Aubrey Chichonyi Kalungia

Background/Objectives: The right diagnostic tests, for the right patient, at the right time, are key to optimising antimicrobial use (AMU) and preventing antimicrobial resistance (AMR). This study evaluated diagnostic stewardship trends and AMR patterns in Zambian surveillance sentinel sites from 2020 to 2024. Methods: This descriptive, retrospective study analysed routine laboratory data from January 2020 to December 2024 at seven designated AMR surveillance sentinel sites across Zambia. Data on clinical specimens submitted for antimicrobial susceptibility testing were extracted from WHONET and analysed by year, specimen type, and antimicrobial susceptibility profile. Results: A total of 184,788 bacteriology specimens were processed over five years. Urine was the most frequently collected specimen, peaking above 20,000 in 2024. Escherichia coli was the most commonly isolated organism among 15 priority pathogens, comprising 25.9% of the 30,013 isolates. Though a statistically significant increasing trend in total organism isolations was observed annually, only Shigella sp. demonstrated a substantial increase in non-susceptibility to azithromycin (p = 0.027). High resistance was observed with doxycycline, azithromycin, clindamycin, trimethoprim/sulfamethoxazole, ciprofloxacin, and rifampicin, exhibiting resistance ranging from 50% to 80%. Critical AMR alerts included 65% for Vancomycin-Resistant Enterococcus (VRE), 72% for linezolid, and 44% for carbapenems, and possible ESBL-producing Enterobacterales showing the highest overall resistance at 35%, across sentinel sites. Conclusions: Zambia faces a concerning and significant increase in AMR, with high resistance prevalence across commonly used antibiotics. Critical resistance alerts for VRE, linezolid, carbapenems, and possible ESBL-producing Enterobacterales underscore an urgent need for robust antimicrobial stewardship and continuous diagnostic surveillance.

Background/Objectives: Antimicrobial resistance (AMR) is a critical global health threat, with sub-Saharan Africa disproportionately affected. Antimicrobial stewardship (AMS) programs are essential in combating AMR; however, data on their implementation in resource-limited settings like Zambia remain scarce. This study assessed the post-implementation status of World Health Organization (WHO) AMS core elements in selected public hospitals in Zambia. Methods: A cross-sectional pre- and post-intervention survey was conducted in 11 public hospitals across Zambia’s 10 provinces. Baseline (pre-implementation) and 12-month follow-up (post-implementation) assessments were carried out using the WHO-adapted Periodic National and Healthcare Facility Assessment Tool. The six AMS core elements evaluated included leadership, accountability, AMS actions, education, monitoring, and feedback. Results: The average AMS program score increased from 59% at pre-implementation to 81% at post-implementation. Significant improvements were observed in education and training (+36%) and accountability (+31%). While leadership and monitoring also showed positive trends, gaps persisted in AMS actions (63%) and feedback/reporting mechanisms (68%). Drug and Therapeutics Committee (DTC) functionality improved by 23%, with 90% of facilities now holding regular DTC meetings. Implementation of AMS actions, such as ward rounds, rose from 0% to 73%. Challenges remained in clinical audit feedback, resource mobilization, and prescribing optimization. Variability across facilities highlighted differences in leadership, resources, and technical capacity. Conclusions: AMS implementation in Zambia improved substantially across key domains. However, sustained leadership, adequate financing, and continuous capacity-building are needed to address persistent gaps and ensure long-term success in mitigating AMR.

Background/Objectives: Antimicrobial stewardship programs (ASPs) play a vital role in combating antimicrobial resistance (AMR). However, their implementation in Zambia remains variable despite some notable progress. This study assessed healthcare professionals’ awareness of the Multisectoral National Action Plan (NAP) on AMR, alongside their perceptions, barriers, and implementation practices related to ASPs. Methods: A cross-sectional survey conducted between August and December 2024 included 364 healthcare professionals (HCPs) in 58 randomly selected public healthcare facilities in Zambia. Data were analysed using IBM SPSS 25.0. Results: Findings revealed that while 75.3% of respondents were aware of the Zambian NAP on AMS, only 68.1% of the respondents reported that their hospitals had established AMS committees. Conversely only 41.2% of the respondents stated that their hospitals possessed hospital-specific treatment guidelines. Encouragingly, 97.5% believed ASPs could enhance clinical outcomes and reduce AMR. Key barriers included limited funding (75.9%), inadequate IT infrastructure (64.1%), limited access to essential data (64%), and healthcare workforce shortages (53.8%). Conclusions: Whilst HCPs in Zambia demonstrated high awareness of the NAP and supported ASP implementation, systemic challenges hindered their consistent execution across health facilities. Gaps in treatment guideline development, AMR data usage, and the integration of antimicrobial susceptibility recording systems into clinical activities must be addressed to strengthen ASP efforts nationwide.

