A Stewardship Program Advances Kenya’s Fight against Antimicrobial Resistance

Kenya’s Ministry of Health launched a national action plan in 2017 to combat antimicrobial resistance (AMR) in the country, committing to take urgent action to contain this grave health threat. With the support of the USAID MTaPS program, a new activity has helped 16 health care facilities in Nyeri and Kisumu counties launch new efforts to ensure the appropriate use of antimicrobials.

MTaPS and Kenya collaborate on global health security

AMR refers to the ability of microbes to grow in the presence of a medication that would normally kill them or inhibit their growth. While it is a natural evolutionary phenomenon that happens as microbes adapt to naturally produced antimicrobials, the indiscriminate use of antimicrobial medicines has accelerated its progress. AMR threatens the effective treatment of infections and leads to prolonged duration of illness, higher morbidity and mortality rates, and increased health care costs.

The USAID MTaPS program is supporting the national plan as part of its mandate to forward the Global Health Security Agenda in 11 countries, promoting three pillars of defense against AMR: multisectoral coordination, infection prevention and control, and antimicrobial stewardship (AMS).

The aim of AMS programs is to optimize the use of antimicrobials in countries to mitigate their overuse and misuse, the main drivers of antimicrobial resistance.

Introducing AMS program in health care facilities

MTaPS worked with 16 health facilities to conduct a baseline assessment on AMS practices in August 2019 and found that AMS was largely an unknown concept. No facility had an established AMS program.

In response, MTAPS conducted skills building sessions for Medicines and Therapeutics Committees (MTCs) and future AMS teams from each facility. MTCs provide oversight of appropriate management of health products and technologies, including antimicrobials. The training equipped participants with management know-how for AMS and on evidence-based interventions to improve antimicrobial prescribing. At the end of the training, participants from each facility developed an action plan based on perceived gaps and baseline assessment results.

Mentoring a team on AMS interventions and joint problem-solving to address antibiotic prescribing challenges at a healthcare facility. Photo Credit: Doris Bota, MTaPS

Facilities make strides in appropriate antibiotic prescribing

Post-training, all of the participating health care facilities now have AMS teams, either as separate committees or embedded in MTCs, with newly laid work plans. They have also held sensitization sessions on appropriate use of antimicrobials to clinical staff. Achievements made by these teams include:

• Three facilities have categorized their antibiotics based on the World Health Organization’s AWaRe classification—Access, Watch, and Reserve—as outlined in the national AMS guidelines for health care settings in Kenya.
• Two facilities have developed pre-authorization antibiotic order forms and are in the course of sensitizing prescribers on their use.
• Nyeri County Referral Hospital has experienced a decrease in antibiotic prescribing in the outpatient setting from 62% in January 2020 to 52% in March 2020.
• Three hospitals have adopted the county guidelines for conducting antibiotic use audits in outpatient settings.
• Three hospitals are planning to acquire the necessary laboratory infrastructure to conduct antibiotic cultures and sensitivity to determine which type of antibiotic will work best in treating an identified infection.

“The observed decline in antibiotics use at the hospital was a result of a series of capacity building sessions for prescribers in the outpatient department on appropriate antibiotic prescribing, AWaRe classification of antibiotics, and antibiotics prescribing restrictions. The capacity building sessions were carried out by the members of the Antimicrobial Stewardship Subcommittee, which is hosted within the Medicines and Therapeutics Committee.” –  Dr. Sarah Kibira, MTC Committee Secretary and AMS Subcommittee Chairperson, Nyeri County Referral Hospital

Going forward, USAID MTaPS, in collaboration with county AMS leads, is conducting monthly follow-ups and supportive supervision in each facility. The teams monitor the progress of AMS interventions, help facility managers address challenges, and provide mentorship on best AMS practices and antimicrobial use guidelines.