Opportunities and Challenges for Improving Anti-Microbial Stewardship in Low- and Middle-Income Countries; Lessons Learnt from the Maternal Sepsis Intervention in Western Uganda

Antibiotics
Louise AckersSamuel Opio

Abstract

This paper presents findings from an action-research intervention designed to identify ways of improving antimicrobial stewardship in a Ugandan Regional Referral Hospital. Building on an existing health partnership and extensive action-research on maternal health, it focused on maternal sepsis. Sepsis is one of the main causes of maternal mortality in Uganda and surgical site infection, a major contributing factor. Post-natal wards also consume the largest volume of antibiotics. The findings from the Maternal Sepsis Intervention demonstrate the potential for remarkable changes in health worker behaviour through multi-disciplinary engagement. Nurses and midwives create the connective tissue linking pharmacy, laboratory scientists and junior doctors to support an evidence-based response to prescribing. These multi-disciplinary 'huddles' form a necessary, but insufficient, grounding for active clinical pharmacy. The impact on antimicrobial stewardship and maternal mortality and morbidity is ultimately limited by very poor and inconsistent access to antibiotics and supplies. Insufficient and predictable stock-outs undermine behaviour change frustrating health workers' ability to exercise their knowledge and skill for the benefit of...Continue Reading

References

Oct 13, 2001·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·S T Mutyaba, F A Mmiro
Aug 9, 2016·BMC Pregnancy and Childbirth·Joseph NgonziJean-Pierre Van Geertruyden
Oct 12, 2016·South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde·A BrinkG A Richards
Jun 29, 2017·The New England Journal of Medicine·Konrad ReinhartSimon Finfer
Jul 18, 2017·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·J A CoxG Levy Hara
Sep 9, 2017·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·O J DyarUNKNOWN ESGAP (ESCMID Study Group for Antimicrobial stewardshiP)

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BETA
pharmacotherapy

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NVIVO

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