Background: Antimicrobial stewardship (AMS) programs optimize the use of antimicrobials and reduce antimicrobial resistance (AMR). This study evaluated the implementation of AMS programs in Africa using a harmonized regional approach. Methods: This was an exploratory cross-sectional study across five countries involving 32 hospitals using an adapted Periodic National and Hospitals Assessment Tool from the World Health Organization (WHO) policy guidance on integrated AMS activities in human health. Results: This study found baseline scores for AMS core elements ranging from 34% to 79% at the baseline which improved to 58% to 92% at the endline. At baseline, Drugs and Therapeutics Committee (DTC) functionality in updating facility-specific medicines and medical devices ranged from 58% to 100%, and this ranged from 79 to 100% at endline. Classifying antibiotics by WHO AWaRe, classification ranged from 33% to 83% at baseline and 64% to 100% at endline. Leadership commitment scores were 47% at baseline and 66% at endline. Education and training scores were 42% and 63% at baseline and endline, respectively. Reporting and feedback scores were 34% at baseline and 58% at endline. Conclusions: Our study showed that understanding context and standardizing regional stewardship approaches enhanced cross-country learning and improved AMS implementation. Although the challenges in Low- and Middle-Income Countries (LMICs) are similar, they vary by country and can be addressed by strengthening AMS regulatory frameworks and surveillance systems.

Antimicrobial resistance (AMR) is a major public health threat linked to increased morbidity and mortality. It has the potential to return us to the pre-antibiotic era. Antimicrobial stewardship (AMS) programs are recognized as a key intervention to improve antimicrobial use and combat AMR. However, implementation of AMS remains limited in Africa, particularly in Rwanda. This study aimed to assess prescription practices, identify areas for improvement, and promote adherence to AMS principles. Conducted at King Faisal Hospital in Rwanda, this qualitative study used semi-structured interviews with eight participants until saturation was reached. The interviews were recorded, transcribed, and thematically analyzed, revealing four emerging themes. The first theme was on AMS activities that were working well based on availability of microbiology laboratory results and prescription guidelines as factors influencing antibiotic prescription adjustments. The second theme was related to challenges during the implementation of the AMS program, including the prescription of broad-spectrum antibiotics, limited local data on AMR patterns, and stock-outs of essential antibiotics. The third theme was on the importance of adhering to AMR management guidelines at KFH. The last emerged on recommendations from participants centered on regular training for healthcare workers, widespread dissemination of AMR findings across departments, and the enforcement of antibiotic restriction policies. These actions can improve prescription behaviors, upholding the highest standards of patient care, and strengthening the nascent AMS program.

Background: The burden of bacterial bloodstream infections (BSIs) is rapidly increasing in Africa including Rwanda. Methods: This is a retrospective study that investigates the diversity, distribution, and antimicrobial susceptibility profiles of BSI bacteria in three tertiary referral hospitals in Rwanda between 2020 and 2022. Results: A total of 1532 blood culture tests were performed for visiting patients. Overall, the proportions of Gram-negative and Gram-positive bacteria were 48.2% and 51.8, respectively. Staphylococcus aureus was the predominant species accounting for 25% of all Gram-positive BSI species, and Klebsiella species represented 41% of all Gram-negative BSI species. Antimicrobial susceptibility testing revealed that Amikacin exhibited the highest activity against Enterobacter spp., Serratia spp., and Escherichia coli in >92% of cases and Klebsiella spp. in 75.7%. Meropenem and Imipenem were highly efficacious to Salmonella spp. (100% susceptibility), Enterobacter spp. (96.2% and 91.7%, respectively), and Escherichia coli (94.7% and 95.5%, respectively). The susceptibility of Enterococcus spp., S. aureus, and Streptococcus spp. to Vancomycin was 100%, 99.5%, and 97.1%, respectively. Klebsiella spp. was highly sensitive to Colistin (98.7%), Polymyxin B (85.6%), Imipenem (84.9%), and Meropenem (78.5%). Conclusions: We recommend strengthening the implementation of integrated transdisciplinary and multisectoral One Health including AMR stewardship for the surveillance, prevention, and control of AMR in Rwanda.

