Context
In 2015, the Zimbabwe AMR national programme began with the formation of the multi-sectoral national AMR Core Group. The situational analysis conducted to inform the National AMR Action plan revealed widespread, inappropriate antibiotic prescribing, provision and use by doctors, pharmacists, and communities respectively. Some health workers prescribe antibiotics as a first option even when the symptoms or the diagnosis does not suggest a bacterial infection. This scenario was especially marked during the height of the COVID-19 pandemic where antibiotics such as azithromycin were used on a large scale to treat the viral disease. The situation is exacerbated by the emergence of informal markets across the country that sell a range of antibiotics without prescription. The situational analysis contributed to the strategic objectives and proposed activities in the Zimbabwe One Health Antimicrobial Resistance National Action Plan (NAP) 2017-2022.
Problem
Irrational use of antibiotics, a main driver of AMR, is widespread in Zimbabwe. Several surveys have found that most patients are being prescribed antibiotics, empirically and inappropriately. Most of the antibiotic misuse in community and primary care settings occurs during management of syndromic conditions like upper respiratory tract infections and diarrhoea. Prescription of more than one antibiotic at the same time is also widespread.
“Antimicrobial stewardship in community settings and in self-limiting viral infections such as acute respiratory tract infections is an under-researched area. This project will provide valuable insights on AMS at primary care level in the African context.”
Project overview
The aim of this project is to achieve a year-on-year improvement in appropriate antimicrobial prescription and use in selected syndromes through implementing innovative training and communication approaches and clinical management algorithms targeted at prescribers, pharmacists, community-based health workers and communities.
The project consists of five work packages (WP):
- Mapping the use and drivers of antimicrobials in the management of respiratory, reproductive, urinary tract infections and diarrhoea in healthcare delivery in 6 districts of Zimbabwe
- Designing and piloting Information, Education and Communication care pathways (packages) for prescribers in the primary healthcare system, to optimise antibiotic use for respiratory tract infections, reproductive tract infections, urinary tract infections and uncomplicated diarrhoea
- Designing and piloting an Information, Education and Communication package for retail pharmacists and Community Based Health Workers on the symptomatic management of respiratory tract infections, reproductive tract infections, urinary tract infections and diarrhoea without use of antibiotics
- Community mobilisation around the AMR issue and co-creation of community owned solutions on the care of respiratory tract infections, reproductive tract infections, urinary tract infections and diarrhoea, through a modified ‘Responsive Dialogue’ approach
- Assessment of costs and cost-effectiveness, feasibility and acceptability of the interventions; and dissemination of findings among the relevant stakeholder groups
Outcomes
The envisaged outcomes are as follows:
- Optimised prescription and use of antibiotics in primary care settings and the community, for the treatment of respiratory tract infections, reproductive tract infections, urinary tract infections and uncomplicated diarrhoea, through the development and deployment of targeted IEC packages
- Improved policies and practices that use the results of the intervention to sustain appropriate AMU in community and primary care settings, with regards to care of respiratory tract infections, reproductive tract infections, urinary tract infections and uncomplicated diarrhoea
