Epidemiology of antimicrobial use in Malawi: a cross-sectional study using World Health Organisation core antimicrobial use indicators in faith-based health facilities

Background : Antimicrobial resistance (AMR) is a major public health threat globally, with a disproportionate burden in sub-Saharan Africa. Faith-based health facilities provide essential healthcare services to underserved populations, yet data on antimicrobial use in these settings remain limited. Aim : To assess antimicrobial use in Christian Health Association of Malawi health facilities using the World Health Organisation core medicine use indicators. Materials and Methods : A multicentre cross-sectional study was conducted in 29 CHAM health facilities across Malawi between January 2024 and June 2025. Data were collected from facility personnel, inpatient prescriptions, and patient interviews and analysed using descriptive and inferential statistics. Results : Average availability of key antimicrobials was 33.1% (95% CI: 29.7-36.4), while customised formularies were available in 64.3% of health facilities. Among 660 prescriptions analysed, 90.3% contained an antimicrobial agent, but only 33.2% adhered to standard treatment guidelines and 43.6% were prescribed using full generic names. Facilities with pharmacy professionals were more likely to have a facility-specific formulary (84.6% vs. 46.7%, p = 0.037). Conclusion : Antimicrobial stewardship gaps remain substantial in faith-based health facilities in Malawi and across sub-Saharan Africa, highlighting the need for targeted stewardship programmes in faith-based health facilities.