Drivers of Resistance in Uganda and Malawi: The DRUM Consortium

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

Abstract

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. The poorest nations on Earth 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 globally and this is particularly true of sub-Saharan Africa, where diagnostic laboratories are not commonly available.
The "Drivers of Resistance in Uganda and Malawi" or DRUM Consortium will address how human behaviour and antibacterial usage in the home, around 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 is especially interested in the common bacteria E. coli and K. pneumoniae. E. coli is an example of a bacteria that often causes infections in the community, but may also spread around hospitals, whereas K. pneumoniae is a key cause of hospital acquired infections, particularly amongst vulnerable groups such as premature babies. We have chosen to study these bacteria together as they are from the same family and are able to share traits that make them resistant to antibiotics.
The DRUM consortium plans to investigate which aspects of behaviour are most important in spreading antibiotic resistance by surveying human behaviour in relation to antibiotics, water, sanitation and hygiene and by investigating bacterial behaviour in response to these stimuli. We plan to use cutting edge mathematical techniques to "model" which behaviours are most important and then use this information to work with policy experts in Uganda and Malawi to design potential interventions to prevent them from spreading further.

Technical Summary

The Drivers of Resistance in Uganda and Malawi, or DRUM Consortium aims to build an agent based model of the drivers of antimicrobial resistance transmission, using data from urban, peri-urban and rural settings in Uganda and Malawi to inform the model.

We will undertake five packets of work to build the model;
1. Longitudinally collect microbiological data from humans, animals and the environment of households at two levels of sampling intensity and genomically characterise the bacteria isolated;
2. Produce data on the intensity of antibiotic use across human and agricultural domains; the reasons for antibiotic use - and non-use - in different contexts; and drivers that are amenable to change;
3. As these are enteric pathogens, transmitted via the faecal oral route, we will provide a comprehensive outline of WASH behaviours and associated faecal exposure;
4. Determine the evolutionary trajectories of AMR development related to local antibiotic usage to understand if local usage and exposure patterns of antibiotics drive resistance emergence and persistence;
5. Quantify the economic burden from AMR and assess the value for money of potential interventions to tackle it.
At the same time, we will describe the barriers that exist in the AMR policy community and how these can be addressed in through implementing AMR strategic/action plans. The resulting information will be fed back to the policy community. We will use the relationships we develop in this workstream to develop and, in the future, trial interventions based on the output of the model.

Planned Impact

In Low and Middle Income countries (LMIC), there is a high incidence of severe bacterial infection and 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 morbidity and mortality, and is increasing selective pressure for the emergence of AMR pathogens. In many LMIC settings, extended spectrum betalactamase (ESBL) producing infections are locally untreatable due to unavailability of carbapenems or other reserve antibiotics.
The DRUM consortium will base its activities in urban, peri-urban and rural settings in Malawi and Uganda and is focusing on ESBL E. coli (ESBL-E) and K. pneumoniae (ESBL-K) bloodstream infections. These organisms share AMR phenotypes and genes and belong to the same family of bacteria. E. coli, however, are both community acquired and nosocomial, whereas K. pneumoniae are archetypal nosocomial AMR pathogens. Operating in urban, peri-urban and rural settings will enable us to evaluate AMR transmission at different human and animal population densities, with different levels of affluence, WASH infrastructure, burden of infectious diseases and different access to antimicrobials.
We propose a truly interdisciplinary approach, from laboratory to policy implementation to impact on this problem. To minimise AMR emergence and persistence, we will therefore describe the molecular epidemiology of AMR E. coli and K. pneumoniae in the human, animal and environmental context in which antimicrobials are used. Understanding the drivers of AMR transmission within the complex interplay between bacteria, humans, animals, and the environment is key to designing and implementing appropriate, safe, acceptable, and effective interventions. The DRUM Consortium envisages multiple pathways to impact.
1. We aim to have a AMR transmission model developed that can be used by policymakers to understand where evidence gaps remain and to test planned interventions. As part of this work, the model will be developed as a robust, user friendly piece of software. Our predictive model of AMR emergence to leverage fitness against pathogens. The model will be used to predict interventions that are most likely to succeed and this will inform applications to trial intervention strategies.
2. Our consortium includes a plan to identify key figures in AMR policy across multiple sectors in both settings that we will work with to disseminate our findings and to develop intervention strategies.
3. Packaging evidence into multiple 'products' through different formats and media. Our engagement strategy will be used to inform how to best package the evidence for each influential stakeholder. It will also inform the best time and route for the information to be delivered based on the stakeholder mapping. Targeted evidence products such as policy briefs and media briefings will be developed, and evidence dialogues will be held as appropriate. We will also discuss evidence at regional and global forums. Evidence will be disseminated to the research community through attendance at national and international conferences and peer reviewed publication.
We therefore expect that communities throughout East and Southern Africa will benefit from this study, through the development of strategies that will mitigate the spread of antimicrobial resistant bacteria. This in turn will reduce the incidence of locally untreatable bacterial infections.

