2017 Zambia

Antibiotic administration at the University Teaching Hospital, Lusaka, Zambia

Summer 2017

Led by Emily L. Heil, PharmD, and Neha Pandit, PharmD, from the School of Pharmacy, and Cassidy Claassen, MD, from the Institute of Human Virology, University of Maryland School of Medicine

Students (school affiliation): Kaitlyn Doyle (nursing), Gloria Rinomhota (pharmacy), and Dana Valentine (pharmacy)

Project summary

The overall goal of the project was to characterize antimicrobial utilization at the University Teaching Hospital (UTH) in Lusaka, Zambia, in order to lay the groundwork for optimizing antimicrobial stewardship while establishing a sustainable, international research and learning opportunity for UMB students. Students traveled to Lusaka during the summer of 2017 to lead an antibiotic-related quality improvement project in the context of designing the framework for implementing and evaluating antimicrobial stewardship in a resource-limited environment. While at UTH, the students participated in daily interprofessional infectious diseases consult rounds to understand the current inpatient antibiotic prescribing practices. The students participated in the adult third-line HIV clinic, where they observed the roles of the physicians, pharmacists, and nurses in the clinic. The students also provided education to medicine/infectious diseases resident trainees from UTH. To characterize antibiotic administration practices, the student team conducted a point prevalence study to assess the frequency that antibiotic doses were given as prescribed and to identify factors that may have contributed to the missed doses. Results from this project will be used to optimize antibiotic use in resource limited settings as part of antimicrobial stewardship efforts at UTH.

Project outcomes

QI Project: The main objective of the project was to assess the frequency of missed antibiotic doses administered to patients in medical, surgical, and high-cost wards at UTH. The secondary objectives was to assess the risk factors for those missed antibiotic doses. The study was a cross-sectional, chart review of antibiotic doses prescribed and administered. The inclusion criteria of the study were any patients admitted to the medical, surgical, and high-cost wards at UTH who were prescribed antibiotics. Patients were excluded from the study if documentation of antibiotic administration was unclear or unavailable.

Additional data collected from the medication charts included antibiotic names, dosing frequencies prescribed, routes of administration, start dates, discontinued dates if applicable, times of missed doses, dates of chart review, pre-administered future doses, and over-administered doses. The results showed that in all wards, 10.7 percent of prescribed doses were missed. Medical wards missed 8.5 percent of prescribed doses, surgical wards had 13.7 percent, and high-cost wards missed 0 percent of prescribed antibiotic doses. Antibiotics administered more frequently (e.g., three to four times daily) were missed more often than antibiotics dosed once or twice daily. Additionally, intravenous antibiotic doses were missed more frequently than oral doses. 

Teaching: Dr. Pandit delivered a lecture on antiretrovirals. Dr. Heil delivered lectures on antibiotics and antibiotic resistance. Each student delivered a case conference. Gloria Rinomhota delivered a case on a patient with HIV and cervical cancer. Kaitlyn Doyle presented on pressure ulcers. Dana Valentine presented on bacterial meningitis.

Follow-up work

The results of this study were submitted to CUGH as a presentation at the 2018 annual meeting in the spring. The students will be presenting the findings at the University of Maryland School of Pharmacy Research Day in the academic year. Drs. Heil and Pandit will work with Dr. Claassen to determine next steps for the QI project that likely will involve education with nursing and pharmacy staff regarding the study findings. 


"The opportunity to lead an interprofessional team in Lusaka, Zambia, was an unforgettable experience that I hope to build on annually. Having the perspectives of nursing, pharmacy, and medical students allowed us to not only learn from the site but also to learn from each other." — Emily Heil

"The lack of resources in some communities is something that can’t be solved overnight, but what can be done is to have empathy for patients and to do as much that is within one's power as a health care worker to support and care for them ... and that is exactly what I intend to do within my career.  It was my first time on the African continent and a trip with unbelievable moments that I will never forget." — Dana Valentine

"With the current climate of the United States, I feel this experience was pertinent in my development as a young adult. Having experienced another culture even for a short while, with different challenges and lifestyles, reminds me that we are all human. We all suffer, we all bleed, and we can all work toward a common goal if we choose to. Dr. Raki chose to let us have a glimpse of her day-to-day life, the patients chose to trust us to be in the room even though we were foreign, the fellow physicians, nurses, and students of the hospital shared their space and knowledge with us as we all exchanged ideas for the betterment of the patient population. The ability to exchange ideas and wisdom has saved many lives, and I hope to continue expanding my perspective to contribute to this cultural exchange."— Kaitlyn Doyle

"I had always thought of international ground work as being the most important asset in global health. This interprofessional experience allowed me to see a different side of policy and advocacy in global health. I learned that for some of the program implementation to take effect, there must be support from the government as well. It was a realization I had after returning to the United States. As a result of this trip, I took a step and recently emailed my U.S. representative on an important global health issue, which he responded to and offered to help more in that area. I hope to do more advocacy work for global health issues in my profession and continue with international ground work." — Gloria Rinomhota

Read more about the Zambia project trip with a Pharmacy blog entry by Gloria Rinomhota.

Read the 2017 Zambia team presentation from the UMB Global Forum in October.