Implementation of the WHO Point Prevalence Surveys on Antibiotic Use in a Low-Income Country: Experiences and lessons learned from Uganda

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Background Antimicrobial resistance (AMR) poses a significant challenge to global health, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends point prevalence surveys (PPS) as a standardized method for monitoring antibiotic use in hospitals. This manuscript describes Uganda’s experience and lessons learned in implementing the World Health Organisation Point Prevalence Survey methodology (WPPS) in high-volume tertiary hospitals. Methods The WPPS methodology was adapted to align with the health system in Uganda, the existing policies, and information systems, prioritizing inpatient points of care with high antibiotic use, and involving multidisciplinary teams in data collection, capacity building, and continuous quality improvement initiatives. Digitization of the paper-based WPPS tool enhanced and streamlined data collection, reduced errors, and improved data accessibility. Conducting quarterly surveys based on similar methodologies, provided sufficient data points that allowed tracking of trends and gauged the effectiveness of AMS interventions over time, helping to overcome the limitations of single surveys or sparse snapshot data. Results Implementation of the WPPS was feasible and provided actionable outputs on antibiotic prescribing patterns. The approach facilitated capacity building, continuous quality improvement, and the ability to monitor trends in antimicrobial use over time. Key observations from implementation and routine feedback included inadequate documentation of prescriptions and their indications, limited digitalization of patient records, and challenges in integrating WPPS data with broader AMR surveillance systems. Conclusion Uganda’s experience suggests that the WPPS offers a feasible solution for gathering actionable data on antibiotic prescription patterns, which is essential for informing antimicrobial stewardship programmes and supporting policy decisions as intended. Leveraging these insights can strengthen surveillance in Uganda and could guide the development and implementation of AMR surveillance and monitoring frameworks in other LMICs. Strengthening integration with national AMR surveillance frameworks could further enhance the utility of these data in guiding interventions.

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