Resources and barriers of antimicrobial stewardship interventions in sub-Saharan Africa: a mixed methods research protocol
Bibliographic record
Abstract
Antimicrobial resistance (AMR) is a major threat to global health. The annual number of deaths associated with AMR is estimated to increase to 1.9 million in 2050. The (mis)use of antimicrobials is a major driver for the development of AMR. Antimicrobial stewardship programs, aiming to optimize antimicrobial consumption, have demonstrated to be beneficial in certain settings, not only to reduce antimicrobial resistance, but also to shorten length of hospital stay and decrease economic costs. The core elements of these stewardship programs vary for different settings, but facility-specific treatment recommendations are a priority intervention for hospital programs. Sub-Saharan Africa has a high burden of mortality associated with non-AMR and AMR infections. Therefore, the responsible consumption of antimicrobials is important to optimize patient outcomes and to prevent further development of AMR. The thesis proposes a mixed-methods study protocol to assess information about the availability and agreement of facility-specific treatment guidelines with the WHO AWaRe book and to collect experiences of clinicians using these guidelines. A trial network across sub-Saharan Africa will be used to identify sites. This study will help to obtain comprehensive, in-depth insights into antimicrobial stewardship in sub-Saharan Africa. The proposed study design, explanatory sequential, includes a quantitative strand (on the availability and agreement of guidelines), followed by a qualitative strand (semi-structured interviews). iv A vanguard phase, assessing the feasibility of the proposed study, demonstrated that 78% of sites (7/9) provided a treatment guideline, but only one (11%; 1/9) was a facility-specific document. Items, representing important treatment elements, were extracted in over 50% in 4/7 facilities providing any document. Agreement of the guidelines with the WHO AWaRe book varied across facilities. The limited availability of facility-specific guidelines questions the feasibility of the proposed study as originally planned, and therefore, changes might be necessary to proceed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.044 | 0.030 |
| Meta-epidemiology (narrow) | 0.003 | 0.003 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.006 | 0.003 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.005 | 0.005 |
| Research integrity | 0.005 | 0.007 |
| Insufficient payload (model declined to judge) | 0.052 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".