MicroDoc: Developing a guide for managing infections in Zambian rural low-resource health settings

Lack of access to diagnostic tests and guidelines that are inappropriate for poorly resourced facilities can result in incorrect and excessive prescribing of antimicrobial therapy in rural healthcare settings. On Call Africa (OCA) and Virtual Doctors (VD) are two non-governmental organisations that work in healthcare in Zambia. Volunteers and staff from OCA and VD have collaborated with the Zambian Ministry of Health and local healthcare providers to design a guide to support decisions around management of infections specifically in rural primary healthcare settings in Zambia. Local staff were initially surveyed for their attitudes towards treatment of infections, the content they would like capacity building in, and preferred modes of learning. The team, comprising public health and infectious disease doctors and GPs from Ireland and the UK with experience working in Zambia, have created a guide called MicroDoc which encompasses workshops, PDFs, flowcharts and modules relating to management of infections and antimicrobial prescribing. All the content can be downloaded and accessed offline. The Zambian Standard Treatment Guidelines were consulted for antimicrobial choice, supplemented by NICE and WHO where necessary. Red flags for urgent hospital referral are also incorporated, as well as modules about risks of antimicrobial resistance. Early versions of the guide have been distributed to a range of facilities in Zambia's Southern Province, with promising feedback from healthcare providers. In collaboration with local partners and input from facility staff, MicroDoc will be finalised and rolled out to more health posts and health centres in the region, with a view to eventually expanding to other regions. The OCA team has been conducting clinical audits of prescribing practices in two rural health posts and it is hoped that the MicroDoc guide will contribute to improved antimicrobial stewardship as well as better outcomes for patients. KEY MESSAGES: • Management of infectious presentations is particularly challenging in rural low-resource primary healthcare settings in Sub-Saharan countries such as Zambia. • A team from On Call Africa and Virtual Doctors has created a guide called MicroDoc, in collaboration with Zambian health authorities, to support decision making in managing infections in primary care.