Masters Research Project by Doricah Ivayo Sikuku
W64/81396/2015
University of Nairobi
ABSTRACT
Background: Antimicrobial Resistance has been described as a public
health emergency. Antimicrobial stewardship programs have been recommended as
one of the ways of combating AMR. Stewardship Programs have been implemented
and studied in many parts of the world. We found no studies in literature
documenting antimicrobial stewardship in Kenya.
Objective: The
study sought to identify existing antimicrobial stewardship guidelines in
Kenya; and to appraise antimicrobial stewardship at Mbagathi County Referral
Hospital in Nairobi City County, Kenya.
Methodology: This was a cross-sectional mixed methods survey conducted among health practitioners who prescribe, dispense or administer antimicrobials at the Mbagathi County Referral Hospital. It included a preliminary quantitative followed by a qualitative phase. A self-administered questionnaire was used to collect quantitative data. Qualitative data was collected through key informant interviews.
Descriptive data analysis was done. Variables were analyzed using counts and percentages and results presented using tables and graphs. Audio records of the interviews were transcribed. The data was analyzed using the content analysis approach. Codes were identified and extracted from the transcripts.
The codes were used to build themes on the respondents' views on guidelines, stewardship practices, challenges and opportunities for antimicrobial stewardship.
Methodology: This was a cross-sectional mixed methods survey conducted among health practitioners who prescribe, dispense or administer antimicrobials at the Mbagathi County Referral Hospital. It included a preliminary quantitative followed by a qualitative phase. A self-administered questionnaire was used to collect quantitative data. Qualitative data was collected through key informant interviews.
Descriptive data analysis was done. Variables were analyzed using counts and percentages and results presented using tables and graphs. Audio records of the interviews were transcribed. The data was analyzed using the content analysis approach. Codes were identified and extracted from the transcripts.
The codes were used to build themes on the respondents' views on guidelines, stewardship practices, challenges and opportunities for antimicrobial stewardship.
Results: A total of 171 respondents filled the questionnaire from the
242 that were distributed. Standard documentation of antibiotic prescriptions
in patient charts was the most widely used stewardship activity at Mbagathi
County Referral Hospital.
Conclusion and recommendations:
We found no formal stewardship structure or local policy
document available to guide antimicrobial use at the facility. Challenges to be
addressed include laboratory capacity for microbiological diagnosis, drug
supply and training. We recommend the establishment of an antimicrobial stewardship
team to spearhead antimicrobial stewardship at Mbagathi County Referral Hospital.
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