Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-Saharan Africa: A Co-Creation...

Area of Science:

• Global Health
• Infectious Diseases
• Public Health Policy

Background:

• Antimicrobial resistance (AMR) is a significant global health threat requiring effective antimicrobial stewardship (AMS) programs.
• Standardized tools are needed to develop and evaluate AMS initiatives, particularly in resource-limited settings.

Purpose of the Study:

• To adapt and extend an international AMS checklist for use in Sub-Saharan Africa through co-creation and expert consensus.
• To implement and evaluate the contextualized AMS checklist in healthcare settings across four African countries.

Main Methods:

• A modified Delphi approach was used with 14 healthcare professionals to refine an existing AMS checklist.
• The developed 54-item checklist was deployed in 19 healthcare sites across Tanzania, Zambia, Uganda, and Ghana.
• The checklist assessed AMS programs before and after an intervention in 14 sites.

Main Results:

• The AMS checklist demonstrated improvements across all components post-intervention, notably in multidisciplinary AMS structures (79%) and point-prevalence surveys (72%).
• Areas with less improvement included laboratory/imaging access (7%) and financial support for AMS (14%).
• The checklist administration prompted 29 additional AMS activities and contributed uniquely to ongoing efforts.

Conclusions:

• Contextualized, co-created AMS tools are vital for effective antimicrobial use management and local ownership.
• The developed AMS checklist successfully captured improvements and supported AMS efforts in the participating African nations.
• This study provides valuable evidence for adapting AMS practices in low- and middle-income countries.