In September 2025, a national dissemination event in Lusaka, Zambia brought together government leaders, researchers, and local stakeholders to review the outcomes of a three-year antimicrobial stewardship (AMS) project, implemented in Zambia with support from ICARS. The project which ran from January 2022, was conducted across three tertiary, two secondary and four primary health facilities in Zambia, led by the University Teaching Hospital (UTH), Levy Mwanawasa University Teaching Hospital (LUTH), and the Zambia National Public Health Institute (ZNPHI).
The project aimed to address the challenges of bloodstream infections (BSIs) and urinary tract infections (UTIs), both of which place a significant burden on Zambia’s healthcare system. BSIs have been shown to have a particularly high all-cause mortality, 20% of all global deaths in 2020(1), while UTIs account for a global burden of 150 million cases annually(2), leading to high morbidity. Both conditions are commonly associated with irrational use of antibiotics.
A global and local crisis
Opening the event, Kristina Osbjer, ICARS Science Director highlighted the devastating global toll of antimicrobial resistance (AMR), noting that an estimated 1.14 million deaths were directly attributed to bacterial AMR in 2021, surpassing the mortality from malaria and tuberculosis(3). She explained that ICARS, initiated by the Danish Government, provides technical and financial support to low- and middle-income countries to design and implement context-specific solutions to AMR.
In his keynote address, Dr. Christopher Kalila, Chairperson of the Zambia Parliamentary Health Committee, stressed the importance of political commitment and engaging policy and decision-makers to ensure AMR is prioritised in national planning and resource allocation. He called for evidence-based, actionable steps towards domestic AMR funding, especially as donor support declines.
Speaking on behalf of the Director General of ZNPHI, Dr. Joseph Chizimu, Zambia’s AMR Focal Person, underscored the urgent situation, citing high resistance to Access and Watch antibiotics and rising resistance to Reserve antibiotics. He highlighted Zambia’s recent progress in strengthening governance structures, revising the National Action Plan (NAP), expanding surveillance and microbiology capacity, and updating standard treatment guidelines (STGs).
Government commitment
As chief guest, Dr. Kennedy Lishimpi, Permanent Secretary at the Ministry of Health, outlined the relevance of the project in his opening speech, saying:
“The findings being presented today…are not just academic outputs. They provide practical evidence that we can use to refine our policies, allocate resources more efficiently, and strengthen stewardship programmes in real-world settings”
Study findings: successes and challenges
Led by Principal Investigator Dr. Duncan Chanda, the project team presented results from interventions that included AMS training, continuing education, training on how to use the national STGs, and run antimicrobial stewardship (AMS) ward rounds with feedback.
Key findings included:
- UTI management: Polypharmacy was reduced by one third in primary and secondary facilities. Use of Access antibiotics rose to above 75% in secondary facilities.
- BSI management: Predominantly empirical, with a majority of prescriptions involving Watch antibiotics.
- Tertiary facilities: Antibiotic use fell, showing a positive impact of stewardship interventions, but the use of Watch antibiotics remained high compared to Access and Reserve antibiotics.
Appreciation and next steps
Acknowledging the contributions of project partners, Dr. Chanda thanked Jonathan Mayito (ICARS Science Advisor), Kenneth Kapolowe (Project Coordinator), Lawrance Mwenge (Project Economist), Isabella Mukali (Project M&E), Melvin Chanda (Project Pharmacist), the Zambia MoH, ZNPHI, and the participating health facilities for their dedication to implementing the interventions.
The dissemination event concluded with a call for sustained collaboration to build on the lessons learned, with a particular focus on scaling up AMS interventions nationwide and ensuring sustainable financing for Zambia’s AMR response.
References
(1) Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, Colombara DV, Ikuta KS, Kissoon N, Finfer S, Fleischmann-Struzek C, Machado FR, Reinhart KK, Rowan K, Seymour CW, Watson RS, West TE, Marinho F, Hay SI, Lozano R, Lopez AD, Angus DC, Murray CJL, Naghavi M. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020 Jan 18;395(10219):200-211. doi: 10.1016/S0140-6736(19)32989-7.
(2) Kathrin Bausch, Fabian P. Stangl, Jacqui Prieto, Gernot Bonkat, Jennifer Kranz, Urinary Infection Management in Frail or Comorbid Older Individuals, European Urology Focus, Volume 10, Issue 5, 2024.
(3) Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 Naghavi, Mohsen et al. The Lancet, Volume 404, Issue 10459, 1199 – 1226