Antimicrobial stewardship is one of the strategic objectives of the WHO global action plan on antimicrobial resistance. This paper sought to review the extent of implementation of antimicrobial stewardship programmes (ASPs) in African countries and the reported outcomes. We searched five electronic databases, including PubMed, Scopus, Cochrane library, African Journal Online, CINAHL and Google scholar for papers published between 1990 and March 2019. We combined the names of countries in the five regions of Africa with antimicrobial stewardship terms. Studies of any design, employing any stewardship strategies were included. The quality of included studies was assessed using the National Heart, Lung and Blood Institute (NHLBI) quality assessment tool for before and after studies. Of 1752 titles identified, 13 studies met the criteria for inclusion. Seven of the studies were conducted in South Africa, three in Kenya and one each in Sudan, Tanzania and Egypt. Eleven studies were of high quality with low risk of bias. The included studies mainly assessed the outcome using process measures and these were associated with improved compliance with antibiotic guidelines, appropriateness of prescribing, reduction in antibiotic use and cost savings. Decrease in rate of surgical site infections and nonsignificant change in mortality and 30-day readmission rate were reported in two studies respectively. Findings of this review show the paucity of data on implementation of ASPs in African countries. Although the continent is faced with challenges which impact on effective implementation of ASPs, the successes reported in the included studies show that other African countries can implement these programmes.

Pharmacists are critical for attaining the goal of universal health coverage and equitable access to essential health services, particularly in relation to access to medicines and medicines expertise. We describe an analysis of the pharmacy workforce in Nigeria from 2011 to 2016 in order to gain insight on capacity and to inform pharmacy workforce planning and policy development in the country. The study was conducted using census data obtained from the Pharmacists Council of Nigeria (PCN) via a validated data collection tool. The statistical methods used for analysis were descriptive (frequencies, percentages, mean) and linear regression. Secondary data on population distribution per state was obtained from the Federal Bureau of Statistics and the National Population Commission (NPC) of Nigeria. The data showed 21,892 registered pharmacists with only 59% (n = 12,807) in active professional practice. There are also more male (62%) compared to female pharmacists while 42% of the licensed workforce with known area of practice are in community practice followed by hospital pharmacy (11%). A rise in number of pharmacists (0.53–0.66) and new pharmacy graduates per year (0.062–0.083) per 10,000 population was observed over the five years analysed; however the overall density remains significantly low. Pharmacists’ density also varied considerably between states (Median = 0.39; Min - Max: 0.05–4.3). Regionally, more than a third (~ 40%) of the licensed workforce and community pharmacies are situated in the South West region with fewer than 10% of the total in the North East and North West regions combined. A steady decline in number of pharmacists requesting a “letter of good standing” from PCN, a proxy measure of intent to migrate was also observed. The data indicate ongoing deficits in availability and supply of pharmacists in the country with widespread variance in distribution observed across the 36 states and the Federal Capital Territory (FCT). The findings suggest that observed deficits are not solely related to out-migration and highlights the need for policies that will promote increased within-country availability, equitable distribution and retention, especially in the underserved regions of North East and North West of Nigeria.

Objectives: About 18% of urban households in Nigeria depend on packaged sachet water as the primary source of drinking water. This review assessed microbial contamination of these products with an emphasis on total coliforms and the faecal indicator bacteria (FIB) – Escherichia coli (E. coli) and thermotolerant coliforms (TTC).Methods: PubMed/Medline, African Index Medicus, AfroLib, Global Health Library, Embase and the ISI Web of Science databases were searched to identify original research published up to October 2020. The literature findings were synthesised narratively in line with the review objectives. To assess prevalence of microbial contamination, a random effects meta‐analysis, was also conducted using the R metafor package in RStudio. The protocol for this review is registered on PROSPERO with reference number CRD 42019128474.Results: Fifty‐two of 429 studies were identified for inclusion. At 53.27%, contamination prevalence was higher for total coliforms (95% CI: 39.05–66.98, I² = 81%, p < 0.01, 42 studies) than FIB (12.38%, 95% CI: 7.92–18.85, I² = 61%, p < 0.01, 33 studies) suggesting that treatment failure is a major contributor to the poor microbial quality reported in the included studies. Within the FIB group, the prevalence of contamination with E. coli was 13.30% (95% CI: 8.23–20.80, I² = 65%, p < 0.01, 27 studies) versus 6.24% (95% CI: 1.12–28.06, I² = 72%, p < 0.01, six studies) for TTCs. Other microbial contaminants reported were Pseudomonas aeruginosa, Klebsiella and Enterococcus faecalis and these showed multidrug antibiotic resistance.Conclusions: The findings of this review highlight the need for improved regulatory oversight with more stringent monitoring of the microbial quality of sachet water products in Nigeria.

Background: Studies have indicated that a generalisable and translatable global framework is a useful tool for supporting career progression and recognising advanced practice. Aim: To develop and validate a global advanced competency development framework as a tool to advance the pharmacy profession globally. Method: A four-stage multi-methods approach was adopted. In sequence, this comprised an assessment of initial content and a cultural validation of the advanced level framework. Following this, we conducted a transnational modified Delphi followed by an online survey sampling the global pharmacy leadership community. Finally, a series of case studies was constructed exemplifying the framework implementation. Results: Initial validation resulted in a modified draft competency framework comprising 34 developmental competencies across six clusters. Each competency has three phases of advancement to support practitioner progression. The modified Delphi stage provided feedback on framework modifications related to cultural issues, including missing competencies and framework comprehensiveness. External engagement and case study stages provided further validity on the framework implementation and dissemination. Conclusion: The four-staged approach demonstrated transnational validation of a global advanced competency framework as a mapping and development tool for the pharmacy professions. Further study is needed to develop a global glossary of terminologies on advanced and specialist practice. Also, developing an accompanying professional recognition system and education and training programmes to support framework implementation is recommended.