The Effect of Educational Intervention on Healthcare Workers’ Awareness and Knowledge of Antimicrobial Resistance, Stewardship, and Surveillance: Opportunities for Antimicrobial and Diagnostic Stewardship
Introduction: Laboratories are key in conducting surveillance of antimicrobial resistance (AMR) in healthcare facilities. Therefore, laboratory scientists need to understand the concepts of AMR surveillance and antimicrobial stewardship (AMS) programs. This study evaluated the effect of an educational intervention on the laboratory scientists’ knowledge of AMR surveillance, antimicrobial use (AMU), and antimicrobial stewardship (AMS) in Zambia. Materials and Methods: A cross-sectional mixed-methods study was conducted in March 2024 among 12 laboratory scientists from five hospitals across Zambia. Data were analyzed using IBM SPSS version 23.0. The Paired t-test was used to determine the significance between the pre-test and post-test results. We grouped qualitative questions into three themes, namely, (i) strengths, (ii) weaknesses and challenges, and (iii) proposed solutions to increase the capacity of laboratories to perform bacteriology, test for AMR, and conduct surveillance. Thematic analysis was utilized to analyze qualitative data. Results: This study found a knowledge score of 73% pre-training and 89% post-training, indicating a 16% improvement in their knowledge. The lowest in the pre-training assessment was 60%, while the highest was 80%. Additionally, the lowest score in the post-training assessment was 75%, while the highest was 100%. Some of the strengths of the laboratories in conducting microbiology included the presence of physical laboratories, the availability of safety cabinets, incubators, autoclave machines, and the availability of beakers, bunsen burners, and centrifuges. However, some challenges faced by the laboratories included a shortage of microbiology staff, a lack of reagents, and inadequate training in bacteriology, AMR testing, and surveillance. Conclusions: This study found that educational interventions through AMS training increase awareness and knowledge of AMU, AMR, and surveillance of AMR. Our study found that laboratories had many gaps in conducting AMR surveillance. Therefore, there is a need to provide AMS education and training, mentorship programs, capacity building, and adequate resources to strengthen laboratory capacity to conduct AMR testing and surveillance.
References
[1]
Prestinaci, F., Pezzotti, P. and Pantosti, A. (2015) Antimicrobial Resistance: A Global Multifaceted Phenomenon. Pathogens and Global Health, 109, 309-318. https://doi.org/10.1179/2047773215y.0000000030
[2]
Murray, C.J., Ikuta, K.S., Sharara, F., Swetschinski, L., Robles Aguilar, G., Gray, A., et al. (2022) Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis. The Lancet, 399, 629-655. http://www.thelancet.com/article/S0140673621027240/fulltext
[3]
Hutchings, M.I., Truman, A.W. and Wilkinson, B. (2019) Antibiotics: Past, Present and Future. Current Opinion in Microbiology, 51, 72-80. https://doi.org/10.1016/j.mib.2019.10.008
[4]
Salam, M.A., Al-Amin, M.Y., Salam, M.T., Pawar, J.S., Akhter, N., Rabaan, A.A., et al. (2023) Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare, 11, Article 1946. https://doi.org/10.3390/healthcare11131946 https://pubmed.ncbi.nlm.nih.gov/37444780/
[5]
Mudenda, S., Mufwambi, W. and Mohamed, S. (2024) The Burden of Antimicrobial Resistance in Zambia, a Sub-Saharan African Country: A One Health Review of the Current Situation, Risk Factors, and Solutions. Pharmacology & Pharmacy, 15, 403-465. https://doi.org/10.4236/pp.2024.1512024 https://www.scirp.org/journal/paperabs?paperid=137998
