Health professional and facility engagement in antimicrobial resistance prevention and containment strategic initiatives at public hospitals in Southern Ethiopia: facility-based cross-sectional study.

Objective: Antimicrobial resistance (AMR) threatens millions of lives and poses significant health, economic and development challenges. Policies implemented to prevent and contain AMR should address it through a One Health Approach. This study assessed health professional and facility engagement in Southern Ethiopia's AMR prevention and containment strategic initiatives and associated factors.

Design: A hospital-based cross-sectional study was conducted among 634 health professionals.

Settings: Five randomly selected public hospitals from three (Gofa, Gamo and South Omo) zones.

Participants: Health professionals working in the outpatient department in the randomly selected hospitals.

Outcome measure: Health professional and facility engagement in AMR prevention and containment strategies. A binary logistic regression model was used to evaluate the association between the explanatory variables (socio-demographic characteristics, institutional and professional factors) and dependent variables (professional engagement in AMR PCSIs). To avoid many variables and unstable estimates and control possible confounders in the subsequent model, only variables that reached a p value less than 0.25 at binary analysis were used in the multivariate logistic regression analysis to identify factors independently associated with health professional and facility engagement level in AMR prevention and containment strategies.

Result: This study included 634 participants (56.5% males). Among these professionals, the vast majority (n=444, 70.0%) were aware of the One Health perspective on AMR. Concerning health facility engagement in AMR PCSIs, about one-third (n=203; 32.0%) of professionals reported full engagement in the facilities. Nearly one-fourth of professionals (n=169; 26.7%) reported including AMR prevention and containment procedures in their facility's annual plan. The overall health professional and facility engagement in AMR PCSIs was 412 (65.0%). Having a history of sharp injury (adjusted odds ratio (AOR)=1.88 (1.19, 2.97; p=0.007)), working in a general hospital (AOR=3.746 (2.657, 5.282; p=0.000)), having good knowledge on healthcare waste management (AOR=1.99 (1.225, 3.258; p=0.006)) and being from a facility that included AMR prevention and containment in the annual plan (AOR=3.796 (2.01, 7.180; p=0.000)) were positively and independently associated with the dependent variable (professional engagement in AMR PCSIs). However, a working experience of 6-10 years (AOR=0.6 (0.32, 0.96, p<0.05)), receiving infection prevention control training (AOR=1.47 (1.02, 2.13, p=0.041)) and lack of adequate knowledge on One Health approach (AOR=0.50 (0.32, 0.79; p=0.003)) were negatively associated with professional and facility engagement in AMR PCSIs.

Conclusion: In the study area, professional and facility engagement in AMR PCSIs was low. Providing training on infection prevention and control, healthcare waste handling, One Health approach, antimicrobial stewardship for all and disseminating national strategic initiatives to all levels in the healthcare system are important. Researchers willing to work in similar areas must use mixed-method study designs to evaluate the engagement of all (human, animal and environmental) stakeholders toward AMR PCSIs.