Background: Zambia, like many low- and middle-income countries, faces a growing burden of antimicrobial resistance (AMR), driven by the misuse of antimicrobials in both human and animal health, a limited diagnostic capacity, and weak regulatory enforcement. To address this challenge, Standard Treatment Guidelines (STGs) were developed for the veterinary sector, which represents a major milestone in the country’s AMR containment strategy. STGs are evidence-based protocols that guide veterinary professionals in consistently and appropriately diagnosing and treating animal diseases. They promote the rational use of veterinary medicines, and can mitigate AMR and improve animal health outcomes. By translating the best evidence into best practices, STGs also provide a practical foundation for antimicrobial stewardship (AMS) programs. Until 2023, Zambia lacked nationally adopted STGs for the veterinary sector. The introduction and standardization of these guidelines are expected to promote prudent antimicrobial use and raise the standard of care delivered to animal patients across the country. Objective: The aim of this paper is to provide a practical reference for future revisions of STGs and outline the successful methodology used to create STGs in the Zambian animal sector. Methods: A situational analysis was conducted to identify priority animal health conditions and existing treatment gaps within the veterinary sector. A multidisciplinary expert committee was then formed, comprising veterinarians, veterinary paraprofessionals, academics, regulatory authorities, and private sector stakeholders, to lead the development of the STGs. The process was guided by the WHO methodology for developing treatment guidelines, including a comprehensive review of the clinical evidence, local disease patterns, antimicrobial resistance data, and existing treatment practices. Draft STGs were developed with clearly defined, species-specific treatment protocols tailored to the Zambian context. For the validation process, the AGREE II instrument was used to assess the quality, clarity, and applicability of the guidelines. Structured stakeholder consultations with practitioners, policy-makers, and technical experts were held to ensure that the guidelines were practical, evidence-based, and aligned with national priorities. The validated drafts were then disseminated and piloted in selected districts. Conclusions: The development of the species-specific STGs represents an essential turning point in the country’s efforts to promote responsible veterinary care and contain AMR. STGs have become a prominent key support in the delivery of quality animal care. Further, the guidelines will assist in the optimization of antimicrobial use in animal health in Zambia.

Background: Oral cholera vaccines (OCVs) prevent cholera and save lives. Given the recent 2024 country-wide cholera epidemic in Zambia, we determined self-reported OCV uptake, acceptance and confidence among adults living in a high-risk, cholera-prone township in Zambia. Methods: A descriptive cross-sectional study was conducted from April to August 2024, involving 385 randomly selected adult participants residing in the Kanyama township of Lusaka, Zambia. Data were collected using an interviewer-administered questionnaire and statistically analysed. Results: Self-reported uptake of at least one dose of the OCV was 18%, with the majority (315 [82%]) reporting being unvaccinated against cholera. Among those who were unvaccinated, vaccine acceptance was <10% (95% confidence interval [CI] 6.8 to 13.7), with higher rates reported among women than men (p=0.002). Despite this, the majority (210 [84.3%]) expressed confidence in the vaccination program. Those knowledgeable about the OCV were twice as likely to get vaccinated (adjusted odds ratio 2.60 [95% CI 1.19 to 5.68]). Knowledge, attitudes and perceptions were associated with OCV uptake. Conclusions: Self-reported OCV uptake and acceptance were low in a high-risk cholera-prone township in Zambia. Community education on the benefits of the vaccine is urgently needed to enhance confidence and attitudes towards the OCV and improve vaccination rates in the future.

Background/Objectives: Tuberculosis (TB) and HIV co-infection pose significant challenges in resource-limited settings, contributing to multi-drug-resistant TB when treatment fails. This study aimed to identify determinants of TB treatment outcomes among HIV/TB co-infected patients in Lusaka, Zambia. Methods: A retrospective cohort study was conducted at Chilenje, Chipata, and Chawama level one hospitals, using systematic sampling to select 586 patient files. Data were analyzed with SPSS version 23, employing descriptive statistics, chi-square tests, and hierarchical logistic regression. Results: Among the study population (n = 586), consisting predominantly of working-age adults (25–44 years: 61.6%) and males (56.5%), treatment success was 81.3%, with a 12.5% mortality rate across treatment phases. Baseline smear-negative TB, viral load (100,000–199,999 copies/mL), diabetes without hypertension, and negative smear at follow-up independently predicted treatment outcomes. Higher treatment failure odds were linked to smear-negative TB, high viral load, and hypertension–diabetes comorbidity, while CD4 count and HIV treatment status showed no independent effects. Conclusions: These findings underscore the influence of viral load, TB type, comorbidities, and sputum conversion on treatment success, emphasizing the need for targeted monitoring and integrated care, particularly in the continuation phase, to enhance outcomes in this vulnerable population.

