Gaps in Antibiotic Stewardship Found Across Kisii County

Antimicrobial resistance is a growing global problem, and policies for antimicrobial stewardship (AMS) are one key way health systems try to slow it. At the national level in Kenya there is information on AMS policy, but less is known about how well those policies are reaching health workers and facilities at the county level. To fill that gap, Emmanuel Oladipo Babafemi led a baseline assessment of Knowledge, Attitude and Practices (KAP) around antimicrobial prescription and resistance among health care providers in a resource-poor setting, using Kisii County, Kenya as a case study. The research used a paper-based survey targeted at a broad set of care sites — public and private health facilities and community pharmacies — to understand what practitioners know about antimicrobials, how they make prescribing decisions, and whether they follow formal procedures or policies. The goal was to capture a realistic snapshot of AMS implementation on the ground so county leaders and health teams could see where training and policy support might be needed most.

Between October and December 2023 a paper-based survey was carried out across Kisii County. Responses came from 154 facilities spread across the county’s 45 wards, and the data were recorded in Microsoft Excel for coding before being analyzed in RStudio. The findings showed clear gaps: most participants, 111 (72%), agreed they had not received training or education on antimicrobial resistance (AMR) and its public health implications. Nearly half, 75 (49%), said there were no formal procedures requiring prescribers to conduct daily reviews of antibiotic selection until a definitive diagnosis and treatment duration were established, and many reported they were not aware of AMS policy. Respondents also showed limited familiarity with specific resistant organisms and mechanisms: 248 (40%) of responses indicated they were not or not very familiar with Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), Extended-Spectrum Beta-Lactamases (ESBLs), Carbapenemase-producing enterobacterales (CPE), Multidrug-resistant tuberculosis (MDR-TB) and similar threats. Despite these gaps, many respondents expressed interest in workshops to learn more about AMR and AMS.

The study concludes that AMS implementation and uptake are limited across the facilities surveyed in Kisii County. Those findings point to a set of practical challenges that will need urgent action if the county is to strengthen its response to antimicrobial resistance: lack of training, weak or absent local prescribing procedures, and low awareness of key resistant organisms and mechanisms. Importantly, the study suggests that training and education should not be one-size-fits-all; AMS training is likely to be more effective if it is tailored to specific healthcare specialties and to the particular communities and facilities within Kisii County. The expressed interest in workshops indicates there is local willingness to improve knowledge and practices, which county health officials could build on when designing targeted interventions that match the reality of care settings on the ground.