Knowledge attitudes and priorities regarding antimicrobial resistance and antimicrobial stewardship among clinic administrators and clinicians in outpatient medical centres in Kenya: a qualitative study

Mary Wanjiru Kaniu, Aga Khan University

Abstract

Introduction: Antimicrobial resistance is an important global health threat and it is estimated that by 2050 it will account for 10 million deaths globally. Low and middle-income countries are disproportionately affected by the burden of antimicrobial resistance. One of the major causes of antimicrobial resistance is irrationality and overuse of antibiotics. Understanding the knowledge, attitudes, and priorities of healthcare workers and healthcare administrators on antimicrobial resistance and antimicrobial stewardship is pivotal in the implementation of strategies to curb the spread of antimicrobial resistance.

Methods: A qualitative study using in-depth semi-structured interviews was conducted among clinicians and clinic administrators in 12 private outpatient clinics in Kenya. The interviews were audiotaped and field notes were taken. Audiotapes were then transcribed and a thematic analysis was conducted using Nvivo 12 software. The (Capability, Opportunity, and Motivation for Behavior) COM-B model was used to understand the knowledge, attitudes, and priorities surrounding antimicrobial resistance and antimicrobial stewardship.

Results: Twenty-four participants were interviewed. The following main themes emerged: knowledge, agency, experience, barriers to and needs for implementation, opportunities and ideas, importance and prioritization, and attitudes. There was generally a lack of knowledge on antimicrobial stewardship and its components, and participants didn’t perceive antimicrobial resistance to be a problem in their clinics although they reported that it was a problem in the country and globally. There was a lack of prioritization of AMS in the clinics. Patient attitudes and practices were reported as one of the main drivers for antimicrobial resistance with patient and provider education emerging as one of the ways to curb AMR.

Conclusion: The lack of knowledge on antimicrobial stewardship and its components coupled with participants stating that antimicrobial resistance was not a problem in their facilities points to a persistent need to educate both healthcare workers and healthcare administrators on antimicrobial resistance and antimicrobial stewardship to allow them to own the problem and hence be pro-active in implementing measures to curb it.