[6]
Sartorius, B., Gray, A.P., Davis Weaver, N., Robles Aguilar, G., Swetschinski, L.R., Ikuta, K.S., et al. (2024) The Burden of Bacterial Antimicrobial Resistance in the WHO African Region in 2019: A Cross-Country Systematic Analysis. The Lancet Global Health, 12, e201-e216. http://www.thelancet.com/article/S2214109X23005399/fulltext
[7]
Ikuta, K.S., Swetschinski, L.R., Robles Aguilar, G., Sharara, F., Mestrovic, T., Gray, A.P., et al. (2022) Global Mortality Associated with 33 Bacterial Pathogens in 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. The Lancet, 400, 2221-2248. http://www.thelancet.com/article/S0140673622021857/fulltext
[8]
Dadgostar, P. (2019) Antimicrobial Resistance: Implications and Costs. Infection and Drug Resistance, 12, 3903-3910. https://doi.org/10.2147/idr.s234610
[9]
Hillock, N.T., Merlin, T.L., Turnidge, J. and Karnon, J. (2022) Modelling the Future Clinical and Economic Burden of Antimicrobial Resistance: The Feasibility and Value of Models to Inform Policy. Applied Health Economics and Health Policy, 20, 479-486. https://doi.org/10.1007/s40258-022-00728-x
[10]
Poudel, A.N., Zhu, S., Cooper, N., Little, P., Tarrant, C., Hickman, M., et al. (2023) The Economic Burden of Antibiotic Resistance: A Systematic Review and Meta-Analysis. PLOS ONE, 18, e0285170. https://doi.org/10.1371/journal.pone.0285170 https://pubmed.ncbi.nlm.nih.gov/35368230/
[11]
Shrestha, P., Cooper, B.S., Coast, J., Oppong, R., Do Thi Thuy, N., Phodha, T., et al. (2018) Enumerating the Economic Cost of Antimicrobial Resistance per Antibiotic Consumed to Inform the Evaluation of Interventions Affecting Their Use. Antimicrobial Resistance & Infection Control, 7, Article No. 98. https://doi.org/10.1186/s13756-018-0384-3
[12]
Tang, K.W.K., Millar, B.C. and Moore, J.E. (2023) Antimicrobial Resistance (AMR). British Journal of Biomedical Science, 80, Article 11387. https://doi.org/10.3389/bjbs.2023.11387
[13]
de Kraker, M.E.A., Stewardson, A.J. and Harbarth, S. (2016) Will 10 Million People Die a Year Due to Antimicrobial Resistance by 2050? PLOS Medicine, 13, e1002184. https://doi.org/10.1371/journal.pmed.1002184
[14]
O’Neill, J. (2016) Tackling Drug-Resistant Infections Globally: Final Report and Recom-Mendations. The Review on Antimicrobial Resistance. https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
[15]
Otaigbe, I.I. and Elikwu, C.J. (2023) Drivers of Inappropriate Antibiotic Use in Low-and Middle-Income Countries. JAC-Antimicrobial Resistance, 5, dlad062. https://doi.org/10.1093/jacamr/dlad062
[16]
Sartelli, M., Hardcastle, T.C., Catena, F., Chichom-Mefire, A., Coccolini, F., Dhingra, S., et al. (2020) Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery. Antibiotics, 9, Article 497. https://doi.org/10.3390/antibiotics9080497 https://www.mdpi.com/2079-6382/9/8/497/htm
[17]
Turner, P., Rupali, P., Opintan, J.A., Jaoko, W., Feasey, N.A., Peacock, S.J., et al. (2021) Laboratory Informatics Capacity for Effective Antimicrobial Resistance Surveillance in Resource-Limited Settings. The Lancet Infectious Diseases, 21, e170-e174. https://doi.org/10.1016/s1473-3099(20)30835-5 https://pubmed.ncbi.nlm.nih.gov/33865461/
[18]
Mudenda, S., Chabalenge, B., Daka, V., Mfune, R.L., Salachi, K.I., Mohamed, S., et al. (2023) Global Strategies to Combat Antimicrobial Resistance: A One Health Perspective. Pharmacology & Pharmacy, 14, 271-328. https://doi.org/10.4236/pp.2023.148020 http://www.scirp.org/Journal/Paperabs.aspx?paperid=127161
[19]
Parveen, S., Garzon-Orjuela, N., Amin, D., McHugh, P. and Vellinga, A. (2022) Public Health Interventions to Improve Antimicrobial Resistance Awareness and Behavioural Change Associated with Antimicrobial Use: A Systematic Review Exploring the Use of Social Media. Antibiotics, 11, Article 669. https://doi.org/10.3390/antibiotics11050669
