Antimicrobial stewardship: Knowledge, attitudes and practices of healthcare providers in Eastern Uganda

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In low- and middle-income countries (LMICs) like Uganda, additional challenges for effective antimicrobial stewardship include limited resources and healthcare infrastructure. This study assessed current antimicrobial prescribing practices and evaluated healthcare providers' knowledge, attitudes, and practices related to antimicrobial stewardship (AMS) in Eastern Uganda. Methods A cross-sectional study was conducted in healthcare facilities across Eastern Uganda. Data were collected through interviewer administered structured questionnaires. Results 240 respondents completed questionnaires from four health facilities in Eastern Uganda. Respondents were 51.5% male, median age 33 years [IQR 28–38] with 6 years of medical experience [IQR 4–10]. Clinical Officers constituted 22.5%, Medical Doctors 11.2%, Nurses 40.8%, Pharmacists 4.5%, and other categories accounted for 20.8%. Adherence to national and international guidelines on antibiotic use was suboptimal with a high frequency of broad-spectrum antibiotic prescriptions. 75.4% of the respondents reported the presence of an antibiotic resistance control program within their healthcare facility. Most respondents (83.3%) reported a designated leader for AMS at the facility while 86.7% indicated that Pharmacists lead the programmes at facilities. 92.5% of respondents confirmed that there is a policy in place to guide the appropriate dosage and duration of antibiotic treatments. Overall, 98.8% of respondents believed AMR a significant concern and 62.1% indicated that high workloads negatively affect AMS practices. Conclusion The study identifies gaps in antimicrobial prescribing in Eastern Uganda, highlighting the need for improved stewardship programs, training, and policy implementation. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Antimicrobial Resistance Antimicrobial Stewardship Prescribing Practices Healthcare Providers Uganda Figures Figure 1 Figure 2 Figure 3 Background Antimicrobial resistance (AMR) is a global problem of public health importance [1] . Antimicrobial resistance develops through genetic mutations and natural selection, accelerated by misuse and overuse of antimicrobials in humans and animals [2, 3] . In clinical settings, the recent escalation in AMR levels is attributed to antibiotic overuse, misuse or both [1, 4, 5] . In low- and middle-income countries (LMICs), treatment of infectious diseases is empirically based on the World Health Organisation (WHO) guidelines, due in part to the inadequacy of laboratories, few qualified health staff and poor community health seeking behaviours. Consequently, hindering the ability to diagnose disease and determine pathogen susceptibility to antimicrobials [6–8] . This often results in poorly targeted treatment with poor clinical outcomes, widespread AMR and increased economic burden of patient care [7, 8] . The pervasive use of antimicrobial agents contributes significantly to the rise of AMR. Healthcare professionals (HCPs) in public health facilities are predominantly responsible for the hospital administration of these agents following evidence-based guidelines as specified in the Uganda clinical guidelines and WHO guidelines [9] . They have a critical role to play in mitigating the effects of AMR but given that AMR is a rapidly evolving challenge, HCP involved in the surveillance and stewardship of AMR need support in expanding their professional practice in these areas. Therefore, evaluating the knowledge, awareness, and practices of HCPs regarding antimicrobial use (AMU), AMR, and antimicrobial stewardship as recommended by the WHO [9] within hospitals is essential for monitoring antibiotic use, ensuring appropriate prescribing practices, and educating healthcare workers and the public about the risks of antibiotic misuse and overuse [10, 11] . Antimicrobial agent misuse is a principal driver of AMR in humans [12] . Inadequate knowledge and awareness about AMU, AMR, and AMS among HPCs results in improper prescribing, dispensing, and administration of antimicrobials, potentially contributing to the emergence of resistant infections. In LMICs, the determinants of AMR are complex and include a lack of diagnostic tools, unrestricted access to antimicrobials, medication shortages, improper agricultural use of antibiotics, poor hygiene and sanitation, weak regulatory frameworks, substandard clinical care, and insufficient AMS [13, 14] . The presence of substandard antimicrobial agents further exacerbates AMR in these regions. In East Africa, almost half of the isolated organisms are resistant to WHO-recommended antibiotics [15] . Monitoring AMR trends in different regions guides policy with antibiotic producing companies [2, 3, 5, 15] . Whereas the homogeneity in the geographical distribution of AMR prompted the WHO to provide an AMR priority list according to location [2, 3, 5] , effective and standardised stewardship practices are needed across all locales. Rolling out AMS has the potential to preserve the safety and effectiveness of antimicrobials with good patient outcomes both locally and internationally [16–20] . Antimicrobial Stewardship (AMS) programs are essential for addressing antimicrobial resistance (AMR). They should include leadership commitment, accountability, infection prevention and control expertise, education, training, monitoring, and feedback on AMS outcomes. Implementing hospital AMS programs ensures the rational use of antimicrobials by prescribing the correct dose, duration, and route, while also enhancing healthcare providers' knowledge, attitudes, and practices regarding AMR and antimicrobial use. Hospital AMS programs improve prescribing practices [21] . In May 2015, the WHO launched the Global Action Plan (GAP) on AMR, highlighting the importance of education in combating antimicrobial resistance. The Quadripartite Alliance urges member states to develop National Action Plans and improve infection and AMR surveillance. The GAP promotes a One Health approach to raise awareness about AMU, AMR, and AMS, advocating for proper antimicrobial use [22] . Uganda has identified several factors contributing to AMR with microorganisms exhibiting resistance to commonly used antimicrobials in the healthcare system [23] . Studies have highlighted inappropriate antibiotic prescribing patterns in public sector hospitals as a significant issue [23] . The health systems in sub-Saharan Africa (SSA) are illustrative of the challenges that many developing countries face [24, 25] : they are fragmented and with little priority settings coming from within the subcontinent. This study aimed to assess the current antimicrobial prescribing practices in healthcare facilities and evaluate healthcare providers' knowledge, attitudes, and practices related to antimicrobial stewardship in Eastern Uganda. The findings presented herein represent one component of a larger study that aims to examine forms of professional practice that are needed to improve practices associated with AMR surveillance and stewardship. Materials and methods Study Settings This study was conducted in healthcare facilities across Eastern Uganda, namely, Mbale RRH, Soroti RRH, Atutur District Hospital and Ngora District Hospital. Facilities were selected based on their locations, namely urban (Soroti and Mbale RRH) and rural areas (Atutur and Ngora), and regional versus district-level health facilities. The workforce size are fairly typical in these settings, with more women than men at all levels of service delivery (at 54% females and 46% males) [26] . Eastern Uganda was selected because of limited data on AMR stewardships. Study design This was a descriptive cross-sectional study using a quantitative approach to data collection, a structured questionnaire administered to HCPs. Study Population The study included physicians, nurses, pharmacists, laboratory personnel and clinical officers involved in antibiotic prescribing across the four healthcare facilities ranging from primary health centres to tertiary hospitals in Eastern Uganda. See Table 1 . Sampling strategy Table 1: Multistage Sampling procedure Stage Details Sampling Approach Multistage sampling approach starting at district and hospital levels District Selection Purposive selection of four districts across Eastern Uganda: Mbale, Soroti, Atutur, and Ngora Hospital Selection Purposive selection of four high-volume hospitals within selected districts Allocation of Sample Size Proportionate allocation based on the catchment population served by each facility Sample Size Allocation Ninety-six participants from Mbale and Soroti RRHs; twenty-four participants from Ngora and Atutur Hospitals Participant Selection Simple random sampling from available cadres at each hospital Participant Refusals No participants refused to participate in the study To recruit the 240 participants included in this study, a multistage sampling approach was employed, starting at the district and hospital levels. We purposively selected four districts across Eastern Uganda: Mbale, Soroti, Atutur, and Ngora and selected four high-volume hospitals within these districts. We utilized proportionate allocation techniques, basing our calculations on the catchment population served by each facility to determine the required sample size for each facility. From these calculations, we selected ninety-six participants from Mbale and Soroti RRHs and twenty-four participants from Ngora and Atutur Hospitals, respectively. We employed simple random sampling to select our participants from the list of all available cadres (Pharamcist, doctors, clinical officers, nurses, and others involved in prescribing) at each hospital. Considerable flexibility was offered regarding participation opportunities and no participants refused to participate in the study. Data Collection A semi-structured questionnaire designed in electronic format Kobo Toolbox administered bu trained research assistants were used to capture primary data on Antimicrobial Prescribing Practices and Knowledge, Attitudes, and Practices (KAP) and had the following sections: the participant’s socio-demographic variables, attitudes and practices, and knowledge sections (see Supplementary Materials for full questionnaire). To ensure the completeness of our data, all questions were made mandatory and skip logic was applied where necessary. The tools were created in English, as our target respondents were healthcare professionals (HCPs) who were proficient in the language. Trained research assistants then collected the data in English. A comprehensive document review was conducted to inform and shape the development of questions related to current antimicrobial practices. This review provided critical insights into existing guidelines, protocols, and standard practices, ensuring that the questions were relevant, accurate, and reflective of the latest developments in antimicrobial management. We conducted a reliability test to assess the reliability of our twelve-item knowledge scale. Results showed an average interitem covariance of 0.023 and a scale reliability coefficient (Cronbach's alpha) of 0.724. See the results. See Table 2. Table 2: Reliability test for knowledge items Variables Statistic Average interitem