Kampala, Uganda – A narrow path winds through the Katanga slum, a densely packed settlement nestled between Makerere University and Mulago National Referral Hospital. Shanty houses press against each other, women prepare meals on the roadside, and children play around a drainage channel filled with filthy water. Beyond its daily life, Katanga is emblematic of a growing public health crisis in Uganda: antimicrobial resistance (AMR), where bacteria, viruses, and fungi become resistant to drugs designed to kill them.
Dr. Andrew Kambugu, Executive Director of the Infectious Diseases Institute (IDI) at Makerere University, explains that crowded living conditions and poor sanitation create fertile ground for drug-resistant infections, including multi-drug resistant tuberculosis (MDR-TB). “In low-income settlements, the spread of AMR is accelerated. People often take incomplete doses of antibiotics because they cannot afford full treatment, which worsens the problem,” he says.
Antimicrobial resistance develops through misuse of drugs in humans and animals. Dr. Kambugu notes that improper antibiotic use in poultry can contaminate water sources, spreading resistant bacteria to humans. In Uganda, unregulated access to antibiotics, self-medication, and overprescription contribute to the growing threat. “Respiratory infections in children are often viral, yet antibiotics are frequently prescribed,” he adds.
The IDI’s research project, Drivers of Resistance in Uganda and Malawi (DRUM), highlights how human behavior, environmental factors, and agricultural practices all contribute to the rise of drug-resistant infections. The project, supported by the UK Fleming Fund, seeks to track and raise awareness of AMR in urban and rural communities.
Patients in intensive care units (ICU), cancer patients, and children are particularly vulnerable to AMR. “Resistant infections often worsen the outcomes for patients already battling other illnesses,” Dr. Kambugu says. Multi-drug resistant TB poses a severe risk, particularly for patients who cannot adhere to lengthy treatment regimens. Uganda is one of 30 high-burden TB countries, with 91,000 new cases annually, 32% of which involve HIV co-infection.
Dr. Hakim Sendagire, a biochemist at Makerere Medical School, warns that many previously effective antibiotics, such as ampicillin, are now largely ineffective. “We are forced to combine multiple antibiotics to treat infections, and in some cases, no drug is effective,” he says, highlighting the urgent need for new treatment strategies.
Drug-resistant infections place a heavy burden on patients and the healthcare system. Dr. Sendagire recalls a patient with a urinary tract infection who cycled through multiple antibiotics over five days while awaiting lab results, ultimately costing Shs5 million. Beyond financial costs, prolonged illness reduces productivity and strains public health resources.
A July 2025 report by Africa CDC, in collaboration with the African Society for Laboratory Medicine and other partners, reviewed 187,000 laboratory results from 14 African countries, including Uganda. The study found that older adults, hospitalized patients, and those with prior antibiotic use are more likely to experience resistant infections. Dr. Yewande Alimi, One Health Unit Lead at Africa CDC, urges immediate action: “AMR is complex, but African countries must act now together to tackle this silent epidemic.”
IDI has launched community outreach programs in slums like Katanga, Kisenyi, and Kalerwe. Drama groups perform skits and poems to educate residents on the dangers of self-medication and the proper use of antibiotics. Hospitals are tracking AMR trends across Uganda’s 13 regional referral hospitals, identifying alarming resistance rates in common infections such as gonorrhea.
Despite these efforts, the challenge remains immense. Gaps in access to second-line antibiotics, high treatment costs, and insufficient laboratory capacity hinder the fight against AMR. Experts warn that without concerted action, drug-resistant infections could become Uganda’s next public health catastrophe.
Antimicrobial resistance is a growing crisis in Uganda, fueled by poverty, overcrowding, poor sanitation, and misuse of antibiotics. Vulnerable populations, from children to ICU patients, face the highest risk. Combating this silent epidemic requires education, stronger regulation, improved healthcare access, and coordinated national and regional strategies. For Uganda, the stakes are high: failure to address AMR could endanger both public health and economic development.