[20]
Appiah, B., Asamoah-Akuoko, L., Samman, E., Koduah, A., Kretchy, I.A., Ludu, J.Y., et al. (2022) The Impact of Antimicrobial Resistance Awareness Interventions Involving Schoolchildren, Development of an Animation and Parents Engagements: A Pilot Study. Antimicrobial Resistance & Infection Control, 11, Article No. 26. https://doi.org/10.1186/s13756-022-01062-6 https://aricjournal.biomedcentral.com/articles/10.1186/s13756-022-01062-6
[21]
Amponsah, O.K.O., Courtenay, A., Ayisi-Boateng, N.K., Abuelhana, A., Opoku, D.A., Blay, L.K., et al. (2023) Assessing the Impact of Antimicrobial Stewardship Implementation at a District Hospital in Ghana Using a Health Partnership Model. JAC-Antimicrobial Resistance, 5, dlad084. https://doi.org/10.1093/jacamr/dlad084
[22]
Chetty, S., Swe-Han, K.S., Mahabeer, Y., Pillay, A. and Essack, S.Y. (2024) Interprofessional Education in Antimicrobial Stewardship, a Collaborative Effort. JAC-Antimicrobial Resistance, 6, dlae054. https://doi.org/10.1093/jacamr/dlae054
[23]
Martínez, J.L. (2012) Natural Antibiotic Resistance and Contamination by Antibiotic Resistance Determinants: The Two Ages in the Evolution of Resistance to Antimicrobials. Frontiers in Microbiology, 3, Article 1. https://doi.org/10.3389/fmicb.2012.00001
[24]
Allen, H.K. (2014) Antibiotic Resistance Gene Discovery in Food-Producing Animals. Current Opinion in Microbiology, 19, 25-29. https://doi.org/10.1016/j.mib.2014.06.001
[25]
Iossa, G. and White, P.C. (2018) The Natural Environment: A Critical Missing Link in National Action Plans on Antimicrobial Resistance. Bulletin of the World Health Organization, 96, 858-860. https://doi.org/10.2471/blt.18.210898
[26]
Ahmed, S.K., Hussein, S., Qurbani, K., Ibrahim, R.H., Fareeq, A., Mahmood, K.A., et al. (2024) Antimicrobial Resistance: Impacts, Challenges, and Future Prospects. Journal of Medicine, Surgery, and Public Health, 2, Article 100081. https://doi.org/10.1016/j.glmedi.2024.100081
[27]
Booton, R.D., Meeyai, A., Alhusein, N., Buller, H., Feil, E., Lambert, H., et al. (2021) One Health Drivers of Antibacterial Resistance: Quantifying the Relative Impacts of Human, Animal and Environmental Use and Transmission. One Health, 12, Article 100220. https://doi.org/10.1016/j.onehlt.2021.100220
[28]
Irfan, M., Almotiri, A. and AlZeyadi, Z.A. (2022) Antimicrobial Resistance and Its Drivers—A Review. Antibiotics, 11, Article 1362. https://doi.org/10.3390/antibiotics11101362
[29]
Nahar, P., Unicomb, L., Lucas, P.J., Uddin, M.R., Islam, M.A., Nizame, F.A., et al. (2020) What Contributes to Inappropriate Antibiotic Dispensing among Qualified and Unqualified Healthcare Providers in Bangladesh? A Qualitative Study. BMC Health Services Research, 20, Article No. 656. https://doi.org/10.1186/s12913-020-05512-y https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05512-y
[30]
Kakooza, S., Tayebwa, D., Njalira, K.R., Kayaga, E., Asiimwe, I., Komugisha, M., et al. (2023) Reflections on Drivers for the Emergence and Spread of Antimicrobial Resistant Bacteria Detected from Chickens Reared on Commercial Layer Farms in Mukono District, Uganda. Veterinary Medicine: Research and Reports, 14, 209-219. https://doi.org/10.2147/vmrr.s418624 https://www.dovepress.com/reflections-on-drivers-for-the-emergence-and-spread-of-antimicrobial-r-peer-reviewed-fulltext-article-VMRR
[31]
