans, agree trans-disciplinary working practices and approve publications strategies. IDI and Makerere jointly hosted a consortium meeting in January 2019 at which we formally launched the project with Ugandan Ministry of Health and senior officials.
Collaborator Contribution Inputs to development of the workplan for Workstrand 2 - Detailed, longitudinal, microbiological surveillance of humans animals and the environment to describe the dynamics of ESBL-E and ESBL-K and their ecological niche Inputs to development of the workplan for Workstrand 5 - Understanding the drivers of water sanitation and hygiene practices and their relation to the faecal-oral transmission of ESBL-E and ESBL-K Inputs to development of the workplan for Workstrand 7 - Understanding the economical implications of antimicrobial resistance Attendance at monthly programme management meetings and at the kick off meeting in Liverpool in July 2018, also hosting of the Workstrand 2 development meeting in Kampala in January 2019. • Joint meetings held between the site PI, DRUM Study Coordinator and ARCS Sepsis Fellow to allow for synergy across the projects and enable skills transfer between the study coordinator and sepsis fellow based on their respective expertise. • Policy brief/research report working group in partnership with ARCS IDI - LSTM
Impact Signed consortium agreement, contribution to a multi-disciplinary workstrand incorporating a One-Health approach (human microbiology, environment and animal/veterinarian health). Standard Operating procedures written. Ethical approval obtained for all DRUM in Liverpool and Malawi, Uganda under revision. Expert review group appointed and approved, with draft terms of reference. DRUM plans presented at: 1) 3rd Annual National AMR Conference (21-22 Nov 2018), Kampala, Uganda and 2nd Global Network of AMR and IPC Symposium (4-7 Mar 2019), Kampala, Uganda.
Start Year 2018
 
Description Lancaster - CHICAS 
Organisation Lancaster University
Department Centre for Health Informatics, Computing, and Statistics (CHICAS)
Country United Kingdom 
Sector Academic/University 
PI Contribution The partnership has been confirmed contractually, with a consortium agreement containing workplans and agreed budget. Partners have attended monthly Programme Management Meetings and a kick off meeting in Liverpool in June 2018 to devise these workplans, agree trans-disciplinary working practices and approve publications strategies.
Collaborator Contribution Leading Workstrand 6: Dynamical agent-based modelling of AMR in Uganda and Malawi Specific support to development of the workplan and budget for WS6 including the early development of a cohesive model-focused approach and the creation of the dataverse, an online data storage platform which is GDPR compliant,secure, publishable and self-managed. Attendance at monthly programme management meetings and at the kick off meeting in Liverpool in July 2018 as well as at the WS2 strategic planning and stakeholder engagement meeting in Kampala in January 2019.
Impact Signed consortium agreement, online dataverse data bank, contribution to a multi-disciplinary workstrand incorporating a One-Health approach (human microbiology, environment and animal/veterinarian health)
Start Year 2018
 
Description MLW 
Organisation Wellcome Trust
Department Malawi-Liverpool Wellcome Trust Clinical Research Programme
Country Malawi 
Sector Academic/University 
PI Contribution The partnership has been confirmed contractually, with a consortium agreement containing workplans and agreed budget. Partners have attended monthly Programme Management Meetings and a kick off meeting in Liverpool in June 2018 to devise these workplans, agree trans-disciplinary working practices and approve publications strategies.
Collaborator Contribution Lead workstand 2: Detailed, longitudinal, microbiological surveillance of humans, animals and the environment to describe the dynamics of ESBL-E and ESBL-K and their ecological niche. Attendance at monthly programme management meetings and at the kick off meeting in Liverpool in July 2018 as well as at the Workstrand 2 strategic planning meeting in Kampala in January 2019.
Impact Signed consortium agreement, contribution to a multi-disciplinary workstrand incorporating a One-Health approach (human microbiology, environment and animal/veterinarian health). Standard Operating procedures written. Ethical approval obtained for all DRUM in Liverpool and Malawi, Uganda under revision. Expert review group appointed and approved, with draft terms of reference.
Start Year 2018
 
