Knowledge, Attitudes and Practices of Health Professionals in Implementing Antimicrobial Stewardship Programs in Jimma University Medical Center; Opportunities and Challenges: a mixed-method study

Abstract

Background: Antimicrobial stewardship programs (ASP), the integrated interventions to improve proper use of antimicrobials and contain antimicrobial resistance, are facing multifaceted challenges. For the effective implementation of ASP, improving the knowledge, attitudes and practices (KAP) of health care professionals (HCPs) and identifying the potential opportunities and challenges should be priorities in the health facilities. However, the opportunities and challenges are not well studied in resource limited settings like Ethiopia. The current study was aimed to assess the level of KAP of HCPs and identify the opportunities and challenges in Jimma University Medical Center (JUMC). Method: Hospital-based cross-sectional study design was conducted using both quantitative and qualitative methods among HCPs in JUMC who are involved in patient care and hospital leadership. Accordingly, 105 physicians, 140 nurses, 18 pharmacists, 17 midwives and 10 anesthetists were recruited to the study by using systematic random sampling. The participants for the qualitative/interview part of the study were recruited by using purposive sampling. Interview guide was developed based on previous similar studies and relevant antimicrobial stewardship programs checklists. Then statistical and thematic analyses were conducted for the quantitative and qualitative parts, respectively. Results: Among the sample population of 290 participants, 276 responded, making the response rate of 95%. Only 19.6%, 19.6% and 17.0% of the study participants have good knowledge, positive attitude and good practice towards antimicrobial stewardship programs. The good understanding of the hospital leadership on the problem, accredited microbiology laboratory and qualified staffs, the presence of separated ASP unit, devoted and experienced experts, presence of supportive projects, and the effort of Ethiopian Public Health Institute (EPHI) in encouraging the programs are the identified opportunities. Lack of fully committed hospital leadership, lack of dedicated budget for the programs and shortage of microbiology laboratory supplies are the major challenges identified. Conclusion: Even though there are good pioneering antimicrobial stewardship strategies in JUMC, the programs are challenged by lack of full leadership commitment, lack of supplies and technologies and factors related to private health sectors and the community. The newly started stewardship activities like awareness creation sessions, regular trainings and antimicrobial stewardship-oriented ward rounds should be strengthened.