Dakorah, M.P., Agyare, E., Acolatse, J.E.E., Akafity, G., Stelling, J., Chalker, V.J., et al. (2022) Utilising Cumulative Antibiogram Data to Enhance Antibiotic Stewardship Capacity in the Cape Coast Teaching Hospital, Ghana. Antimicrobial Resistance & Infection Control, 11, Article No. 122. https://doi.org/10.1186/s13756-022-01160-5 https://pubmed.ncbi.nlm.nih.gov/36192790/
[32]
Can, F. and Karatuna, O. (2017) The Role of Microbiology Laboratory in Promoting Antimicrobial Stewardship. In: Pulcini, C., Ergönül, Ö., Eds., Antimicrobial Stewardship, Elsevier, 115-128. https://doi.org/10.1016/b978-0-12-810477-4.00009-x
[33]
Moirongo, R.M., Aglanu, L.M., Lamshöft, M., Adero, B.O., Yator, S., Anyona, S., et al. (2022) Laboratory-Based Surveillance of Antimicrobial Resistance in Regions of Kenya: An Assessment of Capacities, Practices, and Barriers by Means of Multi-Facility Survey. Frontiers in Public Health, 10, Article 1003178. https://doi.org/10.3389/fpubh.2022.1003178 https://pubmed.ncbi.nlm.nih.gov/36518572/
[34]
Musa, K., Okoliegbe, I., Abdalaziz, T., Aboushady, A.T., Stelling, J. and Gould, I.M. (2023) Laboratory Surveillance, Quality Management, and Its Role in Addressing Antimicrobial Resistance in Africa: A Narrative Review. Antibiotics, 12, Article 1313. https://doi.org/10.3390/antibiotics12081313 https://pubmed.ncbi.nlm.nih.gov/37627733/
[35]
Yopa, D.S., Anya, P., Mendjime, P., Elouga, T., Nnanga-Nga, E. and Nguefack-Tsague, G. (2023) Evaluation of the Antimicrobial Resistance Surveillance System in Sentinel Sites in Cameroon. Cureus, 15, e40779. https://doi.org/10.7759/cureus.40779 https://www.cureus.com/articles/157468-evaluation-of-the-antimicrobial-resistance-surveillance-system-in-sentinel-sites-in-cameroon
[36]
Patel, R. and Fang, F.C. (2018) Diagnostic Stewardship: Opportunity for a Laboratory-Infectious Diseases Partnership. Clinical Infectious Diseases, 67, 799-801. https://doi.org/10.1093/cid/ciy077 https://pubmed.ncbi.nlm.nih.gov/29547995/
[37]
Malania, L., Wagenaar, I., Karatuna, O., Tambic Andrasevic, A., Tsereteli, D., Baidauri, M., et al. (2021) Setting up Laboratory-Based Antimicrobial Resistance Surveillance in Low-and Middle-Income Countries: Lessons Learned from Georgia. Clinical Microbiology and Infection, 27, 1409-1413. https://doi.org/10.1016/j.cmi.2021.05.027
[38]
Morency-Potvin, P., Schwartz, D.N. and Weinstein, R.A. (2017) Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship. Clinical Microbiology Reviews, 30, 381-407. https://doi.org/10.1128/cmr.00066-16
[39]
Khadse, S.N., Ugemuge, S. and Singh, C. (2023) Impact of Antimicrobial Stewardship on Reducing Antimicrobial Resistance. Cureus, 15, e49935. https://doi.org/10.7759/cureus.49935
[40]
World Health Organization (2015) Global Action Plan on Antimicrobial Resistance. World Health Organization. https://apps.who.int/iris/handle/10665/193736
[41]
Avello, P., Collins, L.M., Gómez, S.A., Luna, F., Fernández Miyakawa, M.E., West, H.M., et al. (2024) National Action Plans on Antimicrobial Resistance in Latin America: An Analysis via a Governance Framework. Health Policy and Planning, 39, 188-197. https://doi.org/10.1093/heapol/czad118
[42]
Willemsen, A., Reid, S. and Assefa, Y. (2022) A Review of National Action Plans on Antimicrobial Resistance: Strengths and Weaknesses. Antimicrobial Resistance & Infection Control, 11, Article No. 90. https://doi.org/10.1186/s13756-022-01130-x https://aricjournal.biomedcentral.com/articles/10.1186/s13756-022-01130-x
[43]
World Health Organization (2024) Library of National Action Plans. World Health Organization. https://www.who.int/teams/surveillance-prevention-control-AMR/national-action-plan-monitoring-evaluation/library-of-national-action-plans
[44]
