‘An Appraisal of the Contextual Drivers of Successful Antimicrobial Stewardship Implementation in Nigerian Healthcare Facilities.
Journal – Journal of Global Antimicrobial Resistance
Article type – Journal research article – Clinical research
Publication date – Aug – 2022
Authors – Joshua O.Obasanya, Oladipo Ogunbode, Victoria Landu-Adams
Keywords – antibiotic prescription behavior, antimicrobial resistance, Antimicrobial stewardship, corruption, diagnostic stewardship, health facility, Nigeria, prescription, rational
Open access – Yes
Speciality – Surgical infection
World region Western Africa
Language – English
Submitted to the One Surgery Index on August 25, 2022 at 9:00 pm
: Antimicrobial resistance (AMR) is a consequence of inappropriate actions, including irrational antimicrobial prescribing and use. AMR remains an emergent and significant public health threat, particularly in low and middle-income countries (LMICs), including Nigeria. Optimizing antimicrobial (AM) use through functional hospital antimicrobial stewardship (AMS) programs is one of the strategies to control the spread of AMR. Literature is replete with evidence, but few studies examined the contextual factors limiting AMS functionality at the facility levels. This study explored the intrinsic contextual factors shaping AMS practice at the three-tiered levels of care.
: This was a qualitative case study with a purposeful sample size of 30 participants drawn from two primary, two secondary, and two tertiary health facilities in Nigeria. Data were coded and categorized for thematic analysis.
: Emergent themes include lack of AMS programs, inadequate guidelines, lack of modern equipment and incorrect diagnosis, absence of continuous medical education, imbalance of power among professionals, and pervasive external influence of pharmaceutical marketing companies. These finding demonstrate that the AMS program is lacking or poorly implemented at the three-tiered level of care.
: We recommended that health facilities establish AMS programs in line with World Health Organization’s stepwise approach. These challenges, if addressed, will promote the successful performance of the AMS program, contributing to rational AM use at all levels of care. Since primary health centres constitute 85.4% of all health facilities, customizing the AMS core elements at this level will contribute to achieving the goals of universal health care.
OSI Number – 21735