Supporting antimicrobial stewardship improvements in a Zambian rural health post through education and digital training
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On Call Africa, World Federation of Public Health Associations, Ireland
On Call Africa, United Kingdom
On Call Africa, Zambia
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A98
Background and Objective: Overprescribing of antibiotics in rural low-resource healthcare settings in Sub-Saharan Africa is common. Volunteers with a non-governmental organisation (NGO) in Zambia’s Southern Province created and delivered interventions in partnership with local healthcare staff, with tha aim of sustainable improvements in antimicrobial stewardship in a rural health post which serves 25,000 people.   Methods: Antibiotic usage in clinics was measured at three intervals over 16 months (April 2021, March 2022, August 2022). Chart reviews evaluated compliance with national guidelines in decision to prescribe and in choice of antibiotic. Data collection and analysis was approved by the Zambian Ministry of Health. After Audit 1, mentoring sessions were carried out over five weeks by volunteers for staff and patients, including live feedback during consultations. After Audit 2, educational resources were produced including infographics on antibiotic resistance (translated to local language Tonga) and a summary of the Zambian Standard Treatment Guidelines. Staff were also trained to use a free digital stock management system using a tablet device, with offline and online functionality and linked with the District Health Office, aiming to improve consistency of medication supply.   Results: A total of 340 consultations were reviewed over the three audits (240, 50 and 50). Ratio of overprescription (antibiotics prescribed: indicated) reduced from 212/59 (3.59:1) to 33/11 (3:1) to 25/9 (2.78:1). Correct antibiotic choice varied from 14/59 (25.9%) to 1/11 (9%) to 3/9 (33%).   Conclusions: There was a steady decline in antibiotic overuse following mentoring and educational interventions. Incorrect choice of antibiotic was mostly reported as due to severe lack of medication availability. A key challenge will be continued improvement in antibiotic stewardship standards and reducing stockouts in this Zambian health post without ongoing oversight from the NGO. Findings can inform implementation of similar projects in other rural low-resource healthcare settings.
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