Developing a Sustainable Antimicrobial Stewardship (AMS) Programme in Ghana: Replicating the Scottish Triad Model of Information, Education and Quality Improvement

Abstract

(1) Background: Our aim was to develop robust and reliable systems for antimicrobial stewardship (AMS) in Keta Municipal Hospital and Ghana Police Hospital. Objectives were to build capacity through training staff in each hospital, establish AMS teams, collect data on antibiotic use and support local quality improvement initiatives. (2) Methods: The Scottish team visited Ghana hospitals on three occasions and the Ghanaian partners paid one visit to Scotland. Regular virtual meetings and email communication were used between visits to review progress and agree on actions. (3) Results: Multi-professional AMS teams established and met monthly with formal minutes and action plans; point prevalence surveys (PPS) carried out and data collected informed a training session; 60 staff participated in training delivered by the Scottish team and Ghanaian team cascaded training to over 100 staff; evaluation of training impact demonstrated significant positive change in knowledge of antimicrobial resistance (AMR) and appropriate antibiotic use as well as improved participant attitudes and behaviours towards AMR, their role in AMS, and confidence in using the Ghana Standard Treatment Guidelines and antimicrobial app. (4) Conclusions: Key objectives were achieved and a sustainable model for AMS established in both hospitals.

Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

“…The design quality and packaging of interventions were reported in nine studies as a facilitator, as using innovative approaches or user-friendly tools to deliver interventions improved the intervention uptake [ 38 , 49 , 51 , 53 , 57 – 61 ]. For example, concise guidelines that clearly outlined the appropriate antibiotics for common infections and interactive training sessions were reported to be more receptive by prescribers.…”

“…Specifically, 12 studies found that it was difficult to promote appropriate behavior among prescribers and users in countries without national policies or guidelines for antibiotic use or those with weak enforcement of existing regulations [ 39 , 40 , 43 , 48 , 52 , 63 , 67 – 72 ]. In contrast, interventions that were developed in line with national AMR initiatives and the availability of national policies and guidelines facilitated the implementation of interventions to improve rational antibiotic use [ 38 , 40 , 46 , 48 , 52 , 68 , 70 , 73 – 75 ].…”

“…In 23 studies, the common challenges faced by implementers and researchers were related to resources, including insufficient financial support for sustaining antimicrobial stewardship activities, shortage of human resources (such as microbiologists, pharmacists, and infectious disease specialists), and lack of technological support to facilitate the administration of interventions [ 38 , 42 – 46 , 48 – 50 , 58 , 62 , 63 , 67 , 69 – 71 , 73 , 75 – 77 , 79 , 85 , 86 ]. It was also commonly reported that prescribers participating in ASPs were often too busy to perform intervention activities.…”

Evaluation of antibiotic prescribing for ambulatory patients seeking primary dental care services in a public hospital in Ghana: a clinical audit study

“…This is in line with our previous studies on antimicrobial use in the hospital. 20 , 32 , 33 , 36 , 37 …”

Fighting Antimicrobial Resistance: Development and Implementation of the Ghanaian National Action Plan (2017–2021)

“…Based on initiatives from universities in cooperation with external partners, a number of point prevalence studies have been performed and/or started at: (a) KNUST Hospital (UHS), Agogo Presbyterian Hospital (APH) and Ejisu Government hospital (EGH) [40]; (b) Keta Municipal Hospital (KMH) and Ghana Police Hospital (GPH) [41]; (c) Ho Teaching Hospital [42]; (d) Point Prevalence Survey at Agogo Hospital and at St. Francis Xavier Hospital at Assin Fosu [personal information from BNITM and KCCR].…”