Description Makerere CHS 
Organisation Makerere University College of Health Sciences
Country Uganda 
Sector Academic/University 
PI Contribution The partnership has been confirmed contractually, with a consortium agreement containing workplans and agreed budget. Partners have attended monthly Programme Management Meetings and a kick off meeting in Liverpool in June 2018 to devise these workplans, agree trans-disciplinary working practices and approve publications strategies. IDI and Makerere jointly hosted a consortium meeting in January 2019 at which we formally launched the project with Ugandan Ministry of Health and senior officials.
Collaborator Contribution Inputs to development of the workplan for workstrand 2 - Detailed, longitudinal, microbiological surveillance of humans, animals and then environment to describe the dynamics of ESBL-E and ESBL-K and their ecological niche. Inputs to development of the workplan for workstrand 8 - Identifying and addressing barriers between in-country sectors involved in AMR control for the delivery of appropriate policy . Attendance at the monthly Programme Management meetings, at the kick-off meeting in Liverpool (July 2018) and at the Workstrand 2 development meeting in Kampala in January 2019.
Impact Signed consortium agreement, and contribution to a multi-disciplinary workplan creation, incorporating a one-health approach. Revised budget to allow for new strategy for policy engagement work in both research countries. Standard Operating procedures written. Ethical approval obtained for all DRUM in Liverpool and Malawi, Uganda under revision. Expert review group appointed and approved, with draft terms of reference.
Start Year 2018
 
Description Sanger 
Organisation The Wellcome Trust Sanger Institute
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution The partnership has been confirmed contractually, with a consortium agreement containing workplans and agreed budget. Partners have attended monthly Programme Management Meetings and a kick off meeting in Liverpool in June 2018 to devise these workplans, agree trans-disciplinary working practices and approve publications strategies.
Collaborator Contribution Inputs to the development of the workplan for workstrand 2: Detailed, longitudinal, microbiological surveillance of humans, animals and the environment to describe the dynamics of ESBL-E and ESBL-K and their ecological niche. Attendance at monthly programme management meetings and at the kick off meeting in Liverpool in July 2018
Impact Signed consortium agreement, contribution to a multi-disciplinary workstrand incorporating a One-Health approach (human microbiology, environment and animal/veterinarian health). Standard Operating procedures written. Ethical approval obtained for all DRUM in Liverpool and Malawi, Uganda under revision. Expert review group appointed and approved, with draft terms of reference.
Start Year 2018
 
Description Strathclyde 
Organisation University of Strathclyde
Department Department of Civil and Environmental Engineering
Country United Kingdom 
Sector Academic/University 
PI Contribution The partnership has been confirmed contractually, with a consortium agreement containing workplans and agreed budget. Partners have attended monthly Programme Management Meetings and a kick off meeting in Liverpool in June 2018 to devise these workplans, agree trans-disciplinary working practices and approve publications strategies.
Collaborator Contribution Leading on the development of an in-depth workplan and budget for workstrand 5: Understanding the drivers of water, sanitation and hygiene practices and their relation to the faecal-oral transmission of ESBL-E and ESBL-K. Coordinating work with MLW and IDI for in-country data collection, and working with the social science teams to ensure strong data on drivers of AMR. Attendance at monthly programme management meetings and at the kick off meeting in Liverpool in July 2018 as well as at the WS2 development meeting in Kampala in January 2019
Impact Signed consortium agreement, contribution to a multi-disciplinary workstrand incorporating a One-Health approach (human microbiology, environment and animal/veterinarian health). Standard Operating procedures written. Ethical approval obtained for all DRUM in Liverpool and Malawi, Uganda under revision. Expert review group appointed and approved, with draft terms of reference.
Start Year 2018
 
Description University of Liverpool 
Organisation University of Liverpool
Country United Kingdom 
Sector Academic/University 
PI Contribution The partnership has been confirmed contractually, with a consortium agreement containing workplans and agreed budget. Partners have attended monthly Programme Management Meetings and a kick off meeting in Liverpool in June 2018 to devise these workplans, agree trans-disciplinary working practices and approve publications strategies.
Collaborator Contribution Lead on workstrand 7: Understanding the economic implications of antimicrobial resistance. Attendance at monthly programme management meetings, a Workstrand 2 strategic planning and stakeholder engagement meeting in Kampala in January 2019 and at the kick off meeting in Liverpool in July 2018.
Impact Signed consortium agreement, contribution to a multi-disciplinary workstrand incorporating a One-Health approach (human microbiology, environment and animal/veterinarian health). Standard Operating procedures written. Ethical approval obtained for all DRUM in Liverpool and Malawi, Uganda under revision. Expert review group appointed and approved, with draft terms of reference.
Start Year 2018
 
