Introduction

Antimicrobial stewardship (AMS) refers to a wide range of procedures and actions to optimize the most efficient use of antibimicrobials. ^{Reference Malan, Labuschagne, Brechtelsbauer, Goff and Schellack1} Unfortunately, Africa is still lacking the full implementation of AMS programs as many health facilities are yet to adopt the programs as was revealed in a scoping review that assessed the implementation of AMS programs in private healthcare facilities in Africa. The study showed a limited implementation of stewardship programs in the continent. ^{Reference Dlungele and Mathibe2} A study in Nigeria found that only 35% of the hospitals had an official organizational structure and an AMS team. Only 24% have facility-specific therapy recommendations on the hospital-specific AMR patterns. Just two facilities (12%) had explicit procedures for evaluating the appropriateness of prescribed antimicrobials after 48 hours, as well as policies on approval for prescribing them. Just two sites (12%) had antimicrobial susceptibility reports for the prior year accessible, and only one hospital regularly tracked the use of antibiotics. ^{Reference Fadare, Ogunleye and Iliyasu3}

A study in 2021 conducted worldwide found that only 10.8% of hospitals in Africa have AMS programs with reasons given as non-availability of prescription guidelines, low use of laboratory services, and a lack of laboratory capacity. ^{Reference Engler, Meyer, Schellack, Kurdi and Godman4} Some public hospitals in South Africa have never had AMS programs as revealed in a quality study, but the hospitals with AMS programs involved practices like audits and feedback on antimicrobial use, monitoring the consumption of antimicrobials, providing regular antibiogram reports were seen in only 38.5% of public hospitals, but most hospitals (63.6%) requested blood cultures before prescriptions. The study revealed overall stewardship programs in many South African public hospitals increased correct prescriptions of antimicrobials from 10% to 80%. ^{Reference Engler, Meyer, Schellack, Kurdi and Godman4}

AMS activities identified at the facility levels were audits and thorough reviews of prescription charts, ward rounds for AMS, training, and review of prescription policies of antimicrobials. ^{Reference Peters, Sheik, Werner, Davies and Willems5}

Challenges identified in South Africa were lack of specialized personnel, time, inadequate management support, poor training, lack of interest by clinicians, lack of guidelines, and financial constraints in microbiological investigations are some of the reasons for the non-effective execution of stewardship programs. ^{Reference Chetty, Reddy, Ramsamy, Dlamini, Reddy-Naidoo and Essack6}

Other factors that hinder effective AMS implementation across African countries include: indiscriminate antibiotic use due to self-medication and over-the-counter access without prescriptions, ^{Reference Togoobaatar and Ikeda7} weak surveillance systems to track resistance patterns, ^{Reference Gebeyehu and Alemayehu8} and resource constraints; many healthcare facilities lack funding, trained personnel, and diagnostic tools essential for AMS programs. ^{Reference Gebeyehu and Alemayehu8}

Despite these challenges, countries like Kenya, South Africa, and Nigeria have implemented AMS activities aligned with global objectives, ^{Reference Gebeyehu and Alemayehu8} some African hospitals have initiated stewardship programs focusing on improving prescribing practices and reducing unnecessary antibiotic use. ^{Reference Gebeyehu and Alemayehu8} A co-creation consensus approach led to the development of an AMS checklist tailored for sub-Saharan Africa. This checklist defines core AMS elements for healthcare settings in Tanzania, Zambia, Uganda, and Ghana. ^{Reference Essack and Fadare9}

Antimicrobial resistance poses a significant public health challenge in Cameroon, with high rates of multidrug-resistant pathogens reported in human, animal, and environmental sectors. The 2019 systematic review by Founou et al revealed multidrug resistance rates of 45–67% among Escherichia coli, Klebsiella pneumoniae, and Staphylococcus spp., underscoring the need for robust AMS frameworks. ^{Reference Founou, Founou and Essack10}

Cameroon launched its National Action Plan (NAP) in 2018, adopted from the World Health Organization’s (WHO) Global Action Plan on AMR. Six objectives comprises the NAP, five of which directly align with the WHO pillars: improving awareness, strengthening surveillance, reducing infection rates, optimizing antimicrobial use, and promoting sustainable investment in combating AMR. ^{Reference Tajoache, Agwenam, Mamboneh, Ekukole, Charles and van der Sande11,12} Despite these efforts, implementation has faced significant challenges as the absence of a defined funding mechanism for NAP activities affects sustainability and scalability, few hospitals have adequate structures for AMR surveillance, infection prevention and control (IPC) committees, or antibiotic stewardship programs, and stakeholder coordination hinder progress. Creating public awareness about AMR remains insufficiently prioritized within the NAP objectives ^{Reference Tajoache, Agwenam, Mamboneh, Ekukole, Charles and van der Sande11} and limited capacity for antimicrobial susceptibility testing hampers efforts to guide clinical decisions effectively. ¹³ The lack of robust surveillance systems and limited capacity for antimicrobial susceptibility testing hinder the effective implementation of AMS. ¹⁴

Due to the widespread of antimicrobial resistance in our clinical settings, the survey aimed to assess the effectiveness of the implementation of AMS in the Limbe Regional Hospital, Buea regional hospital annex, Baptist hospital Mutengene, Kumba Baptist Health Center in the South West Region of Cameroon to establish the current status of the program.