Evaluating hospital performance in antibiotic stewardship to guide action at national and local levels in a lower-middle income setting
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Global Health Action
Abstract
Inappropriate use of antibiotics can lead to the development of resistant
pathogens. Ensuring proper use of these important drugs in all healthcare facilities is
essential. Unfortunately, however, very little is known about how antibiotics are used in
LMIC clinical settings, nor to what degree antibiotic stewardship programmes are in place
and effective.
Objective: We aimed to record all Antibiotic Stewardship policies and structures in place in
16 Kenyan hospitals. We also wanted to examine the context of antibiotic-related practices in
these hospitals.
Methods: We generated a set of questions intended to assess the knowledge and application
of antibiotic stewardship policies and practices in Kenya. Using a set of 17 indicators grouped
into four categories, we surveyed 16 public hospitals across the country. Additionally, we
conducted 31semi-structured interviews with frontline healthcare workers and hospital managers
to explore the context of, and reasons for, the results.
Results: Only one hospital had a resourced ABS policy in place. In all other hospitals, our
survey teams commonly identified structures, resources and processes that in some way
demonstrated partial or full control of antibiotic usage. This was verified by the qualitative
interviews that identified common underlying issues. Most positively, we find evidence
discipline-specific clinical guidelines have been well accepted and have conditioned and
restricted antibiotic use.
Conclusion: Only one hospital had an official ABS programme, but many facilities had
existing structures and resources that could be used to improve antibiotic use. Thus, ABS
Strategies should be built upon existing practices with national ABS policies taking maximum
advantage of existing structures to manage the supply and prescription of antimicrobials. We
conclude that ABS interventions that build on established responsibilities, methods and
practices would be more efficient than interventions that presume a need to establish new
ABS apparatus.
Description
Keywords
Antibiotic Stewardship, Rational drug use, AMR, LMIC, Resistance, Hospitals
Citation
Jacob McKnight, Michuki Maina, Mathias Zosi, Grace Kimemia, Truphena Onyango, Constance Schultsz, Mike English & Olga Tosas-Auguet (2019) Evaluating hospital performance in antibiotic stewardship to guide action at national and local levels in a lower-middle income setting, Global Health Action, 12:sup1, 1761657, DOI: 10.1080/16549716.2020.1761657