Description 2nd Global Network of AMR and Infection Prevention (NAMRIP) Symposium 4-7 March 2019 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presentation provided by site PI (S Jacob); co-Chair of the Organising Committee was DRUM Co-I, Dr Henry Kajumbula
Network funded by GCRF to University of Southampton in collaboration with Makerere University. Theme of conference: 'Innovations towards combating antimicrobial resistance: a whole society engagement'
Primary audience members were researchers from the UK and Uganda interested in forging new collaborations on AMR research in Uganda. Other audience members included Ugandan policymakers
There were requests for further information and plans made for future activity
Year(s) Of Engagement Activity 2019
URL https://www.southampton.ac.uk/namrip/news/2019/03/global-namrip-conf.page?
 
Description 2nd Global Network of AMR and Infection Prevention (NAMRIP) Symposium 4-7 March 2019 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Attended by site PI (S Jacob); study coordinator (S Nanono); co-I (L Mugisha)

Inception and stakeholder meeting to launch the BUILD-Uganda initiative funded through the International Livestock Research Institute (ILRI) by Germany's Federal Ministry for Economic Cooperation and Development (BMZ)

Primary audience members were members of the BUILD consortium from Uganda, Kenya and Germany. Other audience members included Ugandan policymakers and Ugandan-based NGOs interested in One Health and its intersection with AMR
Year(s) Of Engagement Activity 2019
URL https://www.ilri.org/news/boosting-uganda%E2%80%99s-action-plans-livestock-development-%E2%80%93-bmz...
 
Description A poster presentation at the Microbiology Society conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact A poster presentation at the Microbiology Society conference
Year(s) Of Engagement Activity 2018
 
Description A poster presentation at the Society of Applied Microbiology Early Career Scientiest symposium 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact A poster presentation at the Society of Applied Microbiology Early Career Scientiest symposium
Year(s) Of Engagement Activity 2018
 
Description College of Medicine Research Dissemination Conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Claire Jensen presented DRUM at the research conference. The participants included other researchers, postgraduate students, and some policymakers (Charles Mwansambo, Watipaso Kasambara and some of her staff, etc). After the conference there were Requests for further participation, plans made for future activity and requests for further information.
Year(s) Of Engagement Activity 2019
URL https://www.medcol.mw/rdc/
 
Description Community meetings and senzitisation activities (June, August) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact In the residential areas where the DRUM research is taking place, we have held meeting to inform Chiefs and other stakeholders of research activities taking place. The purpose of the stakeholder meetings was to raise awareness of the social research activities taking place.
Plans for further engagement, with the study team returning to the communities to feedback findings from the work
Year(s) Of Engagement Activity 2019
 
Description DRUM Twitter 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Active twitter account with 250 followers. Engagement with the twitter community, including sharing DRUM outputs and sharing other AMR resources.
Year(s) Of Engagement Activity 2018,2019,2020
URL https://twitter.com/drum_consortium?lang=en
 
Description DRUM Website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact DRUM website was created as an online platform to highlight DRUM activities, provide further information to stakeholders about DRUM, section to store DRUM outputs and resources.
Year(s) Of Engagement Activity 2019,2020
URL https://www.drumconsortium.org/
 
Description DRUM: a spatial sampling design conference poster 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Work strand 6, Conference poster describing the experimental spatial design methodology used for the DRUM study. The impact is still to be realised through completion of DRUM data collection and subsequent analysis. This sampling design was implemented in DRUM, and is currently working towards completion of data collection.

Effective spatial sampling is crucial for allowing us to gain a further understanding of the drivers of anti-microbial resistance in Uganda and Malawi. This understanding will provide evidence for implementing interventions designed to reduce the prevalence of untreatable illness.
Year(s) Of Engagement Activity 2019
 
Description EEID sandpit 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This was an event aimed at promoting cross-disciplinary collaboration to apply for "Ecology and Evolution of Infectious Diseases" programme NIH/UKRI.

