A Continental Perspective on Managing Antibiotics: Lessons Derived from Children's Cancer Units in Africa

Abstract Background Antimicrobial stewardship (AMS) in paediatric cancer services optimises antibiotic use to reduce the development of antibiotic resistance. Yet, very little has been published about AMS in African childhood cancer services. This study assessed AMS implementation, identified facilities offering paediatric cancer and AMS services, and gauged staff willingness in Africa to engage in educational programs for immunocompromised children. Methods A web-based, cross-sectional survey was conducted from September to October 2025 and examined healthcare professionals' knowledge, attitudes, and practices regarding AMS in paediatric oncology services across Africa. Quantitative and qualitative analyses were done using a Microsoft Excel Workbook (.xlsx), version 16.78 (23100802), licensed in 2019. Results The survey received 94 responses from 32 (59%) African countries; of which 80 (85%) were included in the final sample after removing duplicate institution responses. Sixty-five (81%) health facilities provided paediatric oncology services. Among these, 42 (65%) have AMS programs. Support was provided by health facility leadership for the AMS programs in 37/42 (88%) facilities. This included hospital leaders involved in implementing appropriate antimicrobial use initiatives as part of their broader health programs. Additionally, 30/42 (71%) facilities integrated AMS activities into their reporting to national AMS committees, and 29/42 (69%) facilities designated AMS champions. The evaluation of healthcare professionals' accountability within the AMS program in paediatric cancer services demonstrated that 36/42 (86%) of the facilities have a designated AMS committee. Whereby, 24/42 (57%) health facilities provided antimicrobial susceptibility testing services, and 19/42 (45%) had antibiograms specific to paediatric cancer units. Regarding healthcare professionals' willingness to participate in the AMS course, 58 (73%) of healthcare professionals from 80 health facilities across Africa have expressed their willingness to participate in the AMS training focused on immunocompromised paediatric patients. Conclusion In Africa, paediatric oncology services have limited access to AMS programs for effective antibiotic management. Professionals rely on standardised international guidelines due to a lack of institutional antibiograms and training programs, underscoring the need for more educational resources. Many health facilities also lack familiarity with integrating AMS into paediatric cancer care.