Effectiveness of antibiotic stewardship programmes in primary health care settings in developing countries

Abstract

Background: Despite the implementation of antimicrobial stewardship programmes (AMS), antibiotic resistance are a rising a major global concern, and the burden is estimated increase. Little is known about program effectiveness, particularly in primary care and in developing nations.

Aim: To assess the effectiveness of antimicrobial stewardship programmes in primary health care.

Methods: A case study assessed the effectiveness of implementation of antimicrobial stewardship at 10 primary health care facilities in Windhoek. From 1 to 31 October 2018, a SWOT analysis of each health facility was conducted through an audit and interview of infection control focal persons to assess the level of compliance to good antimicrobial stewardship practices and policies.

Results: Of the 10 facilities, 90% of the focal persons were aware of systems and polices for good AMS practice. The level of compliance at hospital-based primary health centers was 30.8% compared to clinics (9.1%-36.4%). The main challenge is lack of policies and systems specific to antimicrobial use as well as commitment of financial and human resources to implement AMS programmes in primary health care.

Conclusion: The implementation of antimicrobial stewardship programmes in primary health care is suboptimal. This negatively affects the global efforts to control antimicrobial resistance. There is a need to institutionalise national guidelines for AMS in primary health care.

Keywords: Antibiotic stewardship; Effectiveness; Primary care.