Developing Reliable Systems and Practices for Antimicrobial Stewardship in Zambia: an interview with clinicians at Chipata Central Hospital

Established over 10 years ago, the Health Partnership between Chipata Central Hospital in Zambia and NHS Highlands in the UK has collaborated around wide-ranging projects addressing mental health, clinical supervision and COVID-19.

Through the Commonwealth Partnerships for Antimicrobial Stewardship programme, over the last few years the Partnership has focused on the development, sustainability and implementation of antimicrobial stewardship processes and policies in Chipata Central Hospital (CCH), in the Eastern Province of Zambia.

In recent years Zambia has seen progress towards a more effective AMS infrastructure at national level. Yet limited resources, capacity, and expertise exist at the local level. This project supported local and regional level development of AMS, integrating actions with the Zambian national approach, and aligning with WHO guidance and development. The partnership aimed to increase understanding and implementation of the development and delivery of AMR management and processes at CCH.

Meet two clinicians, Dr. Nkandu Mwelwa and Juliet Nkalamo, who took part in the training:

Q: Tell us about your role at the hospital and how you participated in the CwPAMS training.

Dr. Nkandu: I’m Dr. Nkandu Mwelwa from the Department of Gynecology at Chipata Central Hospital, and I am a registrar in my second year. For this project, I was initially invited to be a part of the AMS Committee and complete the training provided through the CwPAMS programme. After completion, I became the focal point in the department, to introduce others to antimicrobial resistance stewardship and initiate some of the activities from the training.

Juliet: I’m Juliet Nkalamo and I’m a registered nurse in the surgical ward. I was also a participant in the CwPAMS project and afterwards I was selected to train other caregivers on the ward.

Q: What was your overall experience of the training?

Juliet: The experience was overwhelming, and we had a good response from the caregivers. We shared information on the importance of antibiotics, especially the advantages and the disadvantages of them. This was important in terms of compliance because we have challenges with the caregivers about the overuse of antibiotics on the ward. So, they were very interested to know how they are correctly supposed to use them.

Q: What would you like to see going forward for AMS at the hospital?

Dr. Nkandu: The focus now is to try to orient the newly recruited prescribers to the ideas of antimicrobial stewardship activities, so that we ensure a standard of practice. Secondly, we would like to have this training programme delivered to regional facilities. As we are a referral center, we can achieve change at the hospital, but we must support AMS activities in the community which is a battle in the war on antimicrobial resistance.

Q: What was the most significant change you saw from the training?

Juliet: On the ward, I’ve seen the introduction of antimicrobial charts, of which we have now used for some time. These have helped to guide us on the use of antibiotics on patients. You find that some antibiotics were prolonged, and others were misused. The introduction of the charts has really guided us so much on how we’re supposed to use antibiotics.

I’ve also shared my knowledge with colleagues in the department because we thought initially that it maybe wasn’t meant for our cadre. But after completing the training, and we saw the presentation of this programme in our wards, we then saw the impact. We are now gaining much knowledge on antimicrobials, which are really guiding us so much.

Q: What has been the biggest changes the AMS Committee has driven in the hospital?

Dr. Nkandu: In regard to the training, the first task is building change in terms of antimicrobial prescription. It came with challenges because we had outdated practices before knowledge about antimicrobial resistance. So, it involved engaging with fellow prescribers on how we can change practices on antimicrobial use, with the focus on preventing antimicrobial resistance, which was successful.

We’re now successfully managing the use of antibiotics for surgical prophylaxis, which we used to prolong.  In my department, where we conduct a lot of surgeries and caesarean sections, we noticed that some patients would go on prophylaxis for more than five days. So, after the training, it has been limited to three days and we are now even trying to move to single dose prophylaxis. This work is being undertaken as a committee and we are trying to develop antimicrobial policies where we can guide the drugs we use and adhere to the proper standards.

The Commonwealth Partnerships for Antimicrobial Stewardship programme funded Health Partnerships (HP) between UK and African health institutions focusing on strengthening antimicrobial stewardship (AMS) and infection prevention and control (IPC). The programme was funded by the UK Department for Health and Social Care’s Fleming Fund.

The Department of Health and Social Care’s Fleming Fund is a UK Aid programme supporting up to 25 countries across Africa and Asia to tackle antimicrobial resistance (AMR) which is a leading public health threat across the world. The Fleming Fund invests in strengthening data surveillance systems through a portfolio of country grants, regional grants and fellowships managed by Mott MacDonald, and global projects managed by partners.