Background: Antimicrobial Stewardship Programs (ASPs) intended to optimize antibiotic use will be more effective if informed by the current status and patterns of antibiotic utilisation. In Zambia's primary healthcare (PHC) settings, data on ASPs and antibiotic utilisation were inadequate to guide improvements. As a first step, this study assessed antibiotic prescribing and ASP core elements among PHC first-level hospitals (FLHs) in Zambia. Methods: A point prevalence survey was conducted at the five FLHs in Lusaka using the Global-PPS® protocol. Hospital ASP core elements evaluated included hospital leadership commitment, accountability, pharmacy expertise, action, tracking, reporting, and education. Results: Antibiotic use prevalence was 79.8% (146/183). A total of 220 antibiotic prescription encounters were recorded among inpatients, with ceftriaxone (J01DD04, Watch) being the most (50.0%) prescribed. Over 90.0% (202) of the antibiotic prescriptions targeted suspected community-acquired infections, but only 36.8% (81) were compliant with national treatment guidelines. ASP core element implementation was 36.0% (16.2/45), with only two hospitals achieving over 50.0%. The most deficient core elements were accountability, action, tracking, and reporting. Conclusions: ASP implementation in Zambia’s FLHs providing PHC was sub-optimal, with high antibiotic prescribing rates, frequent use of broad-spectrum Watch group antibiotics, and low compliance with national treatment guidelines. As key ways forward, ASPs in Zambia’s PHC require strengthening by adapting the WHO AWaRe recommendations and improving accountability, actions, tracking, and reporting antibiotic use to improve stewardship practice and reduce AMR.

Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antimicrobial stewardship (AMS). There is a need to review current evidence on antibiotic use, access, and AMR, in primary care across key countries.Areas covered: This narrative review analyses publications from 2018 to 2024 regarding access, availability and use of appropriate antibiotics. There were very few studies focussing on a lack of access to antibiotics in primary care. However, there was considerable evidence of high rates of inappropriate antibiotic use, including Watch antibiotics, typically for minor infections, across studied countries exacerbated by patient demand. The high costs of antibiotics in a number of LMICs impacts on their use resulting in short courses and sharing of antibiotics. This can contribute to AMR alongside the use of substandard and falsified antibiotics. Overall, limited implementation of national action plans, insufficient resources, and knowledge gaps, affects sustainable development goals to provide routine access to safe, effective and appropriate antibiotics. There is a clear need to focus health policy on the optimal use of essential AWaRe antibiotics in primary care settings to reduce AMR in LMICs.

Background: There are concerns globally with rising rates of antimicrobial resistance (AMR), particularly in low- and middle-income countries (LMICs). AMR is driven by high rates of inappropriate prescribing and dispensing of antibiotics, particularly Watch antibiotics. To develop future interventions, it is important to document current knowledge, attitudes and practices (KAP) among key stakeholder groups in LMICs. Methods: We undertook a narrative review of published papers among four WHO Regions including African and Asian countries. Relevant papers were sourced from 2018 to 2024 and synthesized by key stakeholder group, country, WHO Region, income level and year. The findings were summarized to identify pertinent future activities for all key stakeholder groups. Results: We sourced 459 papers, with a large number coming from Africa (42.7%). An appreciable number dealt with patients’ KAP (33.1%), reflecting their influence on the prescribing and dispensing of antibiotics. There was marked consistency of findings among key stakeholder groups across the four WHO Regions, all showing concerns with high rates of prescribing of antibiotics for viral infections despite professed knowledge of antibiotics and AMR. There were similar issues among dispensers. Patients’ beliefs regarding the effectiveness of antibiotics for self-limiting infectious diseases were a major challenge, although educational programmes did improve knowledge. The development of the AWaRe (Access, Watch and Reserve) system, including practical prescribing guidance, provides a future opportunity for the standardization of educational inputs. Conclusions: Similar KAP regarding the prescribing and dispensing of antibiotics across LMICs and stakeholder groups presents clear opportunities for standardization of educational input and practical training programmes based on the AWaRe system.