covariance 0.023 Number of items in the scale 12 Scale reliability coefficient 0.724 Data Analysis The data analysis was conducted using STATA ® version 17 software. We computed frequencies, proportions, median and interquartile ranges and the results are summarised below. Results Participants A total of 240 participants were included in the study as follows: Atutur 24 (10.0%), MRRH 96 (40.0%), Ngora 24 (10.0%), and Soroti RRH 96 (40.0%) participants, most from urban locations (84.2%), with a smaller proportion from rural areas (15.8%). The gender distribution was relatively balanced, with 116 females (48.5%) and 124 males (51.5%). The median age of participants was 33 years, with an interquartile range (IQR) of 28 to 38 years. The median years of experience in their respective fields was 6 years, with an IQR of 4 to 10 years with the groups comprising nurses (40.8%), clinical officers (22.5%), other specified positions (20.8%), medical doctors (11.2%), and pharmacists (4.5%), as shown in Table 3 . Table 3: Participants' demographic characteristics Variables Freq. Percentages Health Facility Name Atutur 24 10.00 Mbale RRH 96 40.00 Ngora 24 10.00 Soroti RRH 96 40.00 Location Rural 38 15.8 Urban 202 84.2 Gender Female 116 48.5 Male 124 51.5 Age median [p25, p75] 33[28, 38] - Years of experience median [p25, p75] 6[4, 10] - Position in this hospital Clinical Officer 54 22.5 Medical doctor 27 11.2 Nurse 98 40.8 Others specify 50 20.8 Pharmacist 11 4.5 Prescribing practices Table 4: Reported antibiotic prescribing practices in healthcare facilities in Eastern Uganda, presents the results for antibiotic prescribing practices in Eastern Uganda. Most of the hospitals included in this study had AMS measures in place, with 75.4% having an antibiotic resistance controlling program, 83.3% having a designated AMR leader, and 86.7% having a pharmacist dedicated to improving antimicrobial use. Additionally, 92.5% had policies requiring documentation of antibiotic prescription durations. Of the 240 participants, 90.4% reported their hospitals had specific treatment guidelines based on national standards, 88.8% said the hospitals provided them with access to evidence-based medicine resources, and 76.7% said the hospitals were sharing antibiotic consumption data with them (prescribers). However, only 56.3% consistently use culture results for therapy decisions. See Table 4. Table 4 : Reported antibiotic prescribing practices in healthcare facilities in Eastern Uganda Variable Response %(n) I Don't Know No Yes The existence of an antibiotic resistance program 18.8(45) 5.8(14) 75.4(181) Existence of AMR program leader 12.9(31) 3.8(9) 83.3(200) Availability of an antimicrobial stewardship pharmacist 8.3(20) 5.0(12) 86.7(208) The existence of an antibiotic documentation policy 5.4(13) 2.1(5) 92.5(222) The hospital had specific treatment guideline 7.5(18) 2.1(5) 90.4(217) Availability of evidence to be accessed by staff 3.3(8) 7.9(19) 88.8(213) Availability of antibiotic consumption reports 14.6(35) 8.8(21) 76.7(184) AMS attitudes and practices Figure 1 , presents the results of the possible mechanisms the hospitals used to maintain interdisciplinary communications on AMS. Overall, the most common method was the use of an AMS committee, utilised by 58.6% of the hospitals. Meetings were the second most common method, (38.5%) with monthly reports the least common (2.9%). When disaggregated by facility level, meetings were the most common method used by General Hospitals (Atutur and Ngora 70.8%), followed by committees (20.8%), and monthly reports (8.3%). At the RRH level (Mbale and Soroti), committees were the most common method for maintaining interdisciplinary communications (68.1%), followed by meetings (30.3%), and monthly (1.6%). Participants were asked to identify the roles that were part of the antibiotic resistance controlling committee in their hospital (Figure 2). Figure 2 , presents the perceptions of respondents on the kind of cadres who form the antibiotic resistance controlling committees in the four hospitals. Pharmacists (42.5%) and clinical officers (30.8%) were most frequently reported by participants as being part of the antibiotic resistance committees whereas hospital management representatives (14.2%), infection control representatives (4.2%) nurses (3.3%) and others were less frequently reported as being part of these committees by respondents. Table 5 presents the results of attitudes and practices regarding AMS. When asked about instances of uncertainty regarding the best antimicrobial therapy choice during practice, 52.9% of participants reported feeling this way sometimes, with 33.3% rarely feeling uncertain, and only 2.1% never feeling uncertain. Regarding challenges related to inadequate funding for AMR stewardship activities, 37.5% sometimes experience this issue, compared to only 5.4% who never do. Concerning essential antimicrobial agents at the facility, 48.3% sometimes experience stockouts. Most HCPs reported rarely receiving feedback on their antibiotic prescribing practices from management, with only 2.5% always receiving feedback. See Table 5. Table 5: Attitudes and practices regarding AMR stewardship Variable Response %(n) Always Never Often Rarely Sometimes Uncertainty on antimicrobial choice 4.6(11) 2.1(5) 7.1(17) 33.3(80) 52.9(127) Inadequate funding for AMS activities 10.4(25) 5.4(13) 27.9(67) 18.8(45) 37.5(90) Shortages or stockouts of essential antimicrobial agents 8.8(21) 0 30.0(72) 12.9(31) 48.3(116) Frequency of feedback on antimicrobial prescribing practice 2.5(6) 12.1(29) 7.1(17) 40.8(98) 37.5(90) Figure 3 , presents a graphical depiction of the level of confidence of the cadres we interviewed, regarding antibiotics prescribing. Among the clinical officers, the level of confidence was high, followed by the pharmacist, and nurses compared to the same among medical doctors and other cadres. Table 6 presents healthcare professionals' perceptions of antimicrobial stewardship (AMS). Nearly all respondents (98.8%) identified antimicrobial resistance (AMR) as a critical issue in their practice settings, yet only 26.3% believed there was adequate community hospital support for AMS. Adherence to AMS protocols in hospitals was reported as intermediate (50.8%) to low (33.3%), while confidence in antimicrobial prescribing guidelines varied, with 42.9% of healthcare professionals expressing moderate confidence and 28.7% reporting high confidence. Workload was a significant barrier to AMS implementation, with 68.3% agreeing that current work demands negatively impacted their ability to practice AMS effectively. Regarding the establishment of AMS committees to strengthen stewardship efforts, 68.3% of respondents agreed, and 26.7% strongly agreed. The majority (67.9%) believed that regular audits and feedback could improve adherence to AMS guidelines, with 22.5% strongly supporting this view. Perceptions of government support were mixed, with 66.7% rating current policies as moderately (35%) to highly effective (31.7%) in supporting AMS efforts. Notably, 51.7% expressed confidence that implementing AMS programs could reduce antimicrobial resistance. See Table 6. Table 6: Showing the healthcare professionals' attitudes and practices towards AMR. Variable Total (n) Percent (%) Believe antimicrobial resistance is a significant concern in your practice setting 237 98.8 There is sufficient community awareness and support for antimicrobial stewardship efforts in your hospital 63 26.3 The hospital's level of adherence to antimicrobial stewardship protocols Very High 2 0.8 High 23 9.6 Intermediate 122 50.8 Low 80 33.3 Very low 13 5.4 Healthcare worker's levels of confidence in the knowledge of antimicrobial prescribing as per the guidelines Very High 14 5.8 High 69 28.7 Intermediate 103 42.9 Low 49 20.4 Very Low 5 2.1 The impact of the current workload on healthcare workers' ability to practice antimicrobial stewardship effectively Strongly Agree 16 6.7 Agree 149 62.1 Neutral 60 25.0 Disagree 12 5.0 Strongly Disagree 3 1.3 Establishing antimicrobial stewardship committees within healthcare facilities would enhance antimicrobial stewardship efforts. Strongly Agree 64 26.7 Agree 164 68.3 Neutral 8 3.3 Disagree 2 0.8 Strongly disagree 2 0.8 Regular audits and feedback on antimicrobial prescribing adherence practices would help improve antimicrobial stewardship guidelines Strongly Agree 54 22.5 Agree 163 67.9 Neutral 8 3.3 Disagree 1 0.4 Strongly Disagree 14 5.8 Willing to actively engage in antimicrobial stewardship initiatives in your facility 240 100.0 Believe government policies and regulations are in support of antimicrobial stewardship efforts in Eastern Uganda Extremely effective 6 2.5 Very Effective 76 31.7 Moderately Effective 84 35.0 Slightly effective 48 20.0 Not all effective 26 10.8 Collaboration with other healthcare facilities or organizations would facilitate the implementation of antimicrobial stewardship 240 100.0 Implementing antimicrobial stewardship programs in Eastern Uganda will lead to a reduction in antimicrobial resistance Extremely Confident 20 8.3 Very Confident 124 51.7 Moderately Confident 57 23.8 Somewhat Confident 32 13.3 Not Confident 7 2.9 Knowledge of AMR and stewardship practices Table 7 presents the level of knowledge of AMR and stewardship principles among HCPs. Out of the twelve knowledge questions, nearly all respondents correctly defined AMR (99.2%) and understood stewardship's role (99.6%). Key practices like tailoring therapy based on cultures (95.0%) and avoiding broad-spectrum antibiotics as first-line (65.8%) were recognized. Awareness of stewardship goals (88.8%) and the link between agricultural antibiotic misuse and AMR (87.9%) was high. Yet, confidence in stewardship knowledge was lower (28.3%), suggesting a need for improved education and training. Overall, 98% were knowledgeable in AMR practices and only 2% had limited knowledge. See Table 7 Table 7: Showing the healthcare workers' level of Knowledge of AMR practices. Knowledge item CORRECT FALSE TRUE Antimicrobial resistance (AMR) is the ability of microorganisms to withstand the effect of an antibiotic TRUE 0.8(2) 99.2(238) Antimicrobial stewardship is a program to promote the appropriate use of antimicrobials TRUE 0.4(1) 99.6(239) A core principle of antimicrobial stewardship is to tailor antibiotic therapy based on culture results TRUE 5.0(12) 95.0(228) De-escalation of antibiotic therapy based on culture results is a key component of antimicrobial stewardship TRUE 6.3(15) 93.8(225) Antimicrobial stewardship is a program that aims to reduce the incidence of antibiotic-resistant infections, improve patient outcomes, and decrease health cost TRUE 11.3(27) 88.8(213) Empirical antibiotic therapy should be reassessed within 48-72 hours based on culture results and clinical response TRUE 7.1(17) 92.9(223) Broad-spectrum antibiotics should be used as the first line of treatment for any infection TRUE 34.2(82) 65.8(158) Have you participated in any continuing education programs or workshops related to antimicrobial stewardship in the past year TRUE 40.4(97) 59.6(143) The misuse of antibiotics in agriculture can contribute to the development of AMR in humans TRUE 12.1(29) 87.9(211) Are you aware of the current local or national guidelines for antimicrobial use in your hospital setting TRUE 34.6(83) 65.4(157) Do you always