Bordier, M., Binot, A., Pauchard, Q., Nguyen, D.T., Trung, T.N., Fortané, N., et al. (2018) Antibiotic Resistance in Vietnam: Moving Towards a One Health Surveillance System. BMC Public Health, 18, Article No. 1136. https://doi.org/10.1186/s12889-018-6022-4 http://www.ncbi.nlm.nih.gov/pubmed/30249210
[45]
Rüegg, S.R., Antoine-Moussiaux, N., Aenishaenslin, C., Alban, L., Bordier, M., Bennani, H., et al. (2022) Guidance for Evaluating Integrated Surveillance of Antimicrobial Use and Resistance. CABI One Health, 2022, 1-13. https://doi.org/10.1079/cabionehealth.2022.0007
[46]
Collineau, L., Bourély, C., Rousset, L., Berger-Carbonne, A., Ploy, M., Pulcini, C., et al. (2023) Towards One Health Surveillance of Antibiotic Resistance: Characterisation and Mapping of Existing Programmes in Humans, Animals, Food and the Environment in France, 2021. Eurosurveillance, 28, Article 2200804. https://doi.org/10.2807/1560-7917.es.2023.28.22.2200804
[47]
Haworth-Brockman, M., Saxinger, L.M., Miazga-Rodriguez, M., Wierzbowski, A. and Otto, S.J.G. (2021) One Health Evaluation of Antimicrobial Use and Resistance Surveillance: A Novel Tool for Evaluating Integrated, One Health Antimicrobial Resistance and Antimicrobial Use Surveillance Programs. Frontiers in Public Health, 9, Article 693703. https://doi.org/10.3389/fpubh.2021.693703
[48]
World Health Organization (2018) Global Antimicrobial Resistance Surveillance System (GLASS) Report: Early Implementation 2017-2018. World Health Organization, 1-260. https://www.who.int/publications/i/item/9789241515061
[49]
Tahoon, M.A., Khalil, M.M., Hammad, E., Morad, W.S., awad, S.M. and Ezzat, S. (2020) The Effect of Educational Intervention on Healthcare Providers’ Knowledge, Attitude, & Practice Towards Antimicrobial Stewardship Program At, National Liver Institute, Egypt. Egyptian Liver Journal, 10, Article No. 5. https://doi.org/10.1186/s43066-019-0016-5 https://eglj.springeropen.com/articles/10.1186/s43066-019-0016-5
[50]
Mudenda, S., Kapolowe, K., Chirwa, U., Chanda, M., Chanda, R., Kalaba, R., et al. (2025) Antimicrobial Stewardship Impact on Antibiotic Use in Three Tertiary Hospitals in Zambia: A Comparative Point Prevalence Survey. Antibiotics, 14, Article 284. https://doi.org/10.3390/antibiotics14030284 https://www.mdpi.com/2079-6382/14/3/284/htm
[51]
Mahmoudi, L., Sepasian, A., Firouzabadi, D. and Akbari, A. (2020) The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-Wide Intervention. Risk Management and Healthcare Policy, 13, 1701-1709. https://doi.org/10.2147/rmhp.s265407 https://pubmed.ncbi.nlm.nih.gov/33061704/
[52]
Yusef, D., Hayajneh, W.A., Bani Issa, A., Haddad, R., Al-Azzam, S., Lattyak, E.A., et al. (2020) Impact of an Antimicrobial Stewardship Programme on Reducing Broad-Spectrum Antibiotic Use and Its Effect on Carbapenem-Resistant Acinetobacter baumannii (CRAB) in Hospitals in Jordan. Journal of Antimicrobial Chemotherapy, 76, 516-523. https://doi.org/10.1093/jac/dkaa464
[53]
Nathwani, D., Varghese, D., Stephens, J., Ansari, W., Martin, S. and Charbonneau, C. (2019) Value of Hospital Antimicrobial Stewardship Programs [ASPs]: A Systematic Review. Antimicrobial Resistance & Infection Control, 8, Article No. 35. https://doi.org/10.1186/s13756-019-0471-0
[54]
Kasanga, M., Chileshe, M., Mudenda, S., Mukosha, R., Kasanga, M., Daka, V., et al. (2022) Antibiotic Prescribing Patterns and Prevalence of Surgical Site Infections in Caesarean Section Deliveries at Two Tertiary Hospitals in Lusaka, Zambia. Pharmacology & Pharmacy, 13, 313-330. https://doi.org/10.4236/pp.2022.138024 http://www.scirp.org/journal/PaperInformation.aspx?PaperID=119371
[55]
