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Global Maternal and Child Health · Journal article
Journal of the Pediatric Infectious Diseases Society · September 1, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a descriptive case report of how one tertiary hospital in Nigeria institutionalized an antimicrobial stewardship programme and then scaled it to two satellite facilities via a hub-and-spoke model, supported by a UK-Nigeria health partnership. The report documents process improvements (governance, surveillance, guidelines, community engagement) but does not quantify clinical outcomes, resistance trends, antibiotic consumption changes, or patient-level impacts.
Descriptive implementation case series. University College Hospital, Ibadan, Nigeria (tertiary referral hospital) and two satellite state-level facilities (a children's hospital and a maternity teaching hospital); setting: low- and middle-income country; specific eligibility criteria not stated. Intervention: Antimicrobial stewardship programme institutionalization using bi-directional learning, system strengthening, and contextualized actions including governance structures, point prevalence surveys, AMR and consumption surveillance, evidence-…. Ibadan, Nigeria (tertiary centre) and two state-level facilities in Nigeria.
ASP was established at baseline with fragmented plans, weak AMR/use/consumption surveillance, and limited institutional integration Post-intervention, governance structures improved with clear terms of reference and regularly reviewed action plans Point prevalence surveys and AMR/consumption surveillance were institutionalized; first antibiogram in over two decades was generated
No patient-level clinical outcomes (mortality, morbidity, length of stay, treatment failure) reported
This report demonstrates that institutional antimicrobial stewardship can be established and scaled in resource-limited settings through structured partnerships and contextualized approaches. However, without quantified measures of antibiotic use, resistance prevalence, clinical outcomes, or cost-effectiveness, the direct clinical benefit to patients remains undemonstrated and requires prospective evaluation.
This is a descriptive implementation report of an antimicrobial stewardship programme in a single tertiary hospital and two satellite sites in Nigeria, with no control group, no quantified clinical outcomes, and no comparative data on patient or resistance impacts.
As stated by the source record.
This report demonstrates that institutional antimicrobial stewardship can be established and scaled in resource-limited settings through structured partnerships and contextualized approaches. However, without quantified measures of antibiotic use, resistance prevalence, clinical outcomes, or cost-effectiveness, the direct clinical benefit to patients remains undemonstrated and requires prospective evaluation.
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.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Abstract Corresponding Author Babatunde O. Ogunbosi, MD, Department of Paediatrics, Paediatric Infectious Diseases Unit, University of Ibadan/University College Hospital, Ibadan, Nigeria, +234 802 364 2269, boogunbosi@com.ui.edu.ng Funding This work was supported by the Commonwealth Partnerships for Antimicrobial Stewardship Conflict(s) of Interest Babatunde O. Ogunbosi, no conflict; Chris O. Durojaiye.MD, no conflict; Kayleigh Lehal, no conflict. Background Antimicrobial resistance (AMR), a major global health threat, disproportionately affects low- and middle-income countries (LMICs), especially children and the elderly. Key drivers include antibiotic misuse, limited diagnostics, and weak or absent antimicrobial stewardship programmes (ASP). We report efforts to institutionalise ASP at a tertiary referral hospital in Nigeria and scale-up to sub-national facilities. Methods The Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS), managed by the Global Health Partnerships and Commonwealth Pharmacists Association, and funded by the UK Department of Health and Social Care through the Fleming Fund supported the University College Hospital (UCH), Ibadan, Nigeria – Sheffield Teaching Hospital, NHS Foundation Trust, UK AMS Partnership since 2023. The partnership used bi-directional learning, system strengthening, and contextualized AMS actions to institutionalize ASP at the UCH. Using a hub-and-spoke model, UCH then helped establish ASP at state-level facilities: a children’s hospital and a maternity teaching hospital. Results At baseline, ASP was under-resourced with fragmented plans, weak antimicrobial resistances/use/consumption surveillance, and limited institutional integration. Post intervention, governance structures improved with clear terms of reference and regularly reviewed action plans. Point prevalence surveys and AMR/Consumption surveillance were institutionalised, with the first antibiogram in over two decades used to inform prescribing. Evidence-based treatment guidelines and prescription policies were introduced. Community engagement expanded through One Health AMR activities and student-led initiatives. Lessons from UCH enabled establishment of multidisciplinary ASP at spoke sites, with training, mentorship, and projects addressing prophylactic antibiotic use in newborns. The hub-and-spoke model and learnings were shared with national AMR coordination structures to inform policy and scale-up. Conclusion Health partnerships, contextualized actions, and institutional commitment can institutionalize AMS in LMICs. The hub-and-spoke model proved feasible for scaling ASP and expanding AMR awareness beyond hospital settings. National adoption could accelerate sustainable implementation of Nigeria’s AMR National Action Plan 2.0, and enhance maternal and child health outcomes.
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