use culture, and sensitivity results to guide antibiotic therapy TRUE 43.8(105) 56.3(135) Confident in your knowledge of antimicrobial stewardship principles? TRUE 28.3(68) 71.7(172) Discussion There is limited data reporting AMS knowledge, attitudes and practices in Eastern Uganda, with this study providing novel insights that have the potential to inform policy and practice. The assessment of antimicrobial prescription practices and the evaluation of AMS-related KAP among HCPs in Eastern Uganda are critical steps in combating AMR. This study has identified current strengths and gaps on AMS activities at four health facilities in Eastern Uganda. In addition, the study highlights general targeted interventions, need for training, and systemic support needed to improve antimicrobial use and safeguard the efficacy of antibiotics in Eastern Uganda. In this context, we found health workers possessed a high level of basic knowledge regarding AMS but which did not correspond to the actual practice as some HCPs were found to lack confidence in antibiotic prescription practices. However, while there may be some limitations with our measure of knowledge (lack of a standardised tool and only 70 validity rating), we think it likely that the high level of knowledge we found in this study might be explained by the high-capacity building on AMR and the existence of the Uganda Clinical Guidelines (UCG) for the management of infections in health facilities. The 98% level of knowledge found in our study is higher than the 75% by Mudenda and others in Zambia [21] . We also found a high rate of inappropriate antibiotic prescribing practices within these settings which we think could be linked to the lack of proper diagnostics facilities in hospitals, more especially at the health sub-district level in Uganda. For instance, two out of the four facilities included in this study could not perform microbiological culturing and antimicrobial susceptibility testing. This finding is consistent with what Antoine and colleagues found in their multicentric community-based cohort study among paediatric outpatients, where inappropriate prescriptions were found to be high [27] . Additionally, while a basic level of knowledge of antimicrobial resistance (AMR) was high among our participants, we found that significant gaps existed in the consistent application of stewardship principles. For instance, only 56.3% of healthcare professionals consistently used culture results to guide their therapy decisions and only 28.3% felt confident in their knowledge of antimicrobial stewardship (AMS), possibly due to the lack of culture and sensitivity diagnostic facilities. Furthermore, we found a high frequency of inappropriate antibiotic prescriptions, particularly resulting from the use of broad-spectrum antibiotics possibly driven by factors such as access to diagnostic tools that prevent the opportunity to use narrow-spectrum antibiotics requiring culture and sensitivity results. The findings support the call by Nuwematsiko and colleagues, who also found a high prevalence of inappropriate practices in Central Uganda [28] , for improved diagnostic support and adherence to guidelines. Many HCPs indicated that heavy workloads negatively affect their ability to engage in AMS practices, with 62.1% of participants in our study stating that current workloads were a barrier to effective stewardship. The impact of workload on the quality of care is well-documented. Overburdened healthcare providers may prioritize immediate patient relief over optimal prescribing practices, leading to the misuse of antibiotics. Our study agrees with what Han found on workload and how it negatively affects HCPs’ ability to perform other duties [29]. This underscores the need not only for enhanced training but also for systemic changes aimed at reducing workload and providing more support to HCPs. Moreover, when we tested the healthcare professional level of knowledge, the knowledge score was high, however, but the use of culture and sensitivity to guide therapy and participation in continuous education programs were low at 56.3% and 59.6% respectively. Strengths and limitations This was the first study to our knowledge investigating the current antibiotic stewardship practices in Eastern Uganda. The study achieved a high response rate from participants, which enhanced the reliability and generalizability of the findings. Additionally, by focusing on real-world practices and challenges faced by healthcare providers, the study provides practical insights that can inform policy and intervention strategies to improve AMS in similar settings. However, our study also had limitations. Firstly, the study was only descriptive, and we did not explore any form of association, although it provided an exploratory picture of AMS in Eastern Uganda. Secondly, our study relied heavily on self-reported data from healthcare providers, which may be subject to response bias, as participants might overestimate their knowledge or adherence to AMS practices. Thirdly, the study also primarily focused on public health facilities, potentially overlooking AMS practices in private healthcare settings, which may differ significantly. We also did not include data on patient outcomes, which would have provided a more comprehensive understanding of the impact of AMS practices on health outcomes. And, lastly, while the knowledge scale utilised in this study proved to be reliable, the questions were all positively worded with only True/False response options which may have biased the results. That said, our findings are broadly in line with other similar studies [10] . Conclusion This study provides valuable data on the current situation regarding AMR/AMS knowledge, attitudes and practices in Eastern Uganda. It highlights the need for targeted strategies to improve antimicrobial prescribing practices and enhance the knowledge, attitudes, and practices of healthcare providers. Strengthening these areas is crucial for combating antimicrobial resistance (AMR) in Eastern Uganda and ensuring the future efficacy of antibiotics more widely. Recommendations Based on our findings from this exploratory study on AMS in our setting, we suggest that health facilities should consider the value of implementing (and evaluating) regular training programs for healthcare providers on antimicrobial stewardship and AMR with a need to develop and disseminate clear, context-specific guidelines for antibiotic prescribing. There is also an apparent need to improve access to diagnostic tools and resources necessary for appropriate antimicrobial prescribing and to establish robust monitoring and evaluation systems to track antibiotic prescribing patterns and adherence to guidelines. Finally, there is a pressing need for more detailed and extensive research focused on AMS practices in this region if we are to make further progress in tackling AMR. Abbreviations AMR Antimicrobial Resistance AMS Antimicrobial Stewardship HCPs Healthcare Providers LMICs Low-and Middle-Income Countries WHO World Health Organization RRH Regional Referral Hospital KAP Knowledge, Attitudes, and Practices MRRH Mbale Regional Referral Hospital UNCST Uganda National Council for Science and Technology UCG Uganda Clinical Guidelines Declarations Ethics approval and consent to participate This study was approved by the Research Ethical Committee (REC) of Mbale Regional Referral Hospital (MRRH-2023-357) and the Uganda National Council for Science and Technology (UNCST). Administrative clearances were sought from the office of the director of MRRH, Soroti RRH, and in charge offices of Ngora Hospital and Atutur General Hospitals. Informed consent was sought from all the participants verbally and in writing. Participation in the study was voluntary, and all participants were assured that they were free to withdraw at any point and without consequence. All methods were carried out in accordance with relevant guidelines and regulations in the Declaration of Helsinki. Consent for publication The Mbale Clinical Research Institute (MCRI, www.mcri.ac.ug), a research entity affiliated with the Uganda National Health Research Organization, approved the publication of this manuscript. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Competing interests "The authors declare no conflicts of interest." Funding This work was supported by The Open University’s Open Societal Challenges programme and Mbale Clinical Research Institute (MCRI), Eastern Uganda. Authors' contributions The primary author contributed to this study by conceptualizing the Research design and drafting the initial manuscript. All the coauthors provided expertise in critically revising the manuscript for intellectual content. 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Adegbite, B.R., et al., Knowledge and perception on antimicrobial resistance and antibiotics prescribing attitude among physicians and nurses in Lambarene region, Gabon: a call for setting-up an antimicrobial stewardship program. Antimicrob Resist Infect Control, 2022. 11 (1): p. 44. Mudenda, S., et al., Knowledge, awareness and practices of healthcare workers regarding antimicrobial use, resistance and stewardship in Zambia: a multi-facility cross-sectional study. JAC Antimicrob Resist, 2024. 6 (3): p. dlae076. WHO. Quadripartite call to action for One Health for a safer world . 2023; Available from: https://www.who.int/news/item/27-03-2023-quadripartite-call-to-action-for-one-health-for-a-safer-world. Mayito, J., et al., Characterization of Antibiotic Resistance in Select Tertiary Hospitals in Uganda: An Evaluation of 2020 to 2023 Routine Surveillance Data. Trop Med Infect Dis, 2024. 9 (4) p. 1–19. Cluver, L., et al., Poverty, AIDS and child health: Identifying highest-risk children in South Africa. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2013. 103 (12): p. 910-5. Muula, A.S., My Africa. Poverty, health, disease, and medical journalism. Croatian medical journal, 2009. 50 (6): p. 598-9. Human Resources for Health Audit Report 2017/18. Ministry of Health (Department of Human Resource Management), Republic of Uganda. 2018. Available from: http://library.health.go.ug/human-resources-health/human-resources-health-audit-report-201718. Ardillon, A., et al., Inappropriate antibiotic prescribing and its determinants among outpatient children in 3 low- and middle-income countries: A multicentric community-based cohort study. PLoS Med, 2023. 20 (6): p. e1004211. Nuwematsiko, N., et al. High prevalence of inappropriate antibiotic prescriptions in selected health care facilities in Uganda . Research Square 2024. Available from: https://www.researchsquare.com/article/rs-4442318/v1. Han, M. and X. Zhang, Impact of medical professionals on Carbapenem-resistant Pseudomonas aeruginosa: moderating effect of workload based on the panel data in China. BMC Health Serv Res, 2020. 20 (1): p. 670. Supplementary Material The Supplementary Materials file is not available with this version. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Jun, 2025 Reviewers agreed at journal 19 Jun, 2025 Reviewers invited by journal 12 Jun, 2025 Editor assigned by journal 10 Jun, 2025 Editor invited by journal 28 Feb, 2025 Submission checks completed at journal 28 Feb, 2025 First submitted to journal 19 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6066834","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":422284546,"identity":"82eb62a6-ff30-4785-9099-6b1886e1f3d0","order_by":0,"name":"Jimmy Patrick Alunyo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIiWNgGAWjYDACdgjFDKEMGAz4QXRCAR4tzAiKsQGkRbIBpMWAsBYGiBagPQYHINbhBPzNPGaPeSqA7pNufv64osDO2Pj86sQPDwwY5PnFDmDVInGYx9yY5wzQMpljho1nDJLNzG683SwBdJjhzNkJ2K05zGMmzdsG1CKRYNjYYHDAxuzG2Q0gLQkGt7FrkUdoSf8I1mI84+zmH/i0GCC05IBtMTPg792G1xbDw2xlknPOSDCzyZwpnNlgkGwscYN3m0WCgQROv8gdb94m8abCJplfun3Dx4Y/dob9/Wc33/xRYSPPL43D+0DAxMMgkcwmAeNKgFVK4FQOAow/GBjsEGr4D+BVPQpGwSgYBSMPAAC5zlQ9G5S/hgAAAABJRU5ErkJggg==","orcid":"","institution":"Busitema University","correspondingAuthor":true,"prefix":"","firstName":"Jimmy","middleName":"Patrick","lastName":"Alunyo","suffix":""},{"id":422284547,"identity":"982269e8-7ab7-46ea-8f9b-ea0ca4d13409","order_by":1,"name":"Enid Kawala Kagoya","email":"","orcid":"","institution":"Busitema 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UK","correspondingAuthor":false,"prefix":"","firstName":"Rachel","middleName":"","lastName":"McMullan","suffix":""},{"id":422284554,"identity":"3a8938f4-7fb8-4b20-a31a-333ba761d839","order_by":8,"name":"Peter Olupot-Olupot","email":"","orcid":"","institution":"Busitema University","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Olupot-Olupot","suffix":""}],"badges":[],"createdAt":"2025-02-19 20:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6066834/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6066834/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78209634,"identity":"5f731a85-8d48-46ac-9f6e-95aee5e20592","added_by":"auto","created_at":"2025-03-11 03:22:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24121,"visible":true,"origin":"","legend":"\u003cp\u003eReported methods used by hospitals to maintain interdisciplinary communication.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6066834/v1/a45dac77d2a063347b9d8796.png"},{"id":78209636,"identity":"1a014393-b222-4c64-be00-272442dc0f6e","added_by":"auto","created_at":"2025-03-11 03:22:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":21949,"visible":true,"origin":"","legend":"\u003cp\u003eShowing the composition of the antibiotic’s resistance-controlling program.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6066834/v1/882b407cc8254c151511b04f.png"},{"id":78209635,"identity":"060003e2-ce65-4153-a19a-a95191e1969c","added_by":"auto","created_at":"2025-03-11 03:22:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15145,"visible":true,"origin":"","legend":"\u003cp\u003eShowing the HCP's level of confidence in antibiotic prescribing.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6066834/v1/b931e453dd49f1e73e8d410d.png"},{"id":78211976,"identity":"3c2460e0-edb0-4caa-86c4-bfc0a331334b","added_by":"auto","created_at":"2025-03-11 03:46:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1403892,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6066834/v1/123d8f00-2828-454f-a16f-f3409bd66115.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Antimicrobial stewardship: Knowledge, attitudes and practices of healthcare providers in Eastern Uganda","fulltext":[{"header":"Background","content":"\u003cp\u003eAntimicrobial resistance (AMR) is a global problem of public health importance\u003cb\u003e[1]\u003c/b\u003e. Antimicrobial resistance develops through genetic mutations and natural selection, accelerated by misuse and overuse of antimicrobials in humans and animals\u003cb\u003e[2, 3]\u003c/b\u003e. In clinical settings, the recent escalation in AMR levels is attributed to antibiotic overuse, misuse or both\u003cb\u003e[1, 4, 5]\u003c/b\u003e. In low- and middle-income countries (LMICs), treatment of infectious diseases is empirically based on the World Health Organisation (WHO) guidelines, due in part to the inadequacy of laboratories, few qualified health staff and poor community health seeking behaviours. Consequently, hindering the ability to diagnose disease and determine pathogen susceptibility to antimicrobials\u003cb\u003e[6\u0026ndash;8]\u003c/b\u003e. This often results in poorly targeted treatment with poor clinical outcomes, widespread AMR and increased economic burden of patient care\u003cb\u003e[7, 8]\u003c/b\u003e. The pervasive use of antimicrobial agents contributes significantly to the rise of AMR. Healthcare professionals (HCPs) in public health facilities are predominantly responsible for the hospital administration of these agents following evidence-based guidelines as specified in the Uganda clinical guidelines and WHO guidelines\u003cb\u003e[9]\u003c/b\u003e. They have a critical role to play in mitigating the effects of AMR but given that AMR is a rapidly evolving challenge, HCP involved in the surveillance and stewardship of AMR need support in expanding their professional practice in these areas. Therefore, evaluating the knowledge, awareness, and practices of HCPs regarding antimicrobial use (AMU), AMR, and antimicrobial stewardship as recommended by the WHO\u003cb\u003e[9]\u003c/b\u003e within hospitals is essential for monitoring antibiotic use, ensuring appropriate prescribing practices, and educating healthcare workers and the public about the risks of antibiotic misuse and overuse\u003cb\u003e[10, 11]\u003c/b\u003e. Antimicrobial agent misuse is a principal driver of AMR in humans\u003cb\u003e[12]\u003c/b\u003e. Inadequate knowledge and awareness about AMU, AMR, and AMS among HPCs results in improper prescribing, dispensing, and administration of antimicrobials, potentially contributing to the emergence of resistant infections. In LMICs, the determinants of AMR are complex and include a lack of diagnostic tools, unrestricted access to antimicrobials, medication shortages, improper agricultural use of antibiotics, poor hygiene and sanitation, weak regulatory frameworks, substandard clinical care, and insufficient AMS\u003cb\u003e[13, 14]\u003c/b\u003e. The presence of substandard antimicrobial agents further exacerbates AMR in these regions. In East Africa, almost half of the isolated organisms are resistant to WHO-recommended antibiotics\u003cb\u003e[15]\u003c/b\u003e. Monitoring AMR trends in different regions guides policy with antibiotic producing companies\u003cb\u003e[2, 3, 5, 15]\u003c/b\u003e. Whereas the homogeneity in the geographical distribution of AMR prompted the WHO to provide an AMR priority list according to location\u003cb\u003e[2, 3, 5]\u003c/b\u003e, effective and standardised stewardship practices are needed across all locales. Rolling out AMS has the potential to preserve the safety and effectiveness of antimicrobials with good patient outcomes both locally and internationally\u003cb\u003e[16\u0026ndash;20]\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eAntimicrobial Stewardship (AMS) programs are essential for addressing antimicrobial resistance (AMR). They should include leadership commitment, accountability, infection prevention and control expertise, education, training, monitoring, and feedback on AMS outcomes. Implementing hospital AMS programs ensures the rational use of antimicrobials by prescribing the correct dose, duration, and route, while also enhancing healthcare providers' knowledge, attitudes, and practices regarding AMR and antimicrobial use. Hospital AMS programs improve prescribing practices\u003cb\u003e[21]\u003c/b\u003e. In May 2015, the WHO launched the Global Action Plan (GAP) on AMR, highlighting the importance of education in combating antimicrobial resistance. The Quadripartite Alliance urges member states to develop National Action Plans and improve infection and AMR surveillance. The GAP promotes a One Health approach to raise awareness about AMU, AMR, and AMS, advocating for proper antimicrobial use\u003cb\u003e[22]\u003c/b\u003e.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eUganda has identified several factors contributing to AMR with microorganisms exhibiting resistance to commonly used antimicrobials in the healthcare system\u003cb\u003e[23]\u003c/b\u003e. Studies have highlighted inappropriate antibiotic prescribing patterns in public sector hospitals as a significant issue\u003cb\u003e[23]\u003c/b\u003e. The health systems in sub-Saharan Africa (SSA) are illustrative of the challenges that many developing countries face\u003cb\u003e[24, 25]\u003c/b\u003e: they are fragmented and with little priority settings coming from within the subcontinent.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis study aimed to assess the current antimicrobial prescribing practices in healthcare facilities and evaluate healthcare providers' knowledge, attitudes, and practices related to antimicrobial stewardship in Eastern Uganda. The findings presented herein represent one component of a larger study that aims to examine forms of professional practice that are needed to improve practices associated with AMR surveillance and stewardship.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Settings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in healthcare facilities across Eastern Uganda, namely, Mbale RRH, Soroti RRH, Atutur District Hospital and Ngora District Hospital. Facilities were selected based on their locations, namely urban (Soroti and Mbale RRH) and rural areas (Atutur and Ngora), and regional versus district-level health facilities. The workforce size are fairly typical in these settings, with more women than men at all levels of service delivery (at 54% females and 46% males)\u003cstrong\u003e[26]\u003c/strong\u003e. Eastern Uganda was selected because of limited data on AMR stewardships.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a descriptive cross-sectional study using a quantitative approach to data collection, a structured questionnaire administered to HCPs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included physicians, nurses, pharmacists, laboratory personnel and clinical officers involved in antibiotic prescribing across the four healthcare facilities ranging from primary health centres to tertiary hospitals in Eastern Uganda. \u003cstrong\u003eSee Table 1\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable 1: Multistage Sampling procedure\u0026nbsp;\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"709\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDetails\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSampling Approach\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003eMultistage sampling approach starting at district and hospital levels\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistrict Selection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003ePurposive selection of four districts across Eastern Uganda: Mbale, Soroti, Atutur, and Ngora\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital Selection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003ePurposive selection of four high-volume hospitals within selected districts\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAllocation of Sample Size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003eProportionate allocation based on the catchment population served by each facility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample Size Allocation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003eNinety-six participants from Mbale and Soroti RRHs; twenty-four participants from Ngora and Atutur Hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant Selection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003eSimple random sampling from available cadres at each hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant Refusals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003eNo participants refused to participate in the study\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\n\u003cp\u003eTo recruit the 240 participants included in this study, a multistage sampling approach was employed, starting at the district and hospital levels. We purposively selected four districts across Eastern Uganda: Mbale, Soroti, Atutur, and Ngora and selected four high-volume hospitals within these districts. We utilized proportionate allocation techniques, basing our calculations on the catchment population served by each facility to determine the required sample size for each facility. From these calculations, we selected ninety-six participants from Mbale and Soroti RRHs and twenty-four participants from Ngora and Atutur Hospitals, respectively. We employed simple random sampling to select our participants from the list of all available cadres (Pharamcist, doctors, clinical officers, nurses, and others involved in prescribing) at each hospital. Considerable flexibility was offered regarding participation opportunities and no participants refused to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA semi-structured questionnaire designed in electronic format Kobo Toolbox administered bu trained research assistants were used to capture primary data on Antimicrobial Prescribing Practices and Knowledge, Attitudes, and Practices (KAP) and had the following sections: the participant\u0026rsquo;s socio-demographic variables, attitudes and practices, and knowledge sections (see Supplementary Materials for full questionnaire). To ensure the completeness of our data, all questions were made mandatory and skip logic was applied where necessary.\u003c/p\u003e\n\u003cp\u003eThe tools were created in English, as our target respondents were healthcare professionals (HCPs) who were proficient in the language. Trained research assistants then collected the data in English. A comprehensive document review was conducted to inform and shape the development of questions related to current antimicrobial practices. This review provided critical insights into existing guidelines, protocols, and standard practices, ensuring that the questions were relevant, accurate, and reflective of the latest developments in antimicrobial management. We conducted a reliability test to assess the reliability of our twelve-item knowledge scale. Results showed an average interitem covariance of 0.023 and a scale reliability coefficient (Cronbach\u0026apos;s alpha) of 0.724. See the results. \u003cstrong\u003eSee Table 2.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2:\u0026nbsp;\u003c/strong\u003eReliability test for knowledge items\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"611\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eAverage interitem covariance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eNumber of items in the scale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eScale reliability coefficient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data analysis was conducted using STATA\u003csup\u003e\u0026reg;\u003c/sup\u003e version 17 software. We computed frequencies, proportions, median and interquartile ranges and the results are summarised below.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 240 participants were included in the study as follows: Atutur 24 (10.0%), MRRH 96 (40.0%), Ngora 24 (10.0%), and Soroti RRH 96 (40.0%) participants, most from urban locations (84.2%), with a smaller proportion from rural areas (15.8%). The gender distribution was relatively balanced, with 116 females (48.5%) and 124 males (51.5%). The median age of participants was 33 years, with an interquartile range (IQR) of 28 to 38 years. The median years of experience in their respective fields was 6 years, with an IQR of 4 to 10 years with the groups comprising nurses (40.8%), clinical officers (22.5%), other specified positions (20.8%), medical doctors (11.2%), and pharmacists (4.5%), as shown in \u003cstrong\u003eTable 3\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3:\u003c/strong\u003e Participants\u0026apos; demographic characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51.069%;\"\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 3.7808%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14.7372%;\"\u003e\u003cstrong\u003eFreq.\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.2395%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 23.8006%;\"\u003e\u003cstrong\u003ePercentages\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51.069%;\"\u003eHealth Facility Name\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 3.7808%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14.7372%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.2395%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 23.8006%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eAtutur\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e10.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eMbale RRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e40.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eNgora\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e10.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eSoroti RRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e40.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.6091%;\"\u003e\n \u003cp\u003eLocation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 18.2415%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 33.8236%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e84.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.6091%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 18.2415%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 33.8236%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e48.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e51.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 31.6091%;\"\u003e\n \u003cp\u003eAge median [p25, p75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 18.2415%;\"\u003e\n \u003cp\u003e33[28, 38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 33.8236%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 31.6091%;\"\u003e\n \u003cp\u003eYears of experience median [p25, p75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 18.2415%;\"\u003e\n \u003cp\u003e\u0026nbsp;6[4, 10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 33.8236%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.6091%;\"\u003e\n \u003cp\u003ePosition in this hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 18.2415%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 33.8236%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eClinical Officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eMedical doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e40.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003eOthers specify\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48.7119%;\"\u003e\n \u003cp\u003ePharmacist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22.5073%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8006%;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.6322%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cbr\u003e\n\u003cp\u003e\u003cstrong\u003ePrescribing practices\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Reported antibiotic prescribing practices in healthcare facilities in Eastern Uganda, presents the results for antibiotic prescribing practices in Eastern Uganda. Most of the hospitals included in this study had AMS measures in place, with 75.4% having an antibiotic resistance controlling program, 83.3% having a designated AMR leader, and 86.7% having a pharmacist dedicated to improving antimicrobial use. Additionally, 92.5% had policies requiring documentation of antibiotic prescription durations. Of the 240 participants, 90.4% reported their hospitals had specific treatment guidelines based on national standards, 88.8% said the hospitals provided them with access to evidence-based medicine resources, and 76.7% said the hospitals were sharing antibiotic consumption data with them (prescribers). However, only 56.3% consistently use culture results for therapy decisions. \u003cstrong\u003eSee Table 4.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Reported antibiotic prescribing practices in healthcare facilities in Eastern Uganda\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse %(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI Don\u0026apos;t Know\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe existence of an antibiotic resistance program\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e18.8(45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5.8(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e75.4(181)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExistence of AMR program leader\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12.9(31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3.8(9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e83.3(200)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAvailability of an antimicrobial stewardship pharmacist\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8.3(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5.0(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e86.7(208)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe existence of an antibiotic documentation policy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.4(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2.1(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e92.5(222)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe hospital had specific treatment guideline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.5(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2.1(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e90.4(217)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAvailability of evidence to be accessed by staff\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3.3(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7.9(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e88.8(213)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAvailability of antibiotic consumption reports\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14.6(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8.8(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e76.7(184)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAMS attitudes and practices\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1\u003c/strong\u003e, presents the results of the possible mechanisms the hospitals used to maintain interdisciplinary communications on AMS. \u0026nbsp;Overall, the most common method was the use of an AMS committee, utilised by 58.6% of the hospitals. Meetings were the second most common method, (38.5%) with monthly reports the least common (2.9%).