Al-Omari, A., Al Mutair, A., Alhumaid, S., Salih, S., Alanazi, A., Albarsan, H., et al. (2020) The Impact of Antimicrobial Stewardship Program Implementation at Four Tertiary Private Hospitals: Results of a Five-Years Pre-Post Analysis. Antimicrobial Resistance & Infection Control, 9, Article No. 95. https://doi.org/10.1186/s13756-020-00751-4 https://aricjournal.biomedcentral.com/articles/10.1186/s13756-020-00751-4
[56]
Pallares, C.J., Porras, J., De La Cadena, E., García-Betancur, J.C., Restrepo-Arbeláez, N., Viveros, S.M.C., et al. (2023) Antimicrobial Stewardship Programs in Seven Latin American Countries: Facing the Challenges. BMC Infectious Diseases, 23, Article No. 463. https://doi.org/10.1186/s12879-023-08398-3 https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08398-3
[57]
Kpokiri, E.E., Ladva, M., Dodoo, C.C., Orman, E., Aku, T.A., Mensah, A., et al. (2021) Knowledge, Awareness and Practice with Antimicrobial Stewardship Programmes among Healthcare Providers in a Ghanaian Tertiary Hospital. Antibiotics, 11, Article 6. https://doi.org/10.3390/antibiotics11010006
[58]
Fuller, W., Kapona, O., Aboderin, A.O., Adeyemo, A.T., Olatunbosun, O.I., Gahimbare, L., et al. (2023) Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review. Antibiotics, 12, Article 1613. https://doi.org/10.3390/antibiotics12111613 https://www.mdpi.com/2079-6382/12/11/1613/htm
[59]
Wesangula, E., Chizimu, J.Y., Mapunjo, S., Mudenda, S., Seni, J., Mitambo, C., et al. (2025) A Regional Approach to Strengthening the Implementation of Sustainable Antimicrobial Stewardship Programs in Five Countries in East, Central, and Southern Africa. Antibiotics, 14, Article 266. https://doi.org/10.3390/antibiotics14030266 https://www.mdpi.com/2079-6382/14/3/266/htm
[60]
Mudenda, S., Chabalenge, B., Daka, V., Jere, E., Sefah, I.A., Wesangula, E., et al. (2024) Knowledge, Awareness and Practices of Healthcare Workers Regarding Antimicrobial Use, Resistance and Stewardship in Zambia: A Multi-Facility Cross-Sectional Study. JAC-Antimicrobial Resistance, 6, dlae076. https://doi.org/10.1093/jacamr/dlae076
[61]
Jinks, T., Subramaniam, S., Bassetti, M., Gales, A.C., Kullar, R., Metersky, M.L., et al. (2024) Opportunities to Enhance Diagnostic Testing and Antimicrobial Stewardship: A Qualitative Multinational Survey of Healthcare Professionals. Infectious Diseases and Therapy, 13, 1621-1637. https://doi.org/10.1007/s40121-024-00996-1 https://link.springer.com/article/10.1007/s40121-024-00996-1
[62]
Shawa, M., Paudel, A., Chambaro, H., Kamboyi, H., Nakazwe, R., Alutuli, L., et al. (2024) Trends, Patterns and Relationship of Antimicrobial Use and Resistance in Bacterial Isolates Tested between 2015-2020 in a National Referral Hospital of Zambia. PLOS ONE, 19, e0302053. https://doi.org/10.1371/journal.pone.0302053
[63]
Yamba, K., Mudenda, S., Mpabalwani, E., Mainda, G., Mukuma, M., Samutela, M.T., et al. (2024) Antibiotic Prescribing Patterns and Carriage of Antibiotic-Resistant Escherichia coli and Enterococcus Species in Healthy Individuals from Selected Communities in Lusaka and Ndola Districts, Zambia. JAC-Antimicrobial Resistance, 6, dlae027. https://doi.org/10.1093/jacamr/dlae027
Yamba, K., Lukwesa-Musyani, C., Samutela, M.T., Kapesa, C., Hang’ombe, M.B., Mpabalwani, E., et al. (2023) Phenotypic and Genotypic Antibiotic Susceptibility Profiles of Gram-Negative Bacteria Isolated from Bloodstream Infections at a Referral Hospital, Lusaka, Zambia. PLOS Global Public Health, 3, e0001414. https://doi.org/10.1371/journal.pgph.0001414 https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001414
[66]
Chiyangi, H., Muma, J.B., Malama, S., Manyahi, J., Abade, A., Kwenda, G., et al. (2017) Identification and Antimicrobial Resistance Patterns of Bacterial Enteropathogens from Children Aged 0-59 Months at the University Teaching Hospital, Lusaka, Zambia: A Prospective Cross Sectional Study. BMC Infectious Diseases, 17, Article No. 117. https://doi.org/10.1186/s12879-017-2232-0
