Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing isolates at the MZRH laboratory, and (d) a survey of antimicrobial availability at community pharmacies in the city. Results: 91% of physicians believe antimicrobial resistance is problem in Tanzania, although only 29% of physicians were familiar with the term “antimicrobial stewardship”. Escherichia coli isolates had resistance rates of over 60% to the commonly used agents ciprofloxacin, trimethoprim-sulfamethoxazole, and ceftriaxone. Thirteen out of 14 community pharmacies offered over-the-counter antibiotics for upper respiratory symptoms. Conclusions: International antimicrobial stewardship collaborations can successfully identify opportunities and needs. Evaluating the team’s efforts to improve patient outcomes will be essential.

Purpose. This exploratory qualitative study aimed to analyze the experiences of healthcare providers (HCPs) in pharmacovigilance (PV) and ADR reporting in the southern highland zone of Tanzania. Methods. In 2022, an exploratory qualitative case study using in-depth interviews (IDIs) was conducted to explore the experiences of PV and ADR reporting among HCPs (doctors, nurses, and pharmacists). The study was carried out in a zonal referral hospital and a regional referral hospital of the Tanzanian southern highlands zone. Inductive-deductive thematic analysis was adopted for data analysis. Results. Participants demonstrated adequate knowledge of PV and its related activities including ADR reporting. Knowing the interactions and wrong medication dosage as sources of ADR, signs, and symptoms, stopping the drug, and treating the symptoms following ADR emerged as subthemes linked with adequate knowledge in identifying and managing ADR. Participants perceived reporting ADR as laborious, posing a subjective burden and that not all ADRs needed to be reported. The latter contributed to limited participation in ADR reporting despite that participants were conversant with both physical and online ADR reporting platforms. Conclusion. Although HCPs are well informed about PV and ADR reporting including the benefits to public health, their involvement in ADR reporting is low. In addition to the ongoing on-the-job training and regular supportive supervision for HCPs to improve the ADR practice, there is still a need to explore other strategies to be used as motives for HCPs to report ADR regularly.

Antimicrobial resistance is a growing concern in sub-Saharan Africa, and antimicrobial stewardship (AMS) programs have not been widely implemented in this region. We evaluated antibiotic prescribing patterns and concordance with national guidelines at Mbeya Zonal Referral Hospital (MZRH) in Tanzania. Adult inpatient medical records were chronologically reviewed from January 1, 2018 until 100 records documenting antibiotic therapy were evaluated. The primary endpoint was concordance with national guidelines for indication-based antibiotic selection and duration. Data were summarized using descriptive statistics. Overall, 155 records with sufficient data were reviewed. The 100 records which involved antibiotic therapy represented 171 unique antibiotic courses. The most common indication for antibiotics was bacterial pneumonia. Ceftriaxone and metronidazole, the most commonly used antibiotics, were administered in 40% and 24% of courses, respectively. Indication-based antibiotic selection was concordant with national guidelines in 63% of courses, but this fell to 15% when course duration was taken into account. Antibiotic courses were completed as prescribed 28% of the time among evaluable courses. A microbiologic culture of any kind was obtained in 17% of patients. In conclusion, antibiotic therapy was often incomplete, was generally guideline discordant, exhibited limited diversity of selection, and frequently lacked diagnostic confirmation. These data, combined with local susceptibility patterns, may be used to foster AMS efforts for improved compliance with guidelines at MZRH in the future.

Purpose. This study assessed the awareness, actions, and predictors of actions on adverse drug reaction reporting among patients attending a referral hospital in southern highland Tanzania. Methods. A hospital-based cross-sectional study was conducted from January to August 2022 at Mbeya Zonal Referral Hospital (MZRH) in Mbeya, Tanzania. A total of 792 adult patients with chronic conditions attending outpatient clinics at MZRH were recruited consecutively. A semistructured questionnaire was used to collect demographic characteristics, ADR awareness, and actions when encountering ADR. Data were analyzed using the statistical package for social sciences (SPSS) version 23 and results are summarized using frequency and percentages. Binary logistic regression was used to assess the predictors associated with reporting ADR among patients. $P$ value ≤0.05 was considered statistically significant. Results. Out of 792, 397 (50.1%) were males and 383 (48.6%) had a primary education level. Only 171 (21.6%) participants previously experienced ADR, and 111 (14.1%) were aware that ADR is an unexpected harm that occurs after medication use. The majority 597 (70.3%) of the participants said will report ADR to healthcare providers, 706 (88.9%) prefer reporting ADR to healthcare providers, and 558 (69.1%) said patients are not aware of the importance of reporting ADR. Patients aged below 65 years of age, unemployed ((AOR (95% CI) = 0.4 (0.18–0.87), self-employed ((AOR (95% CI) = 0.5 (0.32–0.83)), and those who ever encountered ADR ((AOR (95% CI) = 0.1 (0.05–0.11)) were more likely to report the ADR to HCPs compared to the rest. Conclusions. The majority of patients are not aware of what is ADR and the importance of ADR reporting. Most of the patients prefer to report ADR to healthcare providers. We recommend an awareness campaign to raise awareness of the patients on ADR and other methods of ADR reporting.