\u003c/p\u003e\n\u003cp\u003eWhen disaggregated by facility level, meetings were the most common method used by General Hospitals (Atutur and Ngora 70.8%), followed by committees (20.8%), and monthly reports (8.3%). At the RRH level (Mbale and Soroti), committees were the most common method for maintaining interdisciplinary communications (68.1%), followed by meetings (30.3%), and monthly (1.6%).\u003c/p\u003e\n\u003cp\u003eParticipants were asked to identify the roles that were part of the antibiotic resistance controlling committee in their hospital (Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e presents the perceptions of respondents on the kind of cadres who form the antibiotic resistance controlling committees in the four hospitals. Pharmacists (42.5%) and clinical officers (30.8%) were most frequently reported by participants as being part of the antibiotic resistance committees whereas hospital management representatives (14.2%), infection control representatives (4.2%) nurses (3.3%) and others were less frequently reported as being part of these committees by respondents. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e presents the results of attitudes and practices regarding AMS. When asked about instances of uncertainty regarding the best antimicrobial therapy choice during practice, 52.9% of participants reported feeling this way sometimes, with 33.3% rarely feeling uncertain, and only 2.1% never feeling uncertain. Regarding challenges related to inadequate funding for AMR stewardship activities, 37.5% sometimes experience this issue, compared to only 5.4% who never do.\u003c/p\u003e\n\u003cp\u003eConcerning essential antimicrobial agents at the facility, 48.3% sometimes experience stockouts. Most HCPs reported rarely receiving feedback on their antibiotic prescribing practices from management, with only 2.5% always receiving feedback. \u003cstrong\u003eSee Table 5.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e5:\u003c/strong\u003e Attitudes and practices regarding AMR stewardship\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"706\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 376px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse %(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlways\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOften\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRarely\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSometimes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUncertainty on antimicrobial choice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4.6(11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.1(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.1(17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e33.3(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e52.9(127)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInadequate funding for AMS activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10.4(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.4(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e27.9(67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e18.8(45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e37.5(90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eShortages or stockouts of essential antimicrobial agents\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8.8(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30.0(72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12.9(31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e48.3(116)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of feedback on antimicrobial prescribing practice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.5(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12.1(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.1(17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e40.8(98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e37.5(90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 3\u003c/strong\u003e, presents a graphical depiction of the level of confidence of the cadres we interviewed, regarding antibiotics prescribing. Among the clinical officers, the level of confidence was high, followed by the pharmacist, and nurses compared to the same among medical doctors and other cadres.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u0026nbsp;\u003c/strong\u003epresents healthcare professionals\u0026apos; perceptions of antimicrobial stewardship (AMS). Nearly all respondents (98.8%) identified antimicrobial resistance (AMR) as a critical issue in their practice settings, yet only 26.3% believed there was adequate community hospital support for AMS. Adherence to AMS protocols in hospitals was reported as intermediate (50.8%) to low (33.3%), while confidence in antimicrobial prescribing guidelines varied, with 42.9% of healthcare professionals expressing moderate confidence and 28.7% reporting high confidence. Workload was a significant barrier to AMS implementation, with 68.3% agreeing that current work demands negatively impacted their ability to practice AMS effectively. Regarding the establishment of AMS committees to strengthen stewardship efforts, 68.3% of respondents agreed, and 26.7% strongly agreed. The majority (67.9%) believed that regular audits and feedback could improve adherence to AMS guidelines, with 22.5% strongly supporting this view. Perceptions of government support were mixed, with 66.7% rating current policies as moderately (35%) to highly effective (31.7%) in supporting AMS efforts. Notably, 51.7% expressed confidence that implementing AMS programs could reduce antimicrobial resistance. \u003cstrong\u003eSee Table 6.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e6:\u0026nbsp;\u003c/strong\u003eShowing the healthcare professionals\u0026apos; attitudes and practices towards AMR.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"678\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eBelieve antimicrobial resistance is a significant concern in your practice setting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e98.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eThere is sufficient community awareness and support for antimicrobial stewardship efforts in your hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eThe hospital\u0026apos;s level of adherence to antimicrobial stewardship protocols\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eVery High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e50.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eVery low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eHealthcare worker\u0026apos;s levels of confidence in the knowledge of antimicrobial prescribing as per the guidelines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eVery High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e28.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eVery Low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eThe impact of the current workload on healthcare workers\u0026apos; ability to practice antimicrobial stewardship effectively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e62.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eEstablishing antimicrobial stewardship committees within healthcare facilities would enhance antimicrobial stewardship efforts.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eAgree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e68.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eStrongly disagree \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003e\u0026nbsp;Regular audits and feedback on antimicrobial prescribing adherence practices would help improve antimicrobial stewardship guidelines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eWilling to actively engage in antimicrobial stewardship initiatives in your facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eBelieve government policies and regulations are in support of antimicrobial stewardship efforts in Eastern Uganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eExtremely effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eVery Effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eModerately Effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e35.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eSlightly effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eNot all effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eCollaboration with other healthcare facilities or organizations would facilitate the implementation of antimicrobial stewardship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eImplementing antimicrobial stewardship programs in Eastern Uganda will lead to a reduction in antimicrobial resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eExtremely Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eVery Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eModerately Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eSomewhat Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 463px;\"\u003e\n \u003cp\u003eNot Confident\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge of AMR and stewardship practices\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e presents the level of knowledge of AMR and stewardship principles among HCPs. Out of the twelve knowledge questions, nearly all respondents correctly defined AMR (99.2%) and understood stewardship\u0026apos;s role (99.6%). Key practices like tailoring therapy based on cultures (95.0%) and avoiding broad-spectrum antibiotics as first-line (65.8%) were recognized. Awareness of stewardship goals (88.8%) and the link between agricultural antibiotic misuse and AMR (87.9%) was high. Yet, confidence in stewardship knowledge was lower (28.3%), suggesting a need for improved education and training. Overall, 98% were knowledgeable in AMR practices and only 2% had limited knowledge. \u0026nbsp;\u003cstrong\u003eSee Table 7\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e7:\u0026nbsp;\u003c/strong\u003eShowing the healthcare workers\u0026apos; level of Knowledge of AMR practices.