Publications

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Brouwer MSM (2020) Mobile colistin resistance gene mcr-1 detected on an IncI1 plasmid in Escherichia coli from meat. in Journal of global antimicrobial resistance

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Hubbard ATM (2021) A novel mutation is responsible for a small-colony-variant phenotype in . in Microbiology (Reading, England)

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Lester R (2020) Sustained Reduction in Third-generation Cephalosporin Usage in Adult Inpatients Following Introduction of an Antimicrobial Stewardship Program in a Large, Urban Hospital in Malawi. in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

 
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%...
 
Title DRUM Poster: Development of a protocol for assessing the role of WASH in AMR distribution in the environment 
Description DRUM Poster: Development of a protocol for assessing the role of WASH in AMR distribution in the environment Presented at UNC Water and Health Conference, October 2019 Tracy Morse, Kondwani Chidziwisano, David Musoke, Derek Cocker, Nick Feasey 
Type Of Art Artwork 
Year Produced 2019 
Impact TBC 
URL https://waterinstitute.unc.edu/wp-content/uploads/sites/3640/2020/09/2019-Conference-program-reduced...
 
Description DRUM is coming to the end of its funding and the various work strands are concluding their fieldwork. DRUM was paused throughout much of 2020 due to the COVID pandemic, but, thanks to a NCE is now on course to finish in late 2021.

DRUM has generated fascinating data about AMR amongst humans, animals and the environment and about antimicrobial usage. We have identified high levels of ESBL producing organisms wherever we have looked. The final clinical and phenotypic microbiological data have been generated in Malawi and shared with statistical modelers in Lancaster. In Uganda, field work is ongoing due to a stricter lockdown and the presidential election but will complete in May 2021. The agent-based model has been constructed and assessed using simulated data and is now being populated by data from WS2. We have approximated 12,000 isolates or complex matrices to sequence and this work is being done now, commencing with large scale DNA extraction.
Exploitation Route Too early to say, there will be considerably more to report next year
Sectors Communities and Social Services/Policy,Environment,Healthcare

URL https://www.drumconsortium.org/
 
Description Annual AMR Awareness Week
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact The African Institute for Development Policy (AFIDEP) joined the Malawi Ministry of Health and Population (MOHP), key stakeholder institutions and organisations from the private sector in a 'Big Walk' through Lilongwe City, Malawi to commemorate Antibiotic Awareness Week. The aim of the Walk was to bring awareness to the general public on the dangers of the misuse and overuse of antibiotics. The theme was 'The future of antibiotic depends on us all' Among the awareness materials were a comic strip, fact sheet and an information sheet on work being done of antimicrobial resistance (AMR) in Malawi produced by AFIDEP.
URL https://www.afidep.org/raising-public-awareness-on-antibiotic-resistance-in-malawi-antibiotic-awaren...
 
Description Annual AMR Press Briefing
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact To kickstart World Health Organisation (WHO)'s Antibiotic Awareness Week 2019, Malawi's Ministry of Health and Population (MOHP), together with key stakeholders, held a press briefing event on 18 November, 2019, at the Public Health Institute of Malawi (PHIM) in Lilongwe, Malawi in a bid to increase media knowledge on antibiotic resistance and its effects as a means of increasing public awareness. The aim of the event was to capacity build members of the press that report on health-related issues on antibiotic resistance, as the media is a critical source of information for the public and policymakers. The African Institute for Development Policy (AFIDEP) was invited to be part of the briefing because of the work MOHP and AFIDEP do on antimicrobial resistance (AMR) through the Drivers of Resistance in Uganda and Malawi (DRUM) project. A key aspect of AFIDEP's work on DRUM is to explore key actors' perceptions of the barriers between sectors to sustainable, collaborative development of policy in line with the Malawi antibacterial resistance strategic plan.
URL https://www.afidep.org/the-role-of-the-media-in-the-fight-against-antibiotic-resistance-antibiotic-a...
 
