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Viral Infections and Outbreaks Research / Data Driven Disease Surveillance · Journal article
Antimicrobial Resistance and Infection Control · July 27, 2026
Encouraging direction, but not yet definitive.
A 3-year multi-component AMR surveillance capacity-building intervention at a tertiary hospital in Malawi produced measurable improvements in surveillance knowledge and processes (NAP knowledge 13.6% to 45.6%, laboratory form completeness 48.6% to 73.9%), but did not significantly alter empirical prescribing practices. The study demonstrates feasibility and value of structured AMR surveillance implementation in low-income settings, though effectiveness is limited by persistent knowledge-practice gaps and lack of electronic data integration.
Quasi-experimental, pre-post assessment without concurrent control group. Healthcare workers and patients at Queen Elizabeth Central Hospital (QECH), a large tertiary referral hospital in southern Malawi. Specific eligibility criteria for healthcare workers and patient file selection are not described.. Intervention: Multi-component AMR surveillance capacity-building intervention delivered over 3 years, supported by Pfizer Inc. and the Wellcome Trust. Specific components are not detailed in the source text.. Compared with: Baseline performance at the same institution prior to intervention; no concurrent control group. Queen Elizabeth Central Hospital, southern Malawi. QECH was one of four sites in the SPIDAAR multi-site initiative..
Knowledge of national AMR action plan improved from 13.6% to 45.6% Laboratory request form completeness increased from 48.6% to 73.9% Empirical antimicrobial prescribing at admission did not change significantly
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians and policy-makers in low-income countries should recognize that structured AMR surveillance capacity-building can improve institutional processes and knowledge, but implementation must address the persistent gap between stated knowledge and actual clinical practice to affect prescribing behaviour. Success depends on national policy alignment, leadership engagement, and integration of electronic data systems.
A quasi-experimental implementation study with pre-post assessments showing meaningful improvements in AMR surveillance knowledge and processes, but limited by absence of a control group, surrogate endpoints (knowledge and form completeness rather than clinical outcomes), and lack of significant change in prescribing behaviour.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and policy-makers in low-income countries should recognize that structured AMR surveillance capacity-building can improve institutional processes and knowledge, but implementation must address the persistent gap between stated knowledge and actual clinical practice to affect prescribing behaviour. Success depends on national policy alignment, leadership engagement, and integration of electronic data systems.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Antimicrobial resistance (AMR) is a growing global health threat, particularly in low- and middle-income countries (LMICs) where infectious diseases are more prevalent. Effective surveillance in these settings is key for tracking resistance trends and informing public health interventions, yet few implementation studies have delineated the particular challenges and opportunities for antimicrobial stewardship (AMS) activities in LMICs. The objective of this study was to evaluate the impact of a multi-component AMR surveillance capacity-building intervention on institutional surveillance capacity, healthcare worker knowledge and practices, and antimicrobial prescribing patterns at a tertiary referral hospital in Malawi. The study was conducted at Queen Elizabeth Central Hospital (QECH), a large tertiary hospital in southern Malawi. QECH was one of four sites participating in the Surveillance Partnership to Improve Data for Action on AMR (SPIDAAR), a multi-component capacity-building initiative supported by Pfizer Inc. and the Wellcome Trust, implemented over a 3-year period. The impact of this intervention on AMS practices and AMR surveillance capacity at this site was evaluated using a quasi-experimental approach including healthcare worker assessments and patient file reviews. A total of 263 and 248 healthcare workers were surveyed at baseline and intervention end period, respectively. 100 patient file reviews were conducted in parallel with the surveys at baseline and end of intervention. There were demonstrable improvements in AMR surveillance across the multiple domains of interest, including clinical assessment, microbiology processes, and data management. Knowledge of the national AMR action plan (NAP) improved from 13.6% to 45.6%, and laboratory request form completeness increased from 48.6% to 73.9%. Empirical antimicrobial prescribing at admission did not change significantly. The persistent gap between self-reported and observed clinical practices highlighted an enduring knowledge-practice challenge. A structured, multi-component AMR surveillance intervention can achieve meaningful improvements in surveillance capacity and healthcare worker knowledge in a tertiary hospital in a low-income country setting. Progress was facilitated by national policy alignment and hospital leadership engagement, and constrained by the absence of integrated electronic data systems and a persistent gap between AMS knowledge and clinical practice. These findings have relevance for similar LMIC settings seeking to strengthen AMR surveillance capacity.
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