# Involvement of community health workers in antimicrobial stewardship interventions and programmes: a scoping review

## TL;DR

This review explores how community health workers can help reduce antibiotic misuse and raise awareness about antimicrobial resistance in low- and middle-income countries.

## Contribution

The study systematically maps the roles and impact of community health workers in antimicrobial stewardship in resource-limited settings.

## Key findings

- Community health workers engage in infection prevention and antibiotic-related tasks, reducing inappropriate use.
- Training and support for CHWs vary, affecting the effectiveness of antimicrobial stewardship interventions.
- Positive outcomes include increased community awareness of AMR and improved adherence to guidelines.

## Abstract

Antimicrobial resistance (AMR) poses a global health threat, especially in low-income and middle-income countries. Community health workers (CHWs) are key actors in infection management and health promotion; however, their involvement in antimicrobial stewardship (AMS) remains unclear. This study aims to assess CHWs’ roles in AMS, examine their training and support, and evaluate outcomes regarding antibiotic use and resistance.

A scoping review was conducted to explore the roles, education, training and antimicrobial-related outcomes of CHWs. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, with the protocol registered in Open Science Framework. Databases including PubMed, EMBASE and CINAHL were searched for studies published in English and Spanish. A narrative synthesis was applied to the identified articles, with the Integrated Quality Criteria for the Review of Multiple Study Designs and Quality Assessment Tool for Studies with Diverse Designs tools employed to assess the risk of bias.

Eight studies were identified, conducted in Uganda, Tanzania, Zambia, Pakistan, Bangladesh and Kenya. CHWs were involved in various AMS activities, such as infection prevention, detection and treatment of conditions such as pneumonia and gastrointestinal infections. CHWs contributed to health education, antibiotic prescription (when authorised) and improved adherence to guidelines. Positive outcomes included reduced inappropriate antibiotic use and increased community awareness of AMR. However, the effectiveness of these interventions varied depending on the local context and resources.

CHWs play an important role in promoting responsible antibiotic use and addressing AMR, particularly in underserved settings. Strengthening their training, expanding selected roles and responsibilities and improving support mechanisms should be considered to enhance their potential contribution to AMS programmes. Further research is needed to optimise CHW interventions and evaluate their long-term impact.