Description Antimicrobial stewardship in Malawi: Optimising antibiotic usage (AMS Issue Brief)
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact This issue brief has been prepared by the African Institute for Development Policy (AFIDEP) based on the study, "Sustained reduction in third-generation cephalosporin usage in adult inpatients following introduction of an antimicrobial stewardship program in a large urban hospital in Malawi (https://pubmed.ncbi.nlm.nih.gov/32060523/). The study sought to demonstrate the feasibility, acceptability and cost-saving of a stewardship program where resources are limited. This issue brief seeks to promote and support the continued investment in antimicrobial resistance solutions.
URL https://www.afidep.org/publication/antimicrobial-stewardship-in-malawi-optimising-antibiotic-usage/
 
Description Evidence Informed Policy Making (EIPM) training, Malawi
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact AFIDEP, through the Drivers of Resistance in Uganda and Malawi (DRUM) and the African Research Collaboration on Sepsis (ARCS) teams, organised a four-day training workshop for policymakers working on issues of antimicrobial resistance (AMR) and sepsis. The training hosted participants from various departments of the Ministry of Health, Malawi Liverpool Wellcome Trust, WaterAid, Water and Environmental Sanitation Network and the Center of Medical Research Lambarene (Gabon). Aim to equip policymakers with the necessary skills to obtain and appraise evidence in order to make informed decisions about healthcare. The training will be followed up by a formal mentoring programme which will run for 8 weeks starting mid-December 2020. The end products from this will be policy briefs. The mentorship activities will also serve as a good platform for policy engagement in both the ARCS and DRUM projects.
URL https://www.afidep.org/strengthening-the-capacity-for-evidence-informed-policymaking-eipm-among-heal...
 
Description Member of MoH AMR TWG Core Group, Malawi
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact Unknown at this time
 
Description Participation in integration of AMR into Integrated Disease Surveillance and Response (IDSR)
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact TBC
 
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 Enabling optimal antimicrobial use in East Africa
Amount £128,259 (GBP)
Funding ID EP/T024984/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 06/2020 
End 05/2021
 
Description Implementation of AMR policy at district level (additional qualitative research at district level) Malawi
Amount £5,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 11/2020 
End 10/2021
 
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 Malawi: Hand Hygiene in Chithinkha ward, QECH
Amount £30,000 (GBP)
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2020 
End 03/2022
 
Description Responsive dialogues to improve public engagement on AMR
Amount £248,385 (GBP)
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 10/2020 
End 09/2022
 
Description Sequencing Klebsiella pneumoniae isolates from Chatinkha neonatal unit
Amount $130,000 (USD)
Funding ID INV-005180 
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 01/2020 
End 08/2021
 
Description Sustainable Plastic Attitudes to benefit Communities and their Environments (SPACES)
Amount £3,415,446 (GBP)
Funding ID NE/V005847/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 01/2021 
End 01/2025
 
Description AFIDEP Malawi 
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 The partnership has continued throughout 2020, with contracts extended by way of no cost extension
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 terms of reference.
Start Year 2018
 
Description CEH 
Organisation UK Centre for Ecology & Hydrology
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. The partnership has continued throughout 2020 with extensions to contracts by way of no cost extensions
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) Working to support research in Malawi and Uganda
Start Year 2018
 
Description DRUM Project Management Committee 
Organisation Lancaster University
Country United Kingdom 
Sector Academic/University 
PI Contribution All partner representation on the DRUM PMC allows monthly meetings at which all core decisions are made which impact the consortium. Standing agenda items include: Progress Updates, Challenges, Recruitment, Strategic decisions and development of the consortium
Collaborator Contribution All partners have attended well, supported publication approval process, and contributed to workplanning and budget alignments
Impact No public outcomes
Start Year 2019
 
