Understanding the Infection Prevention and Control Landscape at a Tertiary Hospital in Blantyre, Malawi

Methods: The scoping review followed the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines and included qualitative studies, close-ended questionnaires, and descriptive observational designs.The Covidence web-based platform was used for literature screening and data extraction including population characteristics, methods, tools and/or questionnaires used, and key findings and the Critical Appraisal Skills Programme (CASP) qualitative checklist was used for qualitative papers.Results: The review identified several key themes related to: 1) patient factors including patient beliefs, expectations, knowledge and understanding, and perceptions of antibiotics, resistance and illness severity; satisfaction with and trust in healthcare providers and shared decision making and empowerment; community attitudes, perceptions and beliefs, and sociocultural factors; 2) provider factors including patient-provider relationship, healthcare utilisation and antibiotic prescribing provision and practices and healthcare delivery in PHC; 3) healthcare system factors including resource constraints and healthcare delivery, diagnostic tools and testing and technological advances and access to care, and 4) uptake, implementation, effectiveness and impact of educational interventions.Patients demonstrated varied levels of knowledge regarding infections and antibiotic resistance, influenced by factors such as migration, cultural background, and health literacy.Motivations for seeking antibiotics included cultural beliefs, family influences, and concerns about illness severity.Discussion: Understanding patient and healthcare provider perspectives and understanding are crucial for designing effective interventions to combat AMR.This study emphasizes the need for enhancing antibiotic stewardship programs, addressing information needs, and considering population diversity and health literacy in educational interventions.Challenges related to resource scarcity and power dynamics within the healthcare system must also be considered, Conclusion: Despite the growing awareness that a substantial portion of antibiotic consumption occurs within PHC settings, patients' roles in the use of antibiotics have often been overlooked.This review emphasizes the importance of understanding patient perspectives in LMICs regarding antibiotic use in PHC settings.The focus should be on implementing targeted interventions for both patients and providers to promote judicious antibiotic use and mitigate the global threat of AMR.