Inventory of Survey Instruments for Monitoring Antimicrobial Use in Primary Care Settings in Low- and Middle-Income...

Area of Science:

• Global Health
• Health Services Research
• Infectious Disease Epidemiology

Background:

• Antimicrobial use is predominantly in primary health care (PHC), necessitating specific data to guide interventions.
• Understanding the landscape of research instruments in PHC is crucial for improving antimicrobial stewardship.
• This study focuses on identifying and describing tools used to measure antimicrobial use in low- and middle-income countries (LMICs).

Purpose of the Study:

• To identify a comprehensive range of research instruments used for measuring antimicrobial use in PHC settings.
• To qualitatively describe the structure, scope, and content of these identified survey instruments.
• To assess the current state of tools for monitoring antimicrobial consumption in LMICs.

Main Methods:

• A narrative review of Medline and agency/network websites was conducted, covering data up to November 2023.
• Survey instruments for antimicrobial use prevalence in LMIC PHC were extracted from publications or requested from authors.
• No language restrictions were applied to the literature search.

Main Results:

• 450 studies were identified, yielding 42 survey instruments (1993-2023), predominantly post-2000.
• Instruments covered multi-country and country-specific implementations across WHO regions, sampling households, health professionals, and drug sellers.
• Surveys typically captured antimicrobial type, prescription status, and reason for use, with infrequent mention of AWaRe classification.

Conclusions:

• Diverse tools exist for measuring antimicrobial use in LMICs, but many lack essential protocols and analytic support.
• Current surveys often focus narrowly on antibiotics, utilize paper-based methods, and rarely incorporate the AWaRe classification.
• Future efforts should expand scope beyond antibiotics, adopt digital systems, include implementation protocols, and standardize indicators using AWaRe variables for robust PHC antimicrobial use monitoring.