Implementation and barriers to antimicrobial stewardship activities in private hospitals in Kampala, Uganda; A case of antimicrobial stewardship programmes

Abstract

Background: Antimicrobial Stewardship has been recommended as one of the ways of combating antimicrobial resistance which has been declared a public health emergency. Stewardship Programs have been implemented and studied in many parts of the world. We found no studies in literature documenting antimicrobial stewardship in private hospitals in Uganda. Objective: To assess implementation and barriers to antimicrobial stewardship programs in selected private hospitals in Kampala, Uganda. Methods: This was a cross-sectional survey using a mixed methods approach. This was carried out by using CwPAMS AMS Checklist and conducting key informant interviews. It was conducted in nineteen private hospitals in Kampala, Uganda. Two KIs were interviewed. Data was collected between August 2020 and September 2020 using the checklist tool and key informant interview guides. Descriptive analysis was used to analyze the checklist which was presented in tables, graphs and texts. The transcripts for the key informant interviews were analyzed using the content analysis approach. Themes were identified. Repeated comparisons involving coding of the conversations in their context and words used was performed. Statements made by respondents were compared. Key Findings: Out of the 17 private hospitals that took part in the study, 13 were non-teaching hospitals, while four were teaching hospitals. Twelve hospitals (70.6%) had senior management teams that have not formally identified AMS as a priority objective for their institutions, and 88.2% of the hospitals had no budget for AMS activities. More than half, (70.5%) of the hospitals had no formal AMS programme/strategy, while ten hospitals had multidisciplinary AMS teams available at their hospitals. In addition, only ten (58.8%) of the hospitals had identified a healthcare professional as a leader for AMS activities. The overwhelming majority, 88.3%, of the hospitals had no document defining roles and responsibilities of the AMS team members. A good number (64.7%) of the hospitals had AMS committees that did not produce a regular dedicated report. Eleven hospitals had no minutes or notes taken during the AMS team meetings. The majority (64.7%) of the hospitals offered access to educational resources to support staff training on how to optimise antimicrobial prescribing. However, in 76.5% of the hospitals, AMS team members did not receive regular training in antimicrobial prescribing and stewardship. The main barriers to AMS activities were found out to be that qualified personnel xiii do not have enough time to perform stewardship activities and a lack of funding for AMS activities in private hospitals. Conclusion: Antimicrobial stewardship activities in private hospitals remain largely unpracticed. Hospitals managements are yet to identify AMS as a priority objective and give financial support for stewardship practices. AMS teams in most hospitals remain dormant, and some staff do not understand the critical importance stewardship practices at their local settings. Education and training of hospital staff on AMS is wanting, although resources on AMS are available. The MoH/NDA should consider interventions in private hospitals so as to promote awareness on antibiotic use and antimicrobial stewardship.