Establishing and Scaling Antimicrobial Stewardship Programmes In Low- and Middle-Income Countries: Lessons from the Ibadan-Sheffield Antimicrobial Stewardship Partnership Programme

Abstract Corresponding Author Babatunde O. Ogunbosi, MD, Department of Paediatrics, Paediatric Infectious Diseases Unit, University of Ibadan/University College Hospital, Ibadan, Nigeria, +234 802 364 2269, boogunbosi@com.ui.edu.ng Funding This work was supported by the Commonwealth Partnerships for Antimicrobial Stewardship Conflict(s) of Interest Babatunde O. Ogunbosi, no conflict; Chris O. Durojaiye.MD, no conflict; Kayleigh Lehal, no conflict. Background Antimicrobial resistance (AMR), a major global health threat, disproportionately affects low- and middle-income countries (LMICs), especially children and the elderly. Key drivers include antibiotic misuse, limited diagnostics, and weak or absent antimicrobial stewardship programmes (ASP). We report efforts to institutionalise ASP at a tertiary referral hospital in Nigeria and scale-up to sub-national facilities. Methods The Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS), managed by the Global Health Partnerships and Commonwealth Pharmacists Association, and funded by the UK Department of Health and Social Care through the Fleming Fund supported the University College Hospital (UCH), Ibadan, Nigeria – Sheffield Teaching Hospital, NHS Foundation Trust, UK AMS Partnership since 2023. The partnership used bi-directional learning, system strengthening, and contextualized AMS actions to institutionalize ASP at the UCH. Using a hub-and-spoke model, UCH then helped establish ASP at state-level facilities: a children’s hospital and a maternity teaching hospital. Results At baseline, ASP was under-resourced with fragmented plans, weak antimicrobial resistances/use/consumption surveillance, and limited institutional integration. Post intervention, governance structures improved with clear terms of reference and regularly reviewed action plans. Point prevalence surveys and AMR/Consumption surveillance were institutionalised, with the first antibiogram in over two decades used to inform prescribing. Evidence-based treatment guidelines and prescription policies were introduced. Community engagement expanded through One Health AMR activities and student-led initiatives. Lessons from UCH enabled establishment of multidisciplinary ASP at spoke sites, with training, mentorship, and projects addressing prophylactic antibiotic use in newborns. The hub-and-spoke model and learnings were shared with national AMR coordination structures to inform policy and scale-up. Conclusion Health partnerships, contextualized actions, and institutional commitment can institutionalize AMS in LMICs. The hub-and-spoke model proved feasible for scaling ASP and expanding AMR awareness beyond hospital settings. National adoption could accelerate sustainable implementation of Nigeria’s AMR National Action Plan 2.0, and enhance maternal and child health outcomes.