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCORRECT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFALSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTRUE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eAntimicrobial resistance (AMR) is the ability of microorganisms to withstand the effect of an antibiotic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e0.8(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e99.2(238)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eAntimicrobial stewardship is a program to promote the appropriate use of antimicrobials\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e0.4(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e99.6(239)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eA core principle of antimicrobial stewardship is to tailor antibiotic therapy based on culture results\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e5.0(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e95.0(228)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eDe-escalation of antibiotic therapy based on culture results is a key component of antimicrobial stewardship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e6.3(15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e93.8(225)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eAntimicrobial stewardship is a program that aims to reduce the incidence of antibiotic-resistant infections, improve patient outcomes, and decrease health cost\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e11.3(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e88.8(213)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eEmpirical antibiotic therapy should be reassessed within 48-72 hours based on culture results and clinical response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e7.1(17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e92.9(223)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eBroad-spectrum antibiotics should be used as the first line of treatment for any infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e34.2(82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e65.8(158)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eHave you participated in any continuing education programs or workshops related to antimicrobial stewardship in the past year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e40.4(97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e59.6(143)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eThe misuse of antibiotics in agriculture can contribute to the development of AMR in humans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e12.1(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e87.9(211)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eAre you aware of the current local or national guidelines for antimicrobial use in your hospital setting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e34.6(83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e65.4(157)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eDo you always use culture, and sensitivity results to guide antibiotic therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e43.8(105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e56.3(135)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eConfident in your knowledge of antimicrobial stewardship principles?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003eTRUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e28.3(68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e71.7(172)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThere is limited data reporting AMS knowledge, attitudes and practices in Eastern Uganda, with this study providing novel insights that have the potential to inform policy and practice. The assessment of antimicrobial prescription practices and the evaluation of AMS-related KAP among HCPs in Eastern Uganda are critical steps in combating AMR. This study has identified current strengths and gaps on AMS activities at four health facilities in Eastern Uganda. In addition, the study highlights general targeted interventions, need for training, and systemic support needed to improve antimicrobial use and safeguard the efficacy of antibiotics in Eastern Uganda. In this context, we found health workers possessed a high level of basic knowledge regarding AMS but which did not correspond to the actual practice as some HCPs were found to lack confidence in antibiotic prescription practices. However, while there may be some limitations with our measure of knowledge (lack of a standardised tool and only 70 validity rating), we think it likely that the high level of knowledge we found in this study might be explained by the high-capacity building on AMR and the existence of the Uganda Clinical Guidelines (UCG) for the management of infections in health facilities. The 98% level of knowledge found in our study is higher than the 75% by Mudenda and others in Zambia\u003cb\u003e[21]\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eWe also found a high rate of inappropriate antibiotic prescribing practices within these settings which we think could be linked to the lack of proper diagnostics facilities in hospitals, more especially at the health sub-district level in Uganda. For instance, two out of the four facilities included in this study could not perform microbiological culturing and antimicrobial susceptibility testing. This finding is consistent with what Antoine and colleagues found in their multicentric community-based cohort study among paediatric outpatients, where inappropriate prescriptions were found to be high\u003cb\u003e[27]\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eAdditionally, while a basic level of knowledge of antimicrobial resistance (AMR) was high among our participants, we found that significant gaps existed in the consistent application of stewardship principles. For instance, only 56.3% of healthcare professionals consistently used culture results to guide their therapy decisions and only 28.3% felt confident in their knowledge of antimicrobial stewardship (AMS), possibly due to the lack of culture and sensitivity diagnostic facilities. Furthermore, we found a high frequency of inappropriate antibiotic prescriptions, particularly resulting from the use of broad-spectrum antibiotics possibly driven by factors such as access to diagnostic tools that prevent the opportunity to use narrow-spectrum antibiotics requiring culture and sensitivity results. The findings support the call by Nuwematsiko and colleagues, who also found a high prevalence of inappropriate practices in Central Uganda \u003cb\u003e[28]\u003c/b\u003e, for improved diagnostic support and adherence to guidelines.\u003c/p\u003e \u003cp\u003eMany HCPs indicated that heavy workloads negatively affect their ability to engage in AMS practices, with 62.1% of participants in our study stating that current workloads were a barrier to effective stewardship. The impact of workload on the quality of care is well-documented. Overburdened healthcare providers may prioritize immediate patient relief over optimal prescribing practices, leading to the misuse of antibiotics. Our study agrees with what Han found on workload and how it negatively affects HCPs\u0026rsquo; ability to perform other duties [29]. This underscores the need not only for enhanced training but also for systemic changes aimed at reducing workload and providing more support to HCPs. Moreover, when we tested the healthcare professional level of knowledge, the knowledge score was high, however, but the use of culture and sensitivity to guide therapy and participation in continuous education programs were low at 56.3% and 59.6% respectively.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis was the first study to our knowledge investigating the current antibiotic stewardship practices in Eastern Uganda. The study achieved a high response rate from participants, which enhanced the reliability and generalizability of the findings. Additionally, by focusing on real-world practices and challenges faced by healthcare providers, the study provides practical insights that can inform policy and intervention strategies to improve AMS in similar settings. However, our study also had limitations. Firstly, the study was only descriptive, and we did not explore any form of association, although it provided an exploratory picture of AMS in Eastern Uganda. Secondly, our study relied heavily on self-reported data from healthcare providers, which may be subject to response bias, as participants might overestimate their knowledge or adherence to AMS practices. Thirdly, the study also primarily focused on public health facilities, potentially overlooking AMS practices in private healthcare settings, which may differ significantly. We also did not include data on patient outcomes, which would have provided a more comprehensive understanding of the impact of AMS practices on health outcomes. And, lastly, while the knowledge scale utilised in this study proved to be reliable, the questions were all positively worded with only True/False response options which may have biased the results. That said, our findings are broadly in line with other similar studies \u003cb\u003e[10]\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides valuable data on the current situation regarding AMR/AMS knowledge, attitudes and practices in Eastern Uganda. It highlights the need for targeted strategies to improve antimicrobial prescribing practices and enhance the knowledge, attitudes, and practices of healthcare providers. Strengthening these areas is crucial for combating antimicrobial resistance (AMR) in Eastern Uganda and ensuring the future efficacy of antibiotics more widely.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003e Based on our findings from this exploratory study on AMS in our setting, we suggest that health facilities should consider the value of implementing (and evaluating) regular training programs for healthcare providers on antimicrobial stewardship and AMR with a need to develop and disseminate clear, context-specific guidelines for antibiotic prescribing.\u003c/p\u003e \u003cp\u003e There is also an apparent need to improve access to diagnostic tools and resources necessary for appropriate antimicrobial prescribing and to establish robust monitoring and evaluation systems to track antibiotic prescribing patterns and adherence to guidelines.\u003c/p\u003e \u003cp\u003eFinally, there is a pressing need for more detailed and extensive research focused on AMS practices in this region if we are to make further progress in tackling AMR.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAMR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntimicrobial Resistance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntimicrobial Stewardship\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCPs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealthcare Providers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-and Middle-Income Countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRegional Referral Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKnowledge, Attitudes, and Practices\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMRRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMbale Regional Referral Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUNCST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUganda National Council for Science and Technology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUCG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e Uganda Clinical Guidelines\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Research Ethical Committee (REC) of Mbale Regional Referral Hospital (MRRH-2023-357) and the Uganda National Council for Science and Technology (UNCST). Administrative clearances were sought from the office of the director of MRRH, Soroti RRH, and in charge offices of Ngora Hospital and Atutur General Hospitals. Informed consent was sought from all the participants verbally and in writing. Participation in the study was voluntary, and all participants were assured that they were free to withdraw at any point and without consequence. All methods were carried out in accordance with relevant guidelines and regulations in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Mbale Clinical Research Institute (MCRI, www.mcri.ac.ug), a research entity affiliated with the Uganda National Health Research Organization, approved the publication of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026quot;The authors declare no conflicts of interest.\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by The Open University\u0026rsquo;s Open Societal Challenges programme and Mbale Clinical Research Institute (MCRI), Eastern Uganda.