Description DRUM Project Management Committee 
Organisation Makerere University
Department Infectious Diseases Institute
Country Uganda 
Sector Academic/University 
PI Contribution All partner representation on the DRUM PMC allows monthly meetings at which all core decisions are made which impact the consortium. Standing agenda items include: Progress Updates, Challenges, Recruitment, Strategic decisions and development of the consortium
Collaborator Contribution All partners have attended well, supported publication approval process, and contributed to workplanning and budget alignments
Impact No public outcomes
Start Year 2019
 
Description DRUM Project Management Committee 
Organisation Makerere University College of Health Sciences
Country Uganda 
Sector Academic/University 
PI Contribution All partner representation on the DRUM PMC allows monthly meetings at which all core decisions are made which impact the consortium. Standing agenda items include: Progress Updates, Challenges, Recruitment, Strategic decisions and development of the consortium
Collaborator Contribution All partners have attended well, supported publication approval process, and contributed to workplanning and budget alignments
Impact No public outcomes
Start Year 2019
 
Description DRUM Project Management Committee 
Organisation The Wellcome Trust Sanger Institute
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution All partner representation on the DRUM PMC allows monthly meetings at which all core decisions are made which impact the consortium. Standing agenda items include: Progress Updates, Challenges, Recruitment, Strategic decisions and development of the consortium
Collaborator Contribution All partners have attended well, supported publication approval process, and contributed to workplanning and budget alignments
Impact No public outcomes
Start Year 2019
 
Description DRUM Project Management Committee 
Organisation UK Centre for Ecology & Hydrology
Country United Kingdom 
Sector Public 
PI Contribution All partner representation on the DRUM PMC allows monthly meetings at which all core decisions are made which impact the consortium. Standing agenda items include: Progress Updates, Challenges, Recruitment, Strategic decisions and development of the consortium
Collaborator Contribution All partners have attended well, supported publication approval process, and contributed to workplanning and budget alignments
Impact No public outcomes
Start Year 2019
 
Description DRUM Project Management Committee 
Organisation University of Liverpool
Country United Kingdom 
Sector Academic/University 
PI Contribution All partner representation on the DRUM PMC allows monthly meetings at which all core decisions are made which impact the consortium. Standing agenda items include: Progress Updates, Challenges, Recruitment, Strategic decisions and development of the consortium
Collaborator Contribution All partners have attended well, supported publication approval process, and contributed to workplanning and budget alignments
Impact No public outcomes
Start Year 2019
 
Description DRUM Project Management Committee 
Organisation University of Strathclyde
Country United Kingdom 
Sector Academic/University 
PI Contribution All partner representation on the DRUM PMC allows monthly meetings at which all core decisions are made which impact the consortium. Standing agenda items include: Progress Updates, Challenges, Recruitment, Strategic decisions and development of the consortium
Collaborator Contribution All partners have attended well, supported publication approval process, and contributed to workplanning and budget alignments
Impact No public outcomes
Start Year 2019
 
Description DRUM Project Management Committee 
Organisation Wellcome Trust
Department Malawi-Liverpool Wellcome Trust Clinical Research Programme
Country Malawi 
Sector Academic/University 
PI Contribution All partner representation on the DRUM PMC allows monthly meetings at which all core decisions are made which impact the consortium. Standing agenda items include: Progress Updates, Challenges, Recruitment, Strategic decisions and development of the consortium
Collaborator Contribution All partners have attended well, supported publication approval process, and contributed to workplanning and budget alignments
Impact No public outcomes
Start Year 2019
 
Description IDI Uganda 
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. The partnership has continued throughout 2020, with contracts extended by way of no cost extension
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 terms of reference.
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. The partnership has continued throughout 2020, with contracts extended by way of no cost extension
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) Working to support research in Malawi and Uganda
Start Year 2018
 
Description MBIRA Malawi Collaboration 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Country United Kingdom 
Sector Academic/University 
PI Contribution Workstrand 2 researchers will contribute to this study
Collaborator Contribution LSHTM researchers will work with DRUM workstrand 2 researchers on this study
Impact This is a pan-African study run through LSHTM (PI: Alex Aitkin), assessing the mortality of AMR BSIs in Africa. The SWARM-HUB component of DRUM is linked to this.
Start Year 2020
 