[67]
Mudenda, S., Malama, S., Munyeme, M., Matafwali, S.K., Kapila, P., Katemangwe, P., et al. (2023) Antimicrobial Resistance Profiles of Escherichia coli Isolated from Laying Hens in Zambia: Implications and Significance on One Health. JAC-Antimicrobial Resistance, 5, dlad060. https://doi.org/10.1093/jacamr/dlad060 https://academic.oup.com/jacamr/article/5/3/dlad060/7175370
[68]
Mudenda, S., Matafwali, S.K., Malama, S., Munyeme, M., Yamba, K., Katemangwe, P., et al. (2022) Prevalence and Antimicrobial Resistance Patterns of Enterococcus Species Isolated from Laying Hens in Lusaka and Copperbelt Provinces of Zambia: A Call for AMR Surveillance in the Poultry Sector. JAC-Antimicrobial Resistance, 4, dlac126. https://doi.org/10.1093/jacamr/dlac126 https://academic.oup.com/jacamr/article/4/6/dlac126/6955595
[69]
Chanda, W., Manyepa, M., Chikwanda, E., Daka, V., Chileshe, J., Tembo, M., et al. (2019) Evaluation of Antibiotic Susceptibility Patterns of Pathogens Isolated from Routine Laboratory Specimens at Ndola Teaching Hospital: A Retrospective Study. PLOS ONE, 14, e0226676. https://doi.org/10.1371/journal.pone.0226676 https://pubmed.ncbi.nlm.nih.gov/31869354/
[70]
Kasanga, M., Shempela, D.M., Daka, V., Mwikisa, M.J., Sikalima, J., Chanda, D., et al. (2024) Antimicrobial Resistance Profiles of Escherichia coli Isolated from Clinical and Environmental Samples: Findings and Implications. JAC-Antimicrobial Resistance, 6, dlae061. https://doi.org/10.1093/jacamr/dlae061
[71]
Kasanga, M., Kwenda, G., Wu, J., Kasanga, M., Mwikisa, M.J., Chanda, R., et al. (2023) Antimicrobial Resistance Patterns and Risk Factors Associated with ESBL-Producing and MDR Escherichia coli in Hospital and Environmental Settings in Lusaka, Zambia: Implications for One Health, Antimicrobial Stewardship and Surveillance Systems. Microorganisms, 11, Article 1951. https://doi.org/10.3390/microorganisms11081951 https://www.mdpi.com/2076-2607/11/8/1951/htm
[72]
Kasanga, M., Mukosha, R., Kasanga, M., Siyanga, M., Mudenda, S., Solochi, B.B., et al. (2021) Antimicrobial Resistance Patterns of Bacterial Pathogens: Their Distribution in University Teaching Hospitals in Zambia. Future Microbiology, 16, 811-824. https://doi.org/10.2217/fmb-2021-0104
[73]
Zambia National Public Health Institute (2017) Multi-Sectoral National Action Plan on Antimicrobial Resistance. Zambia National Public Health Institute. https://www.afro.who.int/publications/multi-sectoral-national-action-plan-antimicrobial-resistance-2017-2027
[74]
Zambia National Public Health Institute (2019) Prioritised Activities of Zambia’s Multisectoral National Action Plan on Antimicrobial Resistance. World Health Organization. https://www.afro.who.int/publications/prioritised-activities-zambias-multi-sectoral-national-action-plan-antimicrobial
[75]
Mudenda, S., Lubanga, A., Jamshed, S., Biemba, B., Sakala, R., Chiyabi, M., et al. (2025) Point Prevalence Survey of Antibiotic Use in Level 1 Hospitals in Zambia: Future Prospects for Antimicrobial Stewardship Programs. Infection and Drug Resistance, 18, 887-902. https://doi.org/10.2147/idr.s509522 https://www.dovepress.com/point-prevalence-survey-of-antibiotic-use-in-level-1hospitals-in-zambi-peer-reviewed-fulltext-article-IDR
[76]
Kalungia, A.C., Mwambula, H., Munkombwe, D., Marshall, S., Schellack, N., May, C., et al. (2019) Antimicrobial Stewardship Knowledge and Perception among Physicians and Pharmacists at Leading Tertiary Teaching Hospitals in Zambia: Implications for Future Policy and Practice. Journal of Chemotherapy, 31, 378-387.
