Taking Opportunities, Taking Medicines: Antibiotic Use in Rural Eastern Uganda

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Abstract

The ways in which dimensions of health and healthcare intersect with economics and politics in particular contexts requires close attention. In this article we connect concerns about antibiotic overuse in Uganda to the social milieu created through policies that follow President Museveni’s vision for a population who kulembeka, “tap wealth.” Ethnography fieldwork in rural Eastern Uganda illustrates how taking medicines in rural households reflects a wider landscape of everyday imperatives to “tap” opportunities in a context of acute precarity. We argue for a closer connection between medical and economic anthropology to push forward understanding of health, medicines and wellbeing in Africa.

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Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control.

Moses Kamya, Emmanuel Arinaitwe, Humphrey Wanzira … (2015)

The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three subcounties: Walukuba (peri-urban), Kihihi (rural), and Nagongera (rural). Annual entomological inoculation rate (aEIR) was estimated from monthly Centers for Disease Control and Prevention (CDC) light trap mosquito collections. Children aged 0.5-10 years were provided long-lasting insecticidal nets (LLINs) and followed for measures of parasite prevalence, anemia and malaria incidence. Estimates of aEIR were 2.8, 32.0, and 310 infectious bites per year, and estimates of parasite prevalence 7.4%, 9.3%, and 28.7% for Walukuba, Kihihi, and Nagongera, respectively. Over the 2-year study, malaria incidence per person-years decreased in Walukuba (0.51 versus 0.31, P = 0.001) and increased in Kihihi (0.97 versus 1.93, P < 0.001) and Nagongera (2.33 versus 3.30, P < 0.001). Of 2,582 episodes of malaria, only 8 (0.3%) met criteria for severe disease. The prevalence of anemia was low and not associated with transmission intensity. In our cohorts, where LLINs and prompt effective treatment were provided, the risk of complicated malaria and anemia was extremely low. However, malaria incidence was high and increased over time at the two rural sites, suggesting improved community-wide coverage of LLIN and additional malaria control interventions are needed in Uganda.

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Current accounts of antimicrobial resistance: stabilisation, individualisation and antibiotics as infrastructure

Clare Chandler (2019)

Antimicrobial resistance (AMR) is one of the latest issues to galvanise political and financial investment as an emerging global health threat. This paper explores the construction of AMR as a problem, following three lines of analysis. First, an examination of some of the ways in which AMR has become an object for action—through defining, counting and projecting it. Following Lakoff’s work on emerging infectious diseases, the paper illustrates that while an ‘actuarial’ approach to AMR may be challenging to stabilise due to definitional and logistical issues, it has been successfully stabilised through a ‘sentinel’ approach that emphasises the threat of AMR. Second, the paper draws out a contrast between the way AMR is formulated in terms of a problem of connectedness—a ‘One Health’ issue—and the frequent solutions to AMR being focused on individual behaviour. The paper suggests that AMR presents an opportunity to take seriously connections, scale and systems but that this effort is undermined by the prevailing tendency to reduce health issues to matters for individual responsibility. Third, the paper takes AMR as a moment of infrastructural inversion (Bowker and Star) when antimicrobials and the work they do are rendered more visible. This leads to the proposal of antibiotics as infrastructure—part of the woodwork that we take for granted, and entangled with our ways of doing life, in particular modern life. These explorations render visible the ways social, economic and political frames continue to define AMR and how it may be acted upon, which opens up possibilities for reconfiguring AMR research and action.

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Quick fix for care, productivity, hygiene and inequality: reframing the entrenched problem of antibiotic overuse

Laurie Denyer Willis, Clare Chandler (2019)

Antimicrobial resistance (AMR) is a major challenge of our time. A key global objective is to reduce antibiotic use (ABU), in order to reduce resistance caused by antimicrobial pressure. This is often set as a ‘behaviour change’ issue, locating intervention efforts in the knowledge and attitudes of individual prescribers and users of medicines. Such approaches have had limited impact and fall short of addressing wider drivers of antibiotic use. To address the magnitude of antibiotic overuse requires a wider lens to view our relationships with these medicines. This article draws on ethnographic research from East Africa to answer the question of what roles antibiotics play beyond their immediate curative effects. We carried out interviews, participant observation and documentary analysis over a decade in northeast Tanzania and eastern and central Uganda. Our findings suggest that antibiotics have become a ‘quick fix’ in our modern societies. They are a quick fix for care in fractured health systems; a quick fix for productivity at local and global scales, for humans, animals and crops; a quick fix for hygiene in settings of minimised resources; and a quick fix for inequality in landscapes scarred by political and economic violence. Conceptualising antibiotic use as a ‘quick fix’ infrastructure shifts attention to the structural dimensions of AMR and antimicrobial use (AMU) and raises our line of sight into the longer term, generating more systemic solutions that have greater chance of achieving equitable impact.

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Journal

Journal ID (nlm-journal-id): 7707343

Journal ID (pubmed-jr-id): 5675

Journal ID (nlm-ta): Med Anthropol

Journal ID (iso-abbrev): Med Anthropol

Title: Medical anthropology

ISSN (Print): 0145-9740

ISSN (Electronic): 1545-5882

Publication date Nihms-submitted: 21 March 2023

Publication date (Print): May-Jun 2022

Publication date (Electronic): 24 March 2022

Publication date PMC-release: 27 March 2023

Volume: 41

Issue: 4

Pages: 418-430

Affiliations

[a ]Infectious Diseases Research Collaboration, Kampala, Uganda

[b ]Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK

[c ]Department of Social Anthropology, The University of Edinburgh, Edinburgh, UK

[d ]Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK

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Author contributors

Data were collected by SN. Analysis was done by SN, CIRC, LDW and SGS. The manuscript was drafted by SN in collaboration with all the other authors. All authors approved the final version of the manuscript.

CONTACT Susan Nayiga susannaiga@ 123456gmail.com P.O.Box 7475, Plot 2C Nakasero Hill Road, Kampala, Uganda

Author information

Susan Nayiga http://orcid.org/0000-0002-1895-4035

Laurie Denyer Willis http://orcid.org/0000-0003-2630-9092

Sarah G Staedke http://orcid.org/0000-0003-2505-821X

Clare IR Chandler http://orcid.org/0000-0001-6499-7522

Article

Manuscript ID: NIHMS1881822

DOI: 10.1080/01459740.2022.2047676

PMC ID: 10040720

PubMed ID: 35324360

SO-VID: db7a85cc-b7bf-4b17-8108-3b97e21d4508

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

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Taking Opportunities, Taking Medicines: Antibiotic Use in Rural Eastern Uganda

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Herbal Medicines Journal (Herb Med J)

Most cited references 53

Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control.

Current accounts of antimicrobial resistance: stabilisation, individualisation and antibiotics as infrastructure

Quick fix for care, productivity, hygiene and inequality: reframing the entrenched problem of antibiotic overuse

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Cited by 7

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