Combatting AMR: reflections on CwPAMS successes in Nigeria

Antimicrobial stewardship presents unique challenges, morphing into new problems that require innovative solutions depending on the context. In spring 2024, delegations from THET and the Commonwealth Pharmacists Association (CPA) conducted a series of visits to Health Partnerships in several countries, as part of the ongoing Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) 2 programme. 

Three CwPAMS 2 Health Partnerships are located in and around Lagos, the most populous city in Africa. A team of THET and CPA colleagues embarked on a week-long trip to visit the three partnerships across four sites, joined by representatives from the Nigerian Centre for Disease Control (NCDC). Across the three projects, we were met with warm welcomes, inspiring individuals, and a hospital-wide commitment to combating antimicrobial resistance.  

Lagos University Teaching Hospital (LUTH)  

Located in the heart of Lagos, LUTH is the biggest teaching hospital in the area and an influential institution in the Nigerian health system. With 42 pharmacists, 50 intern pharmacists, and 10 lab technicians, it is one of the foremost medical teaching hospitals in the country. The Deputy Provost at Lagos University Teaching Hospital appreciated the Chief Medical Director for creating an “enabling environment for AMS work”, while also acknowledging thanking the NCDC representatives for their support in the ongoing AMS efforts.  

At the heart of the CwPAMS 2 project in LUTH is Professor Oduyebo, a lecturer in Microbiology since 1998 and chairman of the Antimicrobial Stewardship Committee and the Infection Control and Prevention Committee. Despite challenges with receiving funds from the UK causing delays in the project, Professor Oduyebo was focussed on making the most of the resources she had available, looking toward the upcoming training modules.  

University College Hospital, Ibadan 

First established in 1952 as part of the University of London, UCH Ibadan is a 1,000-bed research and teaching hospital, the first and largest of its kind in Nigeria. One of two national referral labs are located in Nigeria, where they share data with the NCDC that goes to WHO’s Global Antimicrobial Resistance and Use Surveillance System (GLASS). 

Having a national reference lab at the hospital provides a unique opportunity to the CwPAMS 2 team to embed and scale up their efforts on a national level, which they are looking to fully harness.  

The UCH Team is led by Dr Babatunde Ogunbosi, a lecturer in the Department of Paediatrics at the hospital. He leads a large team of dedicated pharmacists and microbiologists, one of whom is the Africa Leadership Fellowship-AMS Programme (ALF-A) Fellow Olayinka Adeyemi. With mentorship from an NHS pharmacist in the UK, she leads her own project within the CwPAMS 2 project, which focuses on training that ties in with the larger CwPAMS 2 project in UCH, Ibadan. Her passion and commitment, along with all the other brilliant professionals we met, are powerful reminders that behind large-scale health system initiatives are driven individuals who are dedicating their lives to create impactful changes.  

Babcock University College Hospital  

Around an hour outside Lagos, Babcock University has a large Ivy League-style campus. During the formal meeting with key individuals at the university, it was clear that there was widespread support for the CwPAMS 2 project from the university and hospital management, exemplified by the Vice Chancellor concluding his remarks by saying “I am personally interested in the fight for AMR – Babcock is totally supportive of the project”.  

The team, headed by Dr Charles Elikwu, have established an operational AMS committee with all departments represented, already having worked with the paediatric department to develop common treatment guidelines. They are now working with other departments for further guidelines, considering clinician preferences, national guidelines, and local resistance patterns. The next 8 months hold exciting things for the project, having secured additional research funding from the university, plans to procure a Vitek machine to help with prescribing, and looking into equipment that will allow them to test for falsified medicines.