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary author contributed to this study by conceptualizing the Research design and drafting the initial manuscript. All the coauthors provided expertise in critically revising the manuscript for intellectual content. The last Author supervised the overall review, provided guidance throughout the manuscript drafting, and critically reviewed and revised the manuscript for important intellectual content. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the healthcare providers and institutions in Eastern Uganda who participated in this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWaters, A., \u003cem\u003eAMR is a shared global problem.\u003c/em\u003e Vet Rec, 2018. \u003cb\u003e183\u003c/b\u003e(14): p. 429.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeale, A.C., et al., \u003cem\u003eAMR Surveillance in low and middle-income settings - A roadmap for participation in the Global Antimicrobial Surveillance System (GLASS).\u003c/em\u003e Wellcome Open Res, 2017. \u003cb\u003e2\u003c/b\u003e: p. 92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRezasoltani, S., et al., \u003cem\u003eAntimicrobial Resistance as a Hidden Menace Lurking Behind the COVID-19 Outbreak: The Global Impacts of Too Much Hygiene on AMR.\u003c/em\u003e Front Microbiol, 2020. \u003cb\u003e11\u003c/b\u003e: p. 590683.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMpagi, J.L., \u003cem\u003eSustaining AMR-Awareness in post National Conference Era: A Case study of Busitema University\u003c/em\u003e. 2019; Available from: https://cdn.southampton.ac.uk/assets/imported/transforms/content-block/UsefulDownloads_Download/D265FE3DCD0B4D7F8EE351376CD9DD23/J%20Mpagi%20-%20AMR-Awareness%20Presentation.pdf.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStewart Williams, J. and S. 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A systematic review of staff attitudes in long-term residential aged-care.\u003c/em\u003e Antimicrobial Resistance \u0026amp; Infection Control, 2022. \u003cb\u003e11\u003c/b\u003e(1): p. 92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. \u003cem\u003eAntimicrobial resistance\u003c/em\u003e. 2023; Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDo, N.T.T., et al., \u003cem\u003eCommunity-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach.\u003c/em\u003e Lancet Glob Health, 2021. \u003cb\u003e9\u003c/b\u003e(5): p. e610-e619.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatee, M., et al., \u003cem\u003eMapping and gap analysis on antimicrobial resistance surveillance systems in Kenya, Tanzania, Uganda and Zambia.\u003c/em\u003e Bulletin of the National Research Centre, 2023. \u003cb\u003e47\u003c/b\u003e(12) p. 1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatawera, V., \u003cem\u003eAntibiotic Resistance in Uganda: Situation Analysis and Recommendations\u003c/em\u003e. Uganda National Academy of Sciences 2015: ISBN: 978-9970-424-10-8, Kampala, Uganda.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodriguez, G.D., et al., \u003cem\u003eImplementation of a Collaborated Antimicrobial Stewardship Program and Outpatient Parenteral Antimicrobial Therapy (OPAT) Unit-driven Monoclonal Antibody Therapy Program for COVID-19 at a NYC Hospital.\u003c/em\u003e Int J Infect Dis, 2022: \u003cb\u003e118\u003c/b\u003e p. 214\u0026ndash;219.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFajt, V.R., et al., \u003cem\u003eA call to action for veterinarians and partners in animal health to collect antimicrobial use data for the purposes of supporting medical decision-making and antimicrobial stewardship.\u003c/em\u003e J Am Vet Med Assoc, 2022: \u003cb\u003e260\u003c/b\u003e(8) p. 853\u0026ndash;859.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLau, T.M.M., et al., \u003cem\u003eA systematic review investigating the use of microbiology outcome measures in randomized controlled trials evaluating antimicrobial stewardship interventions published between 2011 and 2021.\u003c/em\u003e JAC Antimicrob Resist, 2022. \u003cb\u003e4\u003c/b\u003e(1): p. dlac013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHardefeldt, L.Y., et al., \u003cem\u003eAntimicrobial stewardship in companion animal practice: an implementation trial in 135 general practice veterinary clinics.\u003c/em\u003e JAC Antimicrob Resist, 2022. \u003cb\u003e4\u003c/b\u003e(1): p. dlac015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdegbite, B.R., et al., \u003cem\u003eKnowledge and perception on antimicrobial resistance and antibiotics prescribing attitude among physicians and nurses in Lambarene region, Gabon: a call for setting-up an antimicrobial stewardship program.\u003c/em\u003e Antimicrob Resist Infect Control, 2022. \u003cb\u003e11\u003c/b\u003e(1): p. 44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMudenda, S., et al., \u003cem\u003eKnowledge, awareness and practices of healthcare workers regarding antimicrobial use, resistance and stewardship in Zambia: a multi-facility cross-sectional study.\u003c/em\u003e JAC Antimicrob Resist, 2024. \u003cb\u003e6\u003c/b\u003e(3): p. dlae076.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. \u003cem\u003eQuadripartite call to action for One Health for a safer world\u003c/em\u003e. 2023; Available from: https://www.who.int/news/item/27-03-2023-quadripartite-call-to-action-for-one-health-for-a-safer-world.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMayito, J., et al., \u003cem\u003eCharacterization of Antibiotic Resistance in Select Tertiary Hospitals in Uganda: An Evaluation of 2020 to 2023 Routine Surveillance Data.\u003c/em\u003e Trop Med Infect Dis, 2024. \u003cb\u003e9\u003c/b\u003e(4) p. 1\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCluver, L., et al., \u003cem\u003ePoverty, AIDS and child health: Identifying highest-risk children in South Africa.\u003c/em\u003e South African medical journal\u0026thinsp;=\u0026thinsp;Suid-Afrikaanse tydskrif vir geneeskunde, 2013. \u003cb\u003e103\u003c/b\u003e(12): p. 910-5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuula, A.S., \u003cem\u003eMy Africa. Poverty, health, disease, and medical journalism.\u003c/em\u003e Croatian medical journal, 2009. \u003cb\u003e50\u003c/b\u003e(6): p. 598-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eHuman Resources for Health Audit Report 2017/18. Ministry of Health (Department of Human Resource Management), Republic of Uganda. 2018.\u003c/em\u003e Available from: http://library.health.go.ug/human-resources-health/human-resources-health-audit-report-201718.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArdillon, A., et al., \u003cem\u003eInappropriate antibiotic prescribing and its determinants among outpatient children in 3 low- and middle-income countries: A multicentric community-based cohort study.\u003c/em\u003e PLoS Med, 2023. \u003cb\u003e20\u003c/b\u003e(6): p. e1004211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNuwematsiko, N., et al. \u003cem\u003eHigh prevalence of inappropriate antibiotic prescriptions in selected health care facilities in Uganda\u003c/em\u003e. Research Square 2024. Available from: https://www.researchsquare.com/article/rs-4442318/v1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan, M. and X. Zhang, \u003cem\u003eImpact of medical professionals on Carbapenem-resistant Pseudomonas aeruginosa: moderating effect of workload based on the panel data in China.\u003c/em\u003e BMC Health Serv Res, 2020. \u003cb\u003e20\u003c/b\u003e(1): p. 670.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Supplementary Material","content":"\u003cp\u003eThe Supplementary Materials file is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Antimicrobial Resistance, Antimicrobial Stewardship, Prescribing Practices, Healthcare Providers, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-6066834/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6066834/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eAntimicrobial resistance (AMR) is a growing global health threat exacerbated by inappropriate antimicrobial prescribing practices. In low- and middle-income countries (LMICs) like Uganda, additional challenges for effective antimicrobial stewardship include limited resources and healthcare infrastructure. This study assessed current antimicrobial prescribing practices and evaluated healthcare providers' knowledge, attitudes, and practices related to antimicrobial stewardship (AMS) in Eastern Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted in healthcare facilities across Eastern Uganda. Data were collected through interviewer administered structured questionnaires.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e240 respondents completed questionnaires from four health facilities in Eastern Uganda. Respondents were 51.5% male, median age 33 years [IQR 28\u0026ndash;38] with 6 years of medical experience [IQR 4\u0026ndash;10]. Clinical Officers constituted 22.5%, Medical Doctors 11.2%, Nurses 40.8%, Pharmacists 4.5%, and other categories accounted for 20.8%. Adherence to national and international guidelines on antibiotic use was suboptimal with a high frequency of broad-spectrum antibiotic prescriptions. 75.4% of the respondents reported the presence of an antibiotic resistance control program within their healthcare facility. Most respondents (83.3%) reported a designated leader for AMS at the facility while 86.7% indicated that Pharmacists lead the programmes at facilities. 92.5% of respondents confirmed that there is a policy in place to guide the appropriate dosage and duration of antibiotic treatments. Overall, 98.8% of respondents believed AMR a significant concern and 62.1% indicated that high workloads negatively affect AMS practices.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study identifies gaps in antimicrobial prescribing in Eastern Uganda, highlighting the need for improved stewardship programs, training, and policy implementation.\u003c/p\u003e","manuscriptTitle":"Antimicrobial stewardship: Knowledge, attitudes and practices of healthcare providers in Eastern Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-11 03:21:57","doi":"10.21203/rs.3.rs-6066834/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-06-19T09:34:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224340561246053545032290649608550509916","date":"2025-06-19T09:14:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-12T05:14:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-10T05:08:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-02-28T11:58:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-28T07:49:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-02-19T20:14:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"99179fc8-493f-49d0-b281-430bad615e55","owner":[],"postedDate":"March 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":45013840,"name":"Health sciences/Diseases"},{"id":45013841,"name":"Health sciences/Health care"},{"id":45013842,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-03-11T03:21:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-11 03:21:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6066834","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6066834","identity":"rs-6066834","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}