Resources and barriers of antimicrobial stewardship interventions in sub-Saharan Africa: a mixed methods research protocol

Abstract

Antimicrobial resistance (AMR) is a major threat to global health. The annual number of deaths associated with AMR is estimated to increase to 1.9 million in 2050. The (mis)use of antimicrobials is a major driver for the development of AMR. Antimicrobial stewardship programs, aiming to optimize antimicrobial consumption, have demonstrated to be beneficial in certain settings, not only to reduce antimicrobial resistance, but also to shorten length of hospital stay and decrease economic costs. The core elements of these stewardship programs vary for different settings, but facility-specific treatment recommendations are a priority intervention for hospital programs. Sub-Saharan Africa has a high burden of mortality associated with non-AMR and AMR infections. Therefore, the responsible consumption of antimicrobials is important to optimize patient outcomes and to prevent further development of AMR. The thesis proposes a mixed-methods study protocol to assess information about the availability and agreement of facility-specific treatment guidelines with the WHO AWaRe book and to collect experiences of clinicians using these guidelines. A trial network across sub-Saharan Africa will be used to identify sites. This study will help to obtain comprehensive, in-depth insights into antimicrobial stewardship in sub-Saharan Africa. The proposed study design, explanatory sequential, includes a quantitative strand (on the availability and agreement of guidelines), followed by a qualitative strand (semi-structured interviews). iv A vanguard phase, assessing the feasibility of the proposed study, demonstrated that 78% of sites (7/9) provided a treatment guideline, but only one (11%; 1/9) was a facility-specific document. Items, representing important treatment elements, were extracted in over 50% in 4/7 facilities providing any document. Agreement of the guidelines with the WHO AWaRe book varied across facilities. The limited availability of facility-specific guidelines questions the feasibility of the proposed study as originally planned, and therefore, changes might be necessary to proceed.