Implementing AMR surveillance at a tertiary hospital in a low-income country: results from the Surveillance Partnership to Improve Data for Action on AMR (SPIDAAR) in Malawi
- 1Queen Elizabeth Central Hospital, Ministry of Health and Sanitation
- 2Lilongwe Water Board
- 3Department of Microbiology, Kamuzu University of Health Sciences
Abstract
Background Antimicrobial resistance (AMR) is a growing global health threat, particularly in low- and middle-income countries (LMICs) where infectious diseases are more prevalent. Effective surveillance in these settings is key for tracking resistance trends and informing public health interventions, yet few implementation studies have delineated the particular challenges and opportunities for antimicrobial stewardship (AMS) activities in LMICs. The objective of this study was to evaluate the impact of a multi-component AMR surveillance capacity-building intervention on institutional surveillance capacity, healthcare worker knowledge and practices, and antimicrobial prescribing patterns at a tertiary referral hospital in Malawi. Methods The study was conducted at Queen Elizabeth Central Hospital (QECH), a large tertiary hospital in southern Malawi. QECH was one of four sites participating in the Surveillance Partnership to Improve Data for Action on AMR (SPIDAAR), a multi-component capacity-building initiative supported by Pfizer Inc. and the Wellcome Trust, implemented over a 3-year period. The impact of this intervention on AMS practices and AMR surveillance capacity at this site was evaluated using a quasi-experimental approach including healthcare worker assessments and patient file reviews. Results A total of 263 and 248 healthcare workers were surveyed at baseline and intervention end period, respectively. 100 patient file reviews were conducted in parallel with the surveys at baseline and end of intervention. There were demonstrable improvements in AMR surveillance across the multiple domains of interest, including clinical assessment, microbiology processes, and data management. Knowledge of the national AMR action plan (NAP) improved from 13.6% to 45.6%, and laboratory request form completeness increased from 48.6% to 73.9%. Empirical antimicrobial prescribing at admission did not change significantly. The persistent gap between self-reported and observed clinical practices highlighted an enduring knowledge-practice challenge. Conclusion A structured, multi-component AMR surveillance intervention can achieve meaningful improvements in surveillance capacity and healthcare worker knowledge in a tertiary hospital in a low-income country setting. Progress was facilitated by national policy alignment and hospital leadership engagement, and constrained by the absence of integrated electronic data systems and a persistent gap between AMS knowledge and clinical practice. These findings have relevance for similar LMIC settings seeking to strengthen AMR surveillance capacity.
Related
- Antimicrobial resistance of bacteria isolated from blood cultures at a tertiary hospital in Papua New Guinea: implications for antimicrobial stewardship and surveillance
- Laboratory-based surveillance of antimicrobial non-susceptibility in Enterobacter species over 12 years at a tertiary-care hospital in Saudi Arabia
- Factors associated with microbiological non-compliance in ready-to-eat foods: A seven-year analysis of official food safety surveillance data in a tropical low- and middle-income country
- Knowledge and attitudes toward antimicrobial stewardship and the WHO AWaRe antibiotic classification among healthcare professionals at a tertiary hospital in Ethiopia
- Genomic epidemiology of dual carbapenemase-producing Klebsiella pneumoniae and identification of an ST23-KL1 blaKPC-2/blaIMP-4 co-producing isolate in a Chinese tertiary hospital
BibTeX
@article{matemvu2026implementing,
title = {{Implementing AMR surveillance at a tertiary hospital in a low-income country: results from the Surveillance Partnership to Improve Data for Action on AMR (SPIDAAR) in Malawi}},
author = {Zaithwa Matemvu and Patrick Kamalo and Tinenenji Makhambera and Christina Mwinjiwa and Eltas Dziwani and Ethwako Mlia-Phiri and Karen Precious Leman and Edward Filipo and Tanaka Walter and Mphatso Mapiri and Chikumbutso Clara Mpanga and David Kulapani},
journal = {Antimicrobial Resistance and Infection Control},
year = {2026},
month = jul,
doi = {10.1186/s13756-026-01787-8},
url = {https://doi.org/10.1186/s13756-026-01787-8},
note = {CC BY},
}
RIS
TY - JOUR
TI - Implementing AMR surveillance at a tertiary hospital in a low-income country: results from the Surveillance Partnership to Improve Data for Action on AMR (SPIDAAR) in Malawi
AU - Zaithwa Matemvu
AU - Patrick Kamalo
AU - Tinenenji Makhambera
AU - Christina Mwinjiwa
AU - Eltas Dziwani
AU - Ethwako Mlia-Phiri
AU - Karen Precious Leman
AU - Edward Filipo
AU - Tanaka Walter
AU - Mphatso Mapiri
AU - Chikumbutso Clara Mpanga
AU - David Kulapani
PY - 2026
DA - 2026/07/01
JO - Antimicrobial Resistance and Infection Control
DO - 10.1186/s13756-026-01787-8
UR - https://doi.org/10.1186/s13756-026-01787-8
AB - Background Antimicrobial resistance (AMR) is a growing global health threat, particularly in low- and middle-income countries (LMICs) where infectious diseases are more prevalent. Effective surveillance in these settings is key for tracking resistance trends and informing public health interventions, yet few implementation studies have delineated the particular challenges and opportunities for antimicrobial stewardship (AMS) activities in LMICs. The objective of this study was to evaluate the impact of a multi-component AMR surveillance capacity-building intervention on institutional surveillance capacity, healthcare worker knowledge and practices, and antimicrobial prescribing patterns at a tertiary referral hospital in Malawi. Methods The study was conducted at Queen Elizabeth Central Hospital (QECH), a large tertiary hospital in southern Malawi. QECH was one of four sites participating in the Surveillance Partnership to Improve Data for Action on AMR (SPIDAAR), a multi-component capacity-building initiative supported by Pfizer Inc. and the Wellcome Trust, implemented over a 3-year period. The impact of this intervention on AMS practices and AMR surveillance capacity at this site was evaluated using a quasi-experimental approach including healthcare worker assessments and patient file reviews. Results A total of 263 and 248 healthcare workers were surveyed at baseline and intervention end period, respectively. 100 patient file reviews were conducted in parallel with the surveys at baseline and end of intervention. There were demonstrable improvements in AMR surveillance across the multiple domains of interest, including clinical assessment, microbiology processes, and data management. Knowledge of the national AMR action plan (NAP) improved from 13.6% to 45.6%, and laboratory request form completeness increased from 48.6% to 73.9%. Empirical antimicrobial prescribing at admission did not change significantly. The persistent gap between self-reported and observed clinical practices highlighted an enduring knowledge-practice challenge. Conclusion A structured, multi-component AMR surveillance intervention can achieve meaningful improvements in surveillance capacity and healthcare worker knowledge in a tertiary hospital in a low-income country setting. Progress was facilitated by national policy alignment and hospital leadership engagement, and constrained by the absence of integrated electronic data systems and a persistent gap between AMS knowledge and clinical practice. These findings have relevance for similar LMIC settings seeking to strengthen AMR surveillance capacity.
SN - 2047-2994
ER -