Background: Antimicrobial stewardship (AMS) programs optimize use of antimicrobi-als and reduce antimicrobial resistance (AMR). This study evaluated implementation of AMS programs in Africa using a harmonized regional approach. Methods: This was an exploratory cross-sectional study across five countries involving 32 hospitals using adapted Periodic National and Hospitals Assessment Tool in WHO policy guidance on integrated AMS activities in human health. Results: This study found baseline scores for AMS core elements ranging from 34% to 79% and improved to 58% to 92% at the end line. At baseline, DTC functionality in updating facility-specific medicines and medical devices ranged from 58% to 100% and ranged from 79 to 100% at endline. Classifying antibiotics by WHO AWaRe classification ranged from 33% to 83% at baseline and 64% to 100% at endline. Leadership commitment scores were 47% at baseline and 66% at endline. Education and training scores were 42% and 63% at baseline and end-line respectively. Reporting and feedback was 34% at baseline and 58% at endline. Conclusions: Our study showed that understanding context and standardizing regional stewardship approaches enhanced cross-country learning and improved AMS implementation. Although challenges in LMICs are similar, they vary by country and can be addressed by strengthening AMS regulatory frameworks and surveillance systems.

Introduction: Detection of podoconiosis is essential to prevent disability, but diagnostic challenges mean it often goes unnoticed in Rwanda, leading to irreversible harm and social stigma. Methods: This study evaluates the diagnostic performance of the WHO Skin-NTD mobile application and a clinical algorithm implemented by trained community health workers (CHWs) in detecting podoconiosis in endemic communities comparing them with dermatological reports as the clinical reference standard method. Results: Both the WHO Skin-NTD mobile application and the clinical algorithm demonstrated high diagnostic performance for podoconiosis, with different proportion classified positive estimates (66.3% and 71.4% respectively). The mobile application showed a sensitivity of 89.8% (83.4%–94.3%) and specificity of 88.1% (77.1%–95.1%), while the clinical algorithm demonstrated a sensitivity of 96.4% (91.7%–98.8%) and specificity of 86.4% (75.0%–94.0%). Overall diagnostic accuracy was high for both approaches, with Sensitivity + Specificity/2of 0.89 (0.84–0.94) for the mobile application and 0.91 (0.87–0.96) for the clinical algorithm. Conclusion: Both the WHO Skin-NTD mobile application and the clinical algorithm demonstrated high diagnostic performance for detection of podoconiosis by CHWs in Rwanda. However, their use should be guided by context-specific resource availability rather than simultaneous deployment. The clinical algorithm is particularly suitable for low-resource and offline settings, while the mobile application offers added value in settings with digital infrastructure through standardized decision support and enhanced data management. A flexible, context-dependent approach to implementation may optimize case detection and support podoconiosis control efforts in endemic settings.

Background: Point-of-care (POC) diagnostics could improve timely diagnosis of skin neglected tropical diseases (skin NTDs) in settings with limited access to laboratory services. However, evidence on their diagnostic performance, operational feasibility and readiness for decentralized implementation remains fragmented. Methods: We systematically searched PubMed, Web of Science, Google Scholar, and grey literature sources for studies evaluating POC diagnostic technologies for skin NTDs. Diagnostic performance, evidence maturity and operational characteristics were synthesized narratively because of heterogeneity across technologies, populations, reference standards, and reported outcomes. Diagnostic-accuracy studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Results: A short summary of the article’s main findings. Conclusions: POC diagnostics for skin NTDs show promising technological development but uneven evidence of maturity. Molecular technologies have generally progressed further in analytical development than in clinical and field validation, while simpler rapid tests have greater field experience but variable performance. Future research should prioritize prospective clinical and implementation-focused evaluation of complete diagnostic workflows in representative endemic settings.