Description MBIRA Malawi Collaboration 
Organisation Wellcome Trust
Department Malawi-Liverpool Wellcome Trust Clinical Research Programme
Country Malawi 
Sector Academic/University 
PI Contribution Workstrand 2 researchers will contribute to this study
Collaborator Contribution LSHTM researchers will work with DRUM workstrand 2 researchers on this study
Impact This is a pan-African study run through LSHTM (PI: Alex Aitkin), assessing the mortality of AMR BSIs in Africa. The SWARM-HUB component of DRUM is linked to this.
Start Year 2020
 
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. The partnership has continued throughout 2020, with contracts extended by way of no cost extension
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 MRC Phind collaboration - Interventions in early childhood development centres in Malawi 
Organisation University of Malawi
Country Malawi 
Sector Academic/University 
PI Contribution submitted application to MRC PHIND (£150K) for interventions in Early Childhood Development Centres with MLW and UNIMA - builds upon previous work of DRUM and SHARE and Typhoid identifying ECDCs as a potential area of infectious disease transmission.
Collaborator Contribution submitted application to MRC PHIND (£150K) for interventions in Early Childhood Development Centres with MLW and UNIMA - builds upon previous work of DRUM and SHARE and Typhoid identifying ECDCs as a potential area of infectious disease transmission.
Impact submitted application to MRC PHIND (£150K) for interventions in Early Childhood Development Centres with MLW and UNIMA - builds upon previous work of DRUM and SHARE and Typhoid identifying ECDCs as a potential area of infectious disease transmission.
Start Year 2020
 
Description MRC Phind collaboration - Interventions in early childhood development centres in Malawi 
Organisation University of Strathclyde
Country United Kingdom 
Sector Academic/University 
PI Contribution submitted application to MRC PHIND (£150K) for interventions in Early Childhood Development Centres with MLW and UNIMA - builds upon previous work of DRUM and SHARE and Typhoid identifying ECDCs as a potential area of infectious disease transmission.
Collaborator Contribution submitted application to MRC PHIND (£150K) for interventions in Early Childhood Development Centres with MLW and UNIMA - builds upon previous work of DRUM and SHARE and Typhoid identifying ECDCs as a potential area of infectious disease transmission.
Impact submitted application to MRC PHIND (£150K) for interventions in Early Childhood Development Centres with MLW and UNIMA - builds upon previous work of DRUM and SHARE and Typhoid identifying ECDCs as a potential area of infectious disease transmission.
Start Year 2020
 
Description MRC Phind collaboration - Interventions in early childhood development centres in Malawi 
Organisation Wellcome Trust
Department Malawi-Liverpool Wellcome Trust Clinical Research Programme
Country Malawi 
Sector Academic/University 
PI Contribution submitted application to MRC PHIND (£150K) for interventions in Early Childhood Development Centres with MLW and UNIMA - builds upon previous work of DRUM and SHARE and Typhoid identifying ECDCs as a potential area of infectious disease transmission.
Collaborator Contribution submitted application to MRC PHIND (£150K) for interventions in Early Childhood Development Centres with MLW and UNIMA - builds upon previous work of DRUM and SHARE and Typhoid identifying ECDCs as a potential area of infectious disease transmission.
Impact submitted application to MRC PHIND (£150K) for interventions in Early Childhood Development Centres with MLW and UNIMA - builds upon previous work of DRUM and SHARE and Typhoid identifying ECDCs as a potential area of infectious disease transmission.
Start Year 2020
 
Description Makerere CHS Uganda 
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. The partnership has continued throughout 2020, with contracts extended by way of no cost extension
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 consortium wide meetings, and at communications and workstrand meetings on a regular basis.
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 terms of reference.
Start Year 2018
 
Description Nagoya Protocol on Access to genetic material and benefits sharing in Malawi 
Organisation Government of Malawi
Country Malawi 
Sector Public 
PI Contribution The Nagoya protocol on Access to genetic material and benefits sharing has been a major sticking point for DRUM and pose a significant risk to sequencing of DRUM genomes within the project's time frame, especially in view of differences on IP and copyright ownership on sequence data between Sanger and the Malawi Government. In the past three months we have actively engaged the Malawi Government Officials, to understand what would be acceptable to them in terms of the IP and copyright ownership of sequence data. Working with the Sanger Legal Team and Nagoya Compliance Office, we are happy to have developed IP and copyright ownership terms, which we believe, are acceptable to the Malawi Government. A contract is now being drafted to include these terms and we hope it will be signed off soon.
Collaborator Contribution In the past three months we have actively engaged the Malawi Government Officials, to understand what would be acceptable to them in terms of the IP and copyright ownership of sequence data.
Impact IP and copyright ownership terms and a resultant contract
Start Year 2020
 