This was attended by Quantitative, qualitative, and biological researchers with interests in emerging infectious disease ecology and UKRI grant managers
Year(s) Of Engagement Activity 2019
URL https://bbsrc.ukri.org/funding/filter/2019-ecology-evolution-of-infectious-diseases/
 
Description EPAM continuum workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Claire Jenson attended the Community engagement on AMR. Policy makers and researchers attended the workshop and following there were requests for further participation, plans made for future activity and also requests for further information
Year(s) Of Engagement Activity 2019
 
Description Eleanor MacPherson and John Mankhomwa, attended a Veterinary association of Malawi's meeting on AMR and animals - The event combined training and discussion focusing on One Health and antibiotic use in animals 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact This meeting was primarily aimed at the the veterinary community of Malawi but also included stakeholders from the ministry and broader civil society. 30 people attended the event and it sparked discussion on AMR, and provided John and Eleanor with an opportunity to discuss the DRUM social science work to key stakeholders. Malawian vets, senior vet officers and national level representatives from the Animal Health Department of the Ministry of Agriculture, Irrigation and Water Development. There were also stakeholders from civil society were present.
Plans were made for further participation with key stakeholders and request for further information from some stakeholders
Year(s) Of Engagement Activity 2019
URL https://www.afidep.org/raising-public-awareness-on-antibiotic-resistance-in-malawi-antibiotic-awaren...
 
Description Eleanor MacPherson and John Mankhowa presented findings to the College of Medicine Research Dissemination day around the types of antibiotics and how they are used (with case studies around animal meat practices and care at the health centres) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The dissemination day included the academic research community, with delegates drawn nationally and internationally and there were also representatives from Civil Society. The purpose of the meeting was to disseminate research findings to the academic research community.
Plans for further engagement, audience members discussed changing view points
Year(s) Of Engagement Activity 2019
URL https://rdc.medcol.mw
 
Description Epidemics17 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Work strand 6, Workshop attendee (with Jon Read and Mélodie Sammarro) at the Biannual international conference on epidemic analysis
Audience was with International epidemic modelling community., Clinicians, epidemiologists, environmental scientists
Year(s) Of Engagement Activity 2019
URL https://www.elsevier.com/events/conferences/international-conference-on-infectious-disease-dynamics
 
Description Introductory talk on AMR in LMICS at Bristol University for the National PhD Training Scheme in AMR funded by the Medical Research Foundation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact First training cohort on the National PhD Training Scheme in AMR funded by the Medical Research Foundation. Purpose was to give an overview of the AMR situation in different socioeconomic regions. Positive feedback received. Asked to present at the Sepsis 2109 conference in Birmingham on this topic as a result.
Year(s) Of Engagement Activity 2018
 
Description Invited participant at the 5th British-German Frontiers of Science Symposium 2018 March 21 - 24, 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact The Alexander von Humboldt Foundation, the Young Academy, and the Royal Society collaborate to organize the 5th British-German Frontiers of Science Symposia. The conference brings together approximately 60 outstanding young British and German scientists (with up to 15 years of postdoctoral experience), half from the Great Britain and half from Germany.

The participants discuss advances and opportunities of various scientific disciplines, such as chemistry, geosciences, biology, mathematics, physics, and neuroscience. During the conference, 18 scientists from the United Kingdom and Germany introduce the scientifically diverse audience to the excitement of their fields, place their research in larger scientific contexts, illustrate research at the cutting-edge of other disciplines, and stimulate an interdisciplinary discussion among all participants. The conference is intended to encourage the exchange of knowledge across disciplines and to provide opportunities for British-German collaborations and networking. The first British-German FoS symposium took place in Wyboston (UK) in 2006, the second symposium in Potsdam (Germany) in 2008, the third at the Kavli Royal Society International Centre in North Buckinghamshire (UK) and the fourth symposium in Potsdam (Germany).
Year(s) Of Engagement Activity 2018
URL https://www.humboldt-foundation.de/web/brigfos-2018.html
 
