Appraisal of antimicrobial stewardship at Mbagathi county referral hospital, Nairobi city county, Kenya; a mixed methods survey Doricah ivayo Sikuku Science , tropical and infectious diseases, 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. 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.