Utilizing Antimicrobial Use Data for Intervention Design: Advancing Antimicrobial Stewardship Practices in African Health Facilities, across Eight Countries

Abstract

Introduction: Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme, funded by the UK Department of Health and Social Care's Fleming Fund and managed by the Commonwealth Pharmacists Association (CPA) and the Tropical Health and Education Trust, launched its second phase (CwPAMS2) in March 2023. The programme supports the implementation of Point Prevalence Survey (PPS) on antimicrobial use (AMU) in 73 health-facilities across eight African countries: Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda and Zambia. This study assesses how health-facilities in Africa are utilizing PPS data to design and implement antimicrobial stewardship (AMS) interventions. Methods: A mixed-methods research design was adopted in this study, with data collection in 3 phases: pre-, mid- and post-implementation from December2022-March2025. Tools for data collection including monitoring and evaluation forms, surveys and interview guides, were created for each phase and administered remotely and in-person. Monitoring and evaluation indicators were created to assess change and impact. Quantitative data were analyzed using descriptive statistics in Microsoft Excel and SPSS software (V22.0), while qualitative data underwent thematic analysis using NVivo14®. Results: The results show that 51/73 health-facilities had never conducted a PPS prior to CwPAMS2 implementation. Out of 73 health-facilities, 52 have completed PPS data collection and analysis. PPS data analysis led to identification of both low- and high-AMU for each health-facility, as well as areas of non-compliance with local, national, and international guidelines, such as the WHO AWaRe recommendations. Findings are being used to support the design and implementation of AMS interventions including increasing awareness and engagement of hospital management in AMS, establishing governance structures such as AMS committees, delivering AMS-focused training to prescribers, developing institutional antibiotic policies and guidelines, enhancing communication between clinical and laboratory staff, promoting the use of national and global AMS resources to increase guideline adherence at the point-of-care, and utilizing data to inform procurement and use of antimicrobials. These interventions have contributed to the development of 21 health-facility-based AMS Action Plans, delineating actions with specific and time-bound targets. Discussion: PPS implementation at the health-facility level generated local AMU data for tailored interventions, aligning with literature advocating for context-specific approaches to combat antimicrobial resistance. Conclusion: Whilst PPS data utilization helped identify areas for improvement and led to designing and implementing tailored AMS interventions, continued research is needed to evaluate long-term impact and cost-effectiveness and to strengthen capacity-building efforts to mitigate the threat of antimicrobial resistance in Africa.