Description Kick off meeting in Hoima - stakeholder input to DRUM study in Uganda 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact Sensitisation of key stakeholders in the Hoima area of the planned DRUM study. Participants asked questions, influenced plans for the way forward in the area, and felt they had learned more about the potential implications of AMR in their population DRUM team presentation (WASH was David Musoke)
Year(s) Of Engagement Activity 2019
 
Description Kick off meeting in Kampala- stakeholder input to DRUM study in Uganda 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact DRUM team presentation (WASH was David Musoke) Sensitisation of key stakeholders in the Hoima area of the planned DRUM study. Participants asked questions, influenced plans for the way forward in the area, and felt they had learned more about the potential implications of AMR in their population
Year(s) Of Engagement Activity 2019
 
Description Kondwani Chidziwisano participated in a proposal writing workshop in Zambia at the CIDRZ in December 2019. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Course on proposal development with the completion of a proposal to expand research in early childhood development centres. Submitted proposal to US PEER programme which could add value to DRUM and also build in intervention from DRUM findings in institutional settings
Year(s) Of Engagement Activity 2019
 
Description Lancaster/DSTL antibiotic futures 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Work strand 6, Defence policy academic staff at Lancaster associated with the Institute of Social Futures (ISF). Attended Lancaster's Institute of Social Futures workshop with DSTL on "Antibiotic Futures"
Year(s) Of Engagement Activity 2019
URL https://www.lancaster.ac.uk/social-futures/
 
Description Ministry of Health's Antibiotic Awareness (18th-24th November 2019) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Ministry of Health's Antibiotic Awareness was aimed at the Malawian public during an awareness march and public speeches. There was coverage by radio and TV as well as broader members of the public who were provided with leaflets and information about the DRUM study
Eleanor MacPherson and John Mankhowa were invited to attend and the activities including an awareness march on the 20th November 2019. The march and talks consisted of approximately 100 people.
This provided us with an opportunity to further deepen our relationship with the Ministry of Health's AMR unit and feeding back on our ongoing work to stakeholders. We also met with key stakeholders including from the animal health and other members of the AMR technical working group to conduct stakeholder interviews.
Year(s) Of Engagement Activity 2019
 
Description Participation of WASH team in Sanipath at University of Kwa Zulu Natal in January 2020.  
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Kondwani Chidziwisano and Taonga Mwapasa. Learning from Emory University Team on the techniques and processes used in the Sanipath tool for assessing environmental faecal contamination. Supported skills development for participants to implement effective transect walks and environmental sampling in Malawi
Year(s) Of Engagement Activity 2019
URL http://sanipath.org
 
Description Poster presentation by Tracy Morse at UNC Water and Health Conference (October 2019) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Conference attended by 649 attendees from 41 countries. Poster led to discussion and raised interest from a number of potential future partners and academics undertaking research in AMR. NGOs expressed interest to learn more in the Malawian office. Raised significant interest and has led to further collaborations with
(a) CDC (USA) in use of the IDEXX Colilert kit for ESBL E coli which will now be implemented alongside DRUM in both Malawi and Uganda
(b) Emory University (USA) in the use of their Sanipath method - led to attendance at their training in Durban (South Africa) with the team from Kwa Zulu Natal University.
(c) plans to present training with WaterAid Malawi on WASH and AMR
Year(s) Of Engagement Activity 2019
URL https://waterinstitute.unc.edu/conferences/waterandhealth2019/
 
Description Presented ILRI Addis Ababa (10 Jan 2020) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact DRUM "One health" Presentation - - Presented the concept and interim results of DRUM to ILRI, to gain feedback from veterinary experts. Had AMR colleagues on the line from LSHTM and ILRI @ Kenya - 30 (in person) and 15 (online)

The presentation was given by Derek Cocker (local PI) to ILRI members in Ethiopia, most of whom are veterinary experts.External ILRI members, and interested AMR partners at LSHTM

Workshop / Presentation about DRUM work in Malawi, focussing on work packages 2/5, to veterinary colleagues. Discussed about study structure, design, interim results and scope. Stimulated a lot of interest in the project and possible future collaborations

There were request for further participation and requests for further information from this activity
Year(s) Of Engagement Activity 2019
 