Description Nagoya Protocol on Access to genetic material and benefits sharing in Malawi 
Organisation The Wellcome Trust Sanger Institute
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution The Nagoya protocol on Access to genetic material and benefits sharing has been a major sticking point for DRUM and pose a significant risk to sequencing of DRUM genomes within the project's time frame, especially in view of differences on IP and copyright ownership on sequence data between Sanger and the Malawi Government. In the past three months we have actively engaged the Malawi Government Officials, to understand what would be acceptable to them in terms of the IP and copyright ownership of sequence data. Working with the Sanger Legal Team and Nagoya Compliance Office, we are happy to have developed IP and copyright ownership terms, which we believe, are acceptable to the Malawi Government. A contract is now being drafted to include these terms and we hope it will be signed off soon.
Collaborator Contribution In the past three months we have actively engaged the Malawi Government Officials, to understand what would be acceptable to them in terms of the IP and copyright ownership of sequence data.
Impact IP and copyright ownership terms and a resultant contract
Start Year 2020
 
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. The partnership has continued throughout 2020, with contracts extended by way of no cost extension
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 terms of reference. Genome sequencing is underway. Working to support research in Malawi and Uganda
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. The partnership has continued throughout 2020, with contracts extended by way of no cost extension
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, workstrand meetings and communications meetings Working in Malawi
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 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 terms of reference. Working to support research in Malawi and Uganda
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 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 Scientist 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 Scientist symposium
Year(s) Of Engagement Activity 2018
 
Description AFIDEP Malawi : Timveni Radio Interview 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Radio interview undertaken with local Radio & TV station Timveni TV. AFIDEP Research and Policy Associate, Levi Kalitsilo, explaindg that Sepsis arises from any infectious disease-causing agents acquired in either health care facilities or the community, while AMR occurs when microorganisms become resistant to antibiotics. Timveni Radio & TV has a national wide coverage.

The interview concluded with the following call to action:

1. The Ministry of Health must declare sepsis a national health and research priority as recommended by the WHO in May 2017. This should give the appropriate attention needed to pertinent issues such as the collection and storage of data on infection and sepsis-related deaths. This information can be used as a measure of performance and quality indicators for health facilities and the efficiency of the Malawi health system. Fund the operationalisation of the published 2018 National Action Plan on AMR.
2. Hospitals must develop, resource, implement and publish cost-effective AMR and sepsis improvement projects. Supporting collaboration on AMR and sepsis efforts in promoting the integration of AMR into priority disease/health issue areas (eg. Malaria, TB, Sepsis). This will ensure that AMR does not negatively affect disease management (whether sepsis, TB, Malaria etc).
3. There must be increased discourse to put AMR and sepsis on the national health agenda, drawing researchers' attention to the issue and bringing together cross-sectoral stakeholder action in avoiding duplication of efforts and maximising impact.
4. There is a need for more research on AMR and sepsis so that the problems are well understood and managed.
5. All stakeholders including health workers and the communities must be reached more effectively with AMR and sepsis awareness.
Year(s) Of Engagement Activity 2020
 
Description AFIDEP Malawi : Timveni TV interview 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact AFIDEP Research and Policy Associate, Levi Kalitsilo, interviewed on Timveni TV discussing the issues surrounding AMR and sepsis in Malawi. AFIDEP, through the Drivers of Resistance in Uganda and Malawi (DRUM) consortium and the African Research Collaboration on Sepsis (ARCS) project, is at the forefront of contributing to evidence in preventing sepsis and the spread of AMR.

