Evaluating the implementation efficiency of antimicrobial stewardship programs in reducing the burden of antimicrobial resistance at Dar es salaam regional referral hospitals

Abstract

ABSTRACT Background: Antimicrobial resistance (AMR) is a global public health concern affecting hospital and community-acquired infections. It increases the risk of disease spread, severe illness, and death. Multidrug-resistant, extensively drug-resistant, and pan drug resistant bacteria complicate infection treatment. Antimicrobial Stewardship Programs (ASP) aim to curb drug resistance by enhancing the appropriate use of antimicrobials. Despite implementation in Tanzanian hospitals, AMR burden remains high. This study aims to evaluate the efficiency of ASPs and their impact on treating infections. Objectives: To evaluate the implementation efficiency of antimicrobial stewardship programs in reducing the burden of AMR at Dar es Salaam Regional Referral Hospitals. Methodology: This study utilized an exploratory qualitative case study design to investigate experiences and practices across three regional referral hospitals in Dar es Salaam. 11 participants were purposively selected based on their relevance to the research objectives. Data were collected through semi-structured key informant interviews and supplemented by document reviews to gain a comprehensive understanding of each case. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s (2006) thematic analysis method. This systematic approach involved coding and identifying patterns across the data, enabling the extraction of meaningful themes to provide insights into the studied phenomena. Results: The findings of this study highlighted four themes, (1) Adherence to ASP policies and Guidelines, (2) Implementation of ASP in improving healthcare outcomes, (3) Institutional support and facilitators of ASP, and (4) Challenges and Barriers in Program Implementation. Implementing Antimicrobial Stewardship Programs (ASP) in these RRHs to some extent improved adherence to clinical guidelines and reduced prescription errors. Enhanced diagnostic accuracy and targeted empirical treatments led to better patient outcomes. Success was driven by supportive leadership and vi comprehensive training, though challenges like funding limitations, high workloads, and coordination issues remained. Conclusion and recommendation: The implementation of Antibiotics for Prevention (ASP) at Temeke, Mananyamala and Amana hospitals significantly improved antibiotic use and patient care, despite challenges like funding, workloads, and coordination, emphasizing the need for effective leadership and training. The National AMR multi sectoral Coordination Committee should make efforts to prioritize management while integrating ASP with other programs like IPC. In collaboration with other implementing partners, the Ministry of Health should offer financial support to healthcare facilities to strengthen ASP efforts and interventions.