Description Speaker at Bristol AMR Symposium "Colston Lectures" (Nov 2019) - Presented portfolio of AMR work at MLW 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Lecture at AMR symposium in Bristol and there was Requests for participation in DRUM from students as well as Request for further information and also the Audience changed views on AMR in Africa
Year(s) Of Engagement Activity 2019
URL https://www.bristol.ac.uk/amr/events/2019/colston-research-society-symposium.html
 
Description The importance of RSTMH on the issue of drug resistant infections 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact It is appreciated that drug resistant infections (DRIs) are not as geographically constrained as their human, animal or plant hosts and that there are many countries and areas of the world where the effects of DRIs will be disproportionally felt due to limited resources and healthcare-infrastructure, as well as a reduced capacity and capability to monitor and respond to disease.

To limit the consequences of DRIs, a collective response is needed that similarly does not respect geographical and political boundaries.

The international challenge of DRIs is increasingly illustrated by many national and international funding bodies highlighting it as a priority area of research, with an increase in collaborative opportunities to apply for support for investigations into both the problem of DRIs and potential solutions.

Recognition of the multi-disciplinary nature of DRIs is also increasing within the funding landscape and has had a transformative effect on the perception of the DRI problem, at least among many of those applying for funds to try and understand and fix it.

This is where RSTMH plays a key role. RSTMH membership maps well to the areas of greatest vulnerability from drug resistance.

The Society's roles in terms of highlighting priority areas for research, education, dissemination of research findings via publications and advertising funding opportunities is also an important link between research groups, healthcare workers and clinicians, and policy stakeholders across the entire global One Health spectrum.
Year(s) Of Engagement Activity 2018
URL https://rstmh.org/blog/2018/sep/17/importance-rstmh-drug-resistant-infections
 
Description Uganda Malawi training week 1 Blantyre August 2019 - Training of Lawrence, David Fred and Daniel 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Nick Feasey (Study PI) lead the training with the Ugandan PIs, including Veterinary lead, Derek Cocker (Local PI Malawi), Tracy Morse (WASH lead) Taonga Mwapasa
(Study coordinator Malawi), Kondwani Chidziwisano (WASH expert, Malawi) and Ugandan data managers and key study field staff

Key Ugandan DRUM staff attended for discussions about WASH analysis and animal collection methods.
Training on study protocols pertaining to sample collection, observations and data management were completed by senior field staff

Plans made for future activity and decisions made or influenced from the audience
Year(s) Of Engagement Activity 2019
 
Description Uganda Malawi training week 1 Blantyre August 2019 - Training of Shevin, Sylvia and Henry 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Study participants or study members
Results and Impact Derek Cocker (Local PI Malawi) lead the training for the Ugandan PIs / Co-Is, including local study PI and Laboratory lead. Also attended by Taonga Mwapasa (Study coordinator Malawi) and Kondwani Chidziwisano (WASH expert, Malawi) Ugandan study coordinator

Key Ugandan DRUM attended for decision-making on study protocols (lab and field) in Uganda, and local training. Discussions were had about tailoring the study to Uganda specific questions, and how best to negotiate logistic challenges in country. Decisions about eventual household numbers and best ways to train staff were had.

Plans were made for future activity and decisions made or influenced from the audience
Year(s) Of Engagement Activity 2019
 
Description Weekly training and support meetings for field workers 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact WS2 and WS5 research teams (Malawi). Review of weeks data collection, addressing field issues, data gaps or concerns. Continued professional development of field team and addressing problems as they arise
Year(s) Of Engagement Activity 2019
 
Description Wellcome AMR public engagement visit 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Community members (4 groups of 10) pharmacy and drug shop workers and community health workers, national policy makers and civil society

Wellcome AMR public engagement team, in collaboration with EPAM came to Malawi in November to develop a toolkit for locally developed public awareness campaigns. Working with the DRUM field team they held deliberative conversations with people living in Chikwawa, Blantyre and Lilongwe to help develop public engagement messaged. They also talked to pharmacist working in the private sector and drug store owners in Blantyre and Lilongwe. Building on their reflections from the residential work, they held a workshop with national policy makers and civil society representatives.

2 plans for future activity, with the Wellcome Trust committing to funding a grant to pilot the approach in Malawi.
Year(s) Of Engagement Activity 2019