Implementation of antibiotic stewardship programmes in paediatric patients in regional referral hospitals in Tanzania: experience from prescribers and dispensers

Abstract

Background In 2017, Tanzania launched the National Action Plan for Antimicrobial Resistance (NAPAR), 2017–2022 and implementation of antibiotic stewardship programmes (ASPs) was one of the agendas. Since the launch of the National Action Plan, no study has been done to assess its implementation. Objectives To explore the experiences of prescribers and dispensers on implementing ASPs among paediatric patients attending Regional Referral Hospitals (RRHs) in Tanzania. Methods An exploratory qualitative study was conducted among key informants, in 14 RRHs in Tanzania between July and August 2020. A total of 28 key informants, 14 dispensers in charge of pharmacies and 14 medical doctors in charge of paediatric departments (prescribers), were interviewed. A hybrid thematic analysis was conducted on the gathered information. Results Most of the study participants were not conversant with the term ‘antibiotic stewardship’. Some had heard about the programmes but were not aware of the activities involved in the programme. Those who were knowledgeable on ASPs mentioned the lack of existence of such programmes in their settings. They further added that absence or limited knowledge of the stewardship concepts may have influenced the current poor practices. Barriers to the implementation of ASPs mentioned were lack of laboratory facilities to support culture and susceptibility tests, lack of materials and reagents, management pressure to prevent loss or to generate income, patients’ influence and limited training opportunities. Conclusions Despite launching the NAPAR in 2017, we found limited implementation of ASPs in the management of paediatric patients. This study highlighted some barriers and identified possible intervention points.

Antibiotic Utilisation Patterns in Tanzania: A Retrospective Longitudinal Study Comparing Pre- and Post-COVID-19 Pandemic Using Tanzania Medicines and Medical Devices Authority Data

“…15 This may reflect the impact of AMS under the NAP implementation. 16,34,35 Limitations of the study…”

Antimicrobial Stewardship Practices of Community Pharmacists in United Arab Emirates

“…The lower rates for the other strategies under the various core elements can be attributed to challenges faced in their implementation [ 28 ]; thus, there is a need for additional training of pharmacists to expand their roles and capabilities in outpatient antimicrobial stewardship activities. Nkinda L. et al, (2022) reported a dearth of laboratory facilities to support culture and susceptibility tests, the absence of materials and reagents, pressure from management to avoid loss or to generate income, interference from patients, and inadequate training opportunities as barriers to the implementation of the stewardship activities [ 29 ].…”

A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications

“…The recently launched AWaRe book giving treatment guidance on a range of infectious diseases found in ambulatory care should help in this regard going forward [22,23]. Future activities could also include upgrading the curricula for HCPs to better equip them with the necessary confidence and skills to improve prescribing across the sectors [75,142,143]. Universities should also upgrade their continuous professional development (CPD) activities to address concerns with the knowledge and practices of HCPs in ambulatory care settings across Tanzania.…”