Chitatanga Ronald, Yiwombe Chikhulupiliro, Divala Oscar, Msokera Mwayi Prudence, Banda Ellen, Chadwala Hope, Gilmon Manuel Wellington, Kaminyoghe Wezi, Chibwe Innocent, Milala Harry, Kawerama Alinafe, Nyoni Kenneth, Mpanga Chikumbutso, Mwinjiwa Christina, Makondesa Akuzike, Mwehiwa Maurice, Mlombwa Donald, Namalawe Daniel, Benito Silver, Jingini Emmie, Wesangula Evelyn, Matu Martin, Ciccone Emily, Krysiak Robert, Mitambo Collins, Dzowela Titha
Antimicrobial Resistance Coordinating Centre, Public Health Institute of Malawi, Lilongwe, Malawi.
Fleming Fund Country Grant, University of North Carolina Project-Malawi, Lilongwe, Malawi.
Front Public Health. 2025 Jun 12;13:1588778. doi: 10.3389/fpubh.2025.1588778. eCollection 2025.
Antimicrobial resistance (AMR) is a significant global health challenge, particularly in low- and middle-income countries (LMICs). In Malawi, frequent stockouts of essential medicines and the widespread dispensing of antibiotics without prescriptions have exacerbated the AMR burden, highlighting the urgent need for robust antimicrobial stewardship (AMS) interventions. This study presents the first documented baseline assessment of AMS core elements across six public healthcare facilities within Malawi's AMR sentinel surveillance network. Understanding the baseline status of AMS implementation provides a critical reference point to guide future interventions, inform policy, and prioritize resources in the national response to AMR.
This descriptive analysis used data from a national AMS program audit conducted from July 10-14, 2023, in six public hospitals: Malamulo Adventist Hospital, Mzimba South District Hospital, Kamuzu Central Hospital, Queen Elizabeth Central Hospital, Zomba Central Hospital, and Mzuzu Central Hospital. The World Health Organization (WHO) Healthcare Facility AMS Assessment Tool was used to evaluate implementation across key AMS domains, including leadership, accountability, stewardship actions, education, monitoring, surveillance, and reporting. A total of 30 AMS committee members participated using a consensus-based approach.
Of the six hospitals assessed, only one (Kamuzu Central Hospital) demonstrated strong implementation of AMS core elements, achieving a score of 79%. The remaining facilities reported moderate to low performance, with Mzimba District Hospital scoring the lowest (24%). Leadership commitment was inconsistent; only one (16.7%) hospital had fully integrated AMS into its annual plans, and resource allocation was limited. AMS ward rounds and antibiotic prescription audits were either absent or only partially implemented across most facilities. Education and training initiatives were fragmented, with only one (16.7%) hospital partially integrating AMS into staff induction.
This situational analysis reveals critical gaps in AMS implementation across Malawi's national AMR surveillance hospitals. Limited leadership commitment, infrequent AMS ward rounds, and inconsistent education for healthcare workers were major barriers. Targeted interventions are needed to strengthen leadership, establish feasible facility-level AMS actions, and build sustainable capacity among healthcare workers.
抗菌药物耐药性（AMR）是一项重大的全球卫生挑战，在低收入和中等收入国家（LMICs）尤为突出。在马拉维，基本药物频繁缺货以及无处方广泛分发抗生素加剧了AMR负担，凸显了迫切需要强有力的抗菌药物管理（AMS）干预措施。本研究首次记录了马拉维AMR哨点监测网络内六家公共医疗机构AMS核心要素的基线评估情况。了解AMS实施的基线状态为指导未来干预措施、为政策提供信息以及在国家应对AMR中确定资源优先级提供了关键参考点。
本描述性分析使用了2023年7月10日至14日在六家公立医院进行的国家AMS项目审计数据：马拉穆洛基督复临医院、姆津巴南区医院、卡穆祖中央医院、伊丽莎白女王中央医院、宗巴中央医院和姆祖祖中央医院。世界卫生组织（WHO）医疗机构AMS评估工具用于评估关键AMS领域的实施情况，包括领导力、问责制、管理行动、教育、监测、监督和报告。共有30名AMS委员会成员采用基于共识的方法参与。
在评估的六家医院中，只有一家（卡穆祖中央医院）展示了对AMS核心要素的强有力实施，得分79%。其余医疗机构的表现从中等至较低，姆津巴区医院得分最低（24%）。领导力承诺不一致；只有一家（16.7%）医院将AMS完全纳入其年度计划，资源分配有限。大多数医疗机构要么没有进行AMS病房巡查和抗生素处方审核，要么只是部分实施。教育和培训举措分散，只有一家（16.7%）医院将AMS部分纳入员工入职培训。
这种情况分析揭示了马拉维国家AMR监测医院在AMS实施方面的关键差距。领导力承诺有限、AMS病房巡查不频繁以及医护人员教育不一致是主要障碍。需要有针对性的干预措施来加强领导力、制定可行的机构层面AMS行动，并在医护人员中建立可持续的能力。