[77]
Mudenda, S., Hankombo, M., Saleem, Z., Sadiq, M.J., Banda, M., Munkombwe, D., et al. (2021) Knowledge, Attitude, and Practices of Community Pharmacists on Antibiotic Resistance and Antimicrobial Stewardship in Lusaka, Zambia. Journal of Biomedical Research & Environmental Sciences, 2, 1005-1014. https://doi.org/10.37871/jbres1343
[78]
Morrow, R., Rodriguez, A. and King, N. (2015) Colaizzi’s Descriptive Phenomenological Method. The Psychologist, 28, 643-644. http://eprints.hud.ac.uk/id/eprint/26984/
[79]
Wang, H., Wang, H., Yu, X., Zhou, H., Li, B., Chen, G., et al. (2019) Impact of Antimicrobial Stewardship Managed by Clinical Pharmacists on Antibiotic Use and Drug Resistance in a Chinese Hospital, 2010-2016: A Retrospective Observational Study. BMJ Open, 9, e026072. https://doi.org/10.1136/bmjopen-2018-026072 https://bmjopen.bmj.com/content/9/8/e026072
[80]
Okolie, O.J., Igwe, U., Ismail, S.U., Ighodalo, U.L. and Adukwu, E.C. (2022) Systematic Review of Surveillance Systems for AMR in Africa. Journal of Antimicrobial Chemotherapy, 78, 31-51. https://doi.org/10.1093/jac/dkac342
[81]
Steinmann, K.E., Lehnick, D., Buettcher, M., Schwendener-Scholl, K., Daetwyler, K., Fontana, M., et al. (2018) Impact of Empowering Leadership on Antimicrobial Stewardship: A Single Center Study in a Neonatal and Pediatric Intensive Care Unit and a Literature Review. Frontiers in Pediatrics, 6, Article 294. https://doi.org/10.3389/fped.2018.00294
[82]
Ashiru-Oredope, D., Langford, B.J., Bonaconsa, C., Nampoothiri, V., Charani, E. and Goff, D.A. (2023) Global Collaborations in Antimicrobial Stewardship: All Hands on Deck. Antimicrobial Stewardship & Healthcare Epidemiology, 3, e66. https://doi.org/10.1017/ash.2023.122
[83]
Veepanattu, P., Singh, S., Mendelson, M., Nampoothiri, V., Edathadatil, F., Surendran, S., et al. (2020) Building Resilient and Responsive Research Collaborations to Tackle Antimicrobial Resistance—Lessons Learnt from India, South Africa, and Uk. International Journal of Infectious Diseases, 100, 278-282. https://doi.org/10.1016/j.ijid.2020.08.057
[84]
Shrestha, P., He, S. and Legido-Quigley, H. (2022) Antimicrobial Resistance Research Collaborations in Asia: Challenges and Opportunities to Equitable Partnerships. Antibiotics, 11, Article 755. https://doi.org/10.3390/antibiotics11060755
[85]
Iskandar, K., Molinier, L., Hallit, S., Sartelli, M., Hardcastle, T.C., Haque, M., et al. (2021) Surveillance of Antimicrobial Resistance in Low-and Middle-Income Countries: A Scattered Picture. Antimicrobial Resistance & Infection Control, 10, Article No. 63. https://doi.org/10.1186/s13756-021-00931-w https://aricjournal.biomedcentral.com/articles/10.1186/s13756-021-00931-w
[86]
Lapin, J.S., Smith, R.D., Hornback, K.M., Johnson, J.K. and Claeys, K.C. (2023) From Bottle to Bedside: Implementation Considerations and Antimicrobial Stewardship Considerations for Bloodstream Infection Rapid Diagnostic Testing. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 43, 847-863. https://doi.org/10.1002/phar.2813 https://pubmed.ncbi.nlm.nih.gov/37158053/
[87]
Yamba, K., Chizimu, J.Y., Mudenda, S., Lukwesa, C., Chanda, R., Nakazwe, R., et al. (2024) Assessment of Antimicrobial Resistance Laboratory-Based Surveillance Capacity of Hospitals in Zambia: Findings and Implications for System Strengthening. Journal of Hospital Infection, 148, 129-137. https://doi.org/10.1016/j.jhin.2024.03.014
[88]
Shempela, D.M., Mudenda, S., Kasanga, M., Daka, V., Kangongwe, M.H., Kamayani, M., et al. (2024) A Situation Analysis of the Capacity of Laboratories in Faith-Based Hospitals in Zambia to Conduct Surveillance of Antimicrobial Resistance: Opportunities to Improve Diagnostic Stewardship. Microorganisms, 12, Article 1697. https://doi.org/10.3390/microorganisms12081697
[89]
Gebretekle, G.B., Haile Mariam, D., Abebe, W., Amogne, W., Tenna, A., Fenta, T.G., et al. (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, 13, e0208447. https://doi.org/10.1371/journal.pone.0208447
[90]
Chetty, S., Reddy, M., Ramsamy, Y., Dlamini, V.C., Reddy-Naidoo, R. and Essack, S.Y. (2022) Antimicrobial Stewardship in Public-Sector Hospitals in Kwazulu-Natal, South Africa. Antibiotics, 11, Article 881. https://doi.org/10.3390/antibiotics11070881
[91]
Makiko, F., Kalungia, A.C., Kampamba, M., Mudenda, S., Schellack, N., Meyer, J.C., et al. (2025) Current Status and Future Direction of Antimicrobial Stewardship Programs and Antibiotic Prescribing in Primary Care Hospitals in Zambia. JAC-Antimicrobial Resistance, 7, dlaf085. https://doi.org/10.1093/jacamr/dlaf085