Timveni Tv is a digital broadcastion station with substantial reach covering 70% of the population & reaching over 500,000 viewers.
Year(s) Of Engagement Activity 2020
URL https://www.youtube.com/watch?v=VBV-_GXh4W4
 
Description BLOG AFIDEP Africa: Sepsis and Antimicrobial Resistance in the Era of COVID-19: Overcoming Global Health's Triple Crisis 
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 AFIDEP, through the African Research Collaboration on Sepsis (ARCS) programme and Drivers of Resistance in Uganda and Malawi DRUM) consortium, is contributing to the body of scientific knowledge on sepsis and AMR.

Sepsis is a pathway to COVID-19 morbidity and mortality and is a risk factor for in-hospital COVID-19 deaths. Understanding of the relationship between sepsis and COVID-19 is leading to the innovative treatment of COVID-19.

Researchers need to build the scientific evidence of treating sepsis and AMR with insights from COVID-19, which have shown successful outcomes in Africa, such as those among all COVID-19-infected neonates with clinical signs of sepsis. This evidence should inform global health policymakers to support healthcare workers caring for critically ill sepsis and AMR patients.
Year(s) Of Engagement Activity 2020
URL https://www.afidep.org/sepsis-and-antimicrobial-resistance-in-the-era-of-covid-19-overcoming-global-...
 
Description BLOG AFIDEP Africa: Sepsis and antimicrobial resistance: An urgent call to strengthening health information systems 
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 AFIDEP Research and Policy Associate, Levi Kalitsilo explained that Sepsis arises from any infectious disease-causing agents acquired in either health care facilities or the community while AMR occurs when microorganisms become resistant to antibiotics.

AFIDEP, through the Drivers of Resistance in Uganda and Malawi (DRUM) consortium and the African Research Collaboration on Sepsis (ARCS) project, is at the forefront of contributing to evidence in preventing sepsis and the spread of AMR. DRUM seeks to transform understanding of the drivers of AMR as well as design interventions to reduce AMR spread in Uganda and Malawi; while ARCS aims to improve the survival and quality of life of sepsis patients using relevant innovations at the individual and health system level, through multidisciplinary applied health research.
Year(s) Of Engagement Activity 2020
URL https://www.afidep.org/sepsis-and-antimicrobial-resistance-an-urgent-call-to-strengthening-health-in...
 
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 sensitization 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 299 followers. Engagement with the twitter community, including sharing DRUM outputs and sharing other AMR resources.
Year(s) Of Engagement Activity 2018,2019,2020,2021
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 Mankhoma 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 Eleanor MacPherson and John Mankhoma, 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 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 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 IDI Science Fair - Uganda 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Showcase of IDI research for the broader Ugandan health community. I will present updates on DRUM, DRUM+ and Fleming Fund.
Year(s) Of Engagement Activity 2020
 
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 Mankhoma 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 Nature Research Microbiology Blog - Behind the Paper 
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 Blog post - Behind the Paper blog article for Nature Research Microbiology Community on our recent publication in Nature Communications
Year(s) Of Engagement Activity 2020
URL https://naturemicrobiologycommunity.nature.com/posts/predicting-the-unpredictable?utm_source=digest_...
 
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 Presentation of the baseline Malawi WASH results in April - University of Strathclyde, UK 
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 Presentation of the baseline WASH results in April
Presentation of DRUM baseline results for WASH in Malawi to the Drug-Resistant Infections group at MLW to inform them on the study's progress in WASH component of DRUM and how the WASH results relate to the microbiological data
Year(s) Of Engagement Activity 2020
 
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 Stakeholder training on Evidence Informed Policy Making - Malawi 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact We attended a stakeholder training on evidence informed policy making. The training brought together representatives from animal health, human health and WASH. A total of 20 people attended the training and I was given the opportunity to discuss the findings. The training was delivered by AFIDEP
Year(s) Of Engagement Activity 2021
 
Description Strengthening the capacity for Evidence-Informed Policymaking (EIPM) among health policymakers, civil society and researchers in Malawi 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact A blog about a four-day training workshop for policymakers working on issues of antimicrobial resistance (AMR) and sepsis. The training hosted participants from various departments of the Ministry of Health, Malawi Liverpool Wellcome Trust, WaterAid, Water and Environmental Sanitation Network and the Center of Medical Research Lambarene (Gabon).
Year(s) Of Engagement Activity 2021
URL https://www.afidep.org/strengthening-the-capacity-for-evidence-informed-policymaking-eipm-among-heal...
 
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 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 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