Acceptance of antimicrobial stewardship programs in community pharmacies in kampala city.
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ABSTRACT Background: Increasing Antimicrobial resistance (AMR) hastens a post-antibiotic era and so underscores the need for rational and judicious use of antibiotics. World Health organization (WHO) points out antimicrobial stewardship as one of the strategies to slow the development of resistance. Antimicrobial stewardship has been adopted in hospitals but to a small extent in community pharmacies. To implement Antimicrobial stewardship in community pharmacies requires people with the right knowledge, attitudes, right practices and willingness to take up Antimicrobial stewardship programs. Objective: To assess the acceptance of Antimicrobial Stewardship Programs (AMS) by health workers in community pharmacies in Kampala city. Materials and methods: A descriptive cross-sectional study was conducted among health workers in community pharmacies in Kampala, Uganda between April, 2019 and May 2019. Pre-tested, self-administered questionnaires were used for data collection. A simple random-sampling method was used to select community pharmacies to be included in the study. Independent-sample Mann–Whitney U tests, independent sample Kruskal–Wallis tests, and logistic regression analysis were performed with SPSS version 25.0 Results: Of the 275 health workers in community pharmacies, 203 responded to the survey (response rate 73.8%). The participants had good understanding of the drivers of antimicrobial resistance. They showed positive perceptions, but poor practices regarding AMS. All of the participants were of the view that AMS program could be beneficial for health care professionals for improvement of patient care, and 78% (n=159) of participants gave their opinion about incorporation of AMS programs in community pharmacies. Collaboration was never/rarely undertaken by health workers in community pharmacies with other health care professionals over the use of antibiotics (n=158, 77.8%), and a significant proportion of participants (n=178, 87.8%) never/rarely participated in AMS-awareness campaigns. Logistic regression analysis revealed that male sex (OR 0.204, 95% CI 0.104−0.4; P<0.001), age 20–29 years (OR 0.172, 95% CI 0.05−0.595; P=0.005), and <1 year of experience (OR 0.197, 95% CI 0.083−0.468; P<0.001) were the factors associated with poor practices regarding AMS. Conclusion: The present study concludes that health workers in community pharmacies have a good understanding of the drivers of antimicrobial résistance. Health workers in community pharmacies have positive perceptions regarding AMS programs in community pharmacies. In addition, the practices of health workers in community pharmacies regarding AMS were poor. Finally, health workers in community pharmacies were willing to integrate antimicrobial stewardship programs into their practice. We recommend incorporation of AMS programs in community settings, involving health workers in community pharmacies. Further studies should be carried out by researchers on a larger scale in order to evaluate the knowledge and perceptions of health workers in community pharmacies regarding AMR and AMS programs across Uganda.