Table 4.
Barriers to implementation of AMS
| n (%) | ||||
|---|---|---|---|---|
| High-income countries (n = 80) | Low- and middle-income countries (n = 163) | Total (n = 243) | p-value* (α = 0.0026) | |
| Lack of time to perform AMS activities | 50 (62.5) | 78 (47.9) | 128 (52.7) | 0.044 |
| Lack of knowledge on good prescribing practices | 28 (35.0) | 74 (45.4) | 102 (42.0) | 0.160 |
| Lack of funding for AMS programme | 41 (51.3) | 56 (34.4) | 97 (39.9) | 0.017 |
| Lack of cooperation from prescribers | 21 (26.3) | 67 (41.1) | 88 (36.2) | 0.034 |
| Lack of information technology | 37 (46.3) | 36 (22.1) | 73 (30.0) | < 0.001 |
| Unavailability of prescribing guidelines | 6 (7.5) | 58 (35.6) | 64 (26.3) | < 0.001 |
| Lack of qualified personnel | 13 (16.3) | 44 (27.0) | 57 (23.5) | 0.090 |
| Lack of support from hospital management | 14 (17.5) | 40 (24.5) | 54 (22.2) | 0.282 |
| Insufficient laboratory capacity | 10 (12.5) | 57 (35.0) | 54 (22.2) | < 0.001 |
| Lack of expertise/training within the AMS team | 13 (16.3) | 32 (19.6) | 45 (18.5) | 0.644 |
| Suboptimal use of laboratory services | 2 (2.5) | 35 (21.5) | 37 (15.2) | < 0.001 |
| Lack of confidence in the hospital's IPC** processes | 4 (5.0) | 29 (17.8) | 33 (13.6) | 0.011 |
| Lack of trust in prescribing guidelines | 7 (8.8) | 23 (14.1) | 30 (12.4) | 0.324 |
| Regular shortages/stock outs of essential antibiotics | 4 (5.0) | 24 (14.7) | 28 (11.5) | 0.044 |
| Patient demands | 7 (8.8) | 18 (11.0) | 25 (10.3) | 0.743 |
| Poor quality of antibiotics | 0 (0.0) | 15 (9.2) | 15 (6.2) | 0.003 |
| High cost of antibiotics | 0 (0.0) | 15 (9.2) | 15 (6.2) | 0.003 |
| No barriers | 5 (6.3) | 1 (0.6) | 6 (2.5) | 0.016 |
*Statistical significance evaluated using the Pearson’s chi-squared test or Fisher’s exact test. Significance level (α) has been corrected for multiple testing. **Infection prevention and control
Values in boldface indicate statistical significance