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Opportunities and barriers to implementing antibiotic stewardship in low and middle-income countries: Lessons from a mixed-methods study in a tertiary care hospital in Ethiopia

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  • Gebremedhin Beedemariam Gebretekle
  • Damen Haile Mariam
  • Workeabeba Abebe
  • Wondwossen Amogne
  • Admasu Tenna
  • Teferi Gedif Fenta
  • Michael Libman
  • Cedric P Yansouni
  • Makeda Semret

Abstract

Background: Global action plans to tackle antimicrobial resistance (AMR) include implementation of antimicrobial stewardship (AMS), but few studies have directly addressed the challenges faced by low and middle-income countries (LMICs). Our aim was to explore healthcare providers’ knowledge and perceptions on AMR, and barriers/facilitators to successful implementation of a pharmacist-led AMS intervention in a referral hospital in Ethiopia. Methods: Tikur Anbessa Specialized Hospital (TASH) is an 800-bed tertiary center in Addis Ababa, and the site of an ongoing 4-year study on AMR. Between May and July 2017, using a mixed approach of quantitative and qualitative methods, we performed a cross-sectional survey of pharmacists and physicians using a pre-tested questionnaire and semi-structured interviews of purposively selected respondents until thematic saturation. We analyzed differences in proportions of agreement between physicians and pharmacists using χ2 and fisher exact tests. Qualitative data was analyzed thematically. Findings: A total of 406 survey respondents (358 physicians, 48 pharmacists), and 35 key informants (21 physicians and 14 pharmacists) were enrolled. The majority of survey respondents (>90%) strongly agreed with statements regarding the global scope of AMR, the need for stewardship, surveillance and education, but their perceptions on factors contributing to AMR and their knowledge of institutional resistance profiles for common bacteria were less uniform. Close to 60% stated that a significant proportion of S. aureus infections were caused by methicillin-resistant strains (an incorrect statement), while only 48% thought a large proportion of gram-negative infections were caused by cephalosporin-resistant strains (a true statement). Differences were noted between physicians and pharmacists: more pharmacists agreed with statements on links between use of broad-spectrum antibiotics and AMR (p

Suggested Citation

  • Gebremedhin Beedemariam Gebretekle & Damen Haile Mariam & Workeabeba Abebe & Wondwossen Amogne & Admasu Tenna & Teferi Gedif Fenta & Michael Libman & Cedric P Yansouni & Makeda Semret, 2018. "Opportunities and barriers to implementing antibiotic stewardship in low and middle-income countries: Lessons from a mixed-methods study in a tertiary care hospital in Ethiopia," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-15, December.
    • Handle: RePEc:plo:pone00:0208447
    DOI: 10.1371/journal.pone.0208447
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    1. Mickey Urdea & Laura A. Penny & Stuart S. Olmsted & Maria Y. Giovanni & Peter Kaspar & Andrew Shepherd & Penny Wilson & Carol A. Dahl & Steven Buchsbaum & Gerry Moeller & Deborah C. Hay Burgess, 2006. "Requirements for high impact diagnostics in the developing world," Nature, Nature, vol. 444(1), pages 73-79, November.
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