Assessing Antimicrobial Use Patterns in Christian Health Association of Malawi (CHAM) Health Facilities: A Cross-Sectional Study Protocol

IntroductionThe threat of antimicrobial resistance (AMR) in Malawi is high with reported mortality of 19,300 annually, the 23rd highest age-standardised mortality. One of the drivers of AMR is misuse of antibiotics, a phenomenon that has not been adequately researched in Malawi. This study aims to investigate antimicrobial use patterns using prescribing, patient and facility indicators Christian Health Association of Malawi (CHAM) health facilities. MethodsThis will be a multiple cross-sectional study which will collect data from facility (194), patients (388), and prescriptions (3,104). Data will be collected using KoboToolbox v2021, and exported into Microsoft Excel version 2016 for cleaning and coding. Variables will be categorized according to the antimicrobial use indicators. The study will use STATA Version 14 statistical software for data analysis. Subsequently, facilities will be put in GPS map to show hotspots of irrational antimicrobial use. The study will run from January 2024 to December 2025. DiscussionThis study will provide detailed information on frequently used antimicrobials, the cost of antimicrobials relative to medicine budget, the intensity of exposure to antimicrobials, the availability of antimicrobials, patients understanding of antimicrobials use, and availability of important documents for antimicrobial use. Secondarily, the study will unravel the prevalence of irrational antimicrobial use, the main factors contributing to it, and location where irrational use is most prevalent. These findings will inform the national antimicrobial stewardship action plan, aiming to safeguard the available antimicrobials. Ethics and DisseminationThe protocol has been approved by Malawis College of Medicine Research Ethics Committee (COMREC) [Protocol # P.04/24-0651]. Participation in the study will be voluntary, and consent and assent will be sought during data collection. Data will be handled confidentially, with findings disseminated in conferences, to key AMR focused stakeholders, and finally through manuscript publication in a peer reviewed journal.