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Laying the Groundwork for Antimicrobial Stewardship in Bangladesh

We are proud to announce the successful completion of the National Antimicrobial Prescribing Survey (NAPS) at four key healthcare institutions across Bangladesh. This important milestone marks a significant step forward in our national efforts to strengthen antimicrobial stewardship (AMS) and combat the growing threat of antimicrobial resistance (AMR). This initiative was carried out under phase 2 of the CAPTURA project, supported by a Fleming Fund Regional Grant from UK aid and managed by Mott MacDonald. This is in partnership with national stakeholders such as the Communicable Disease Control (CDC) division and the Institute of Epidemiology, Disease Control and Research (IEDCR) under the Directorate General of Health Services (DGHS), and the Directorate General of Drug Administration (DGDA) under the Ministry of Health and Family Welfare (MoHFW), and the Fleming Fund Country Grant to Bangladesh. CAPTURA 2 supports building sustainable systems for collecting high-quality data on antimicrobial use (AMU) and resistance, and translating those insights into evidence-based policy and clinical practice improvements.

The audits were conducted with the full cooperation of national stakeholders, hospital authorities, healthcare professionals, trained survey managers, and data collectors, ensuring accurate and meaningful insights into antimicrobial prescribing practices.

The selection of pilot sites for NAPS in Bangladesh was carried out through a strategic and consultative process to ensure effective and representative implementation. The goal was to include a diverse mix of healthcare facilities across different regions, reflecting the varied landscape of medical service delivery in the country. Key considerations included facility type, geographic distribution, institutional readiness, and the practical feasibility of conducting standardised audits. 

In close coordination with key national health authorities, including the CDC and IEDCR, four hospitals were selected to participate in the pilot phase. This collaborative and inclusive approach ensured strong national alignment and institutional backing for the project. The selected sites were expected to generate valuable insights that would inform future antimicrobial stewardship efforts and guide the scale-up of NAPS across Bangladesh.

NAPS Audit Summary

As part of the Fleming Fund-supported CAPTURA initiatives in Bangladesh, a NAPS audit was conducted across four healthcare facilities between December 2024 and April 2025. A total of 506 patients were surveyed, and 446 antibiotic prescribing records were entered into the system. The participating facilities included Shaheed Suhrawardy Medical College and Hospital (260 patients), Faridpur Medical College Hospital (110 patients), Chattogram General Hospital (108 patients), and Daudkandi Upazila Health Complex (28 patients). The audits provided critical insights into prescribing practices across various hospital settings, supporting efforts to strengthen antimicrobial stewardship nationwide.

Facility Name	Patients Surveyed	Records Entered	Audit Dates
Shaheed Suhrawardy Medical College & Hospital (1350-bed)	260	242	April 9, 10, 12, 15, 2025
Faridpur Medical College Hospital (500-bed)	110	101	Dec 18, 2024; Feb 25–26, 2025
Chattogram General Hospital (250-bed)	108	81	Jan 5–6, 2025
Daudkandi Upazila Health Complex (50-bed)	28	22	Jan 15, 2025

Key Objectives of NAPS audit in hospitals

The NAPS aims to support evidence-based antimicrobial stewardship (AMS) through systematic data collection and analysis. The key objectives of the hospital-based audit include:

• Evaluating antimicrobial prescribing patterns: Assess prescribing practices across key hospital departments such as Medicine, Pediatrics, Surgery, ICU, and Obstetrics & Gynecology to understand current trends and behaviors.

• Identifying opportunities for improvement: Pinpoint areas where antimicrobial use can be optimised, including dose, duration, choice of agent, and documentation of clinical indication.

• Supporting guideline development: Provide robust, locally relevant data to inform the formulation or revision of national AMS guidelines.

• Promoting rational antibiotic use: Encourage responsible prescribing practices among clinicians by highlighting gaps, promoting adherence to best practices, and reducing unnecessary or inappropriate antibiotic use.

Site highlights

Shaheed Suhrawardy Medical College & Hospital (ShSMCH)

Picture: Initiation visit and meeting with the AMS team, ShSMCH, Date: 9 April 2025

ShSMCH is a 1,350-bed prominent government medical institution located in Dhaka, Bangladesh (https://mapcarta.com/N5342132622). Established in 2006, the college is affiliated with the University of Dhaka and operates under the Ministry of Health and Family Welfare. The hospital offers a wide range of specialized medical services alongside undergraduate and postgraduate medical education. With a strong emphasis on academic excellence, patient care, and research, ShSMCH plays a vital role in training future healthcare professionals and delivering quality healthcare to a large and diverse patient population.

Picture: Training for the AMS team, ShSMCH, Date: 10 April 2025

Key highlights:

• Team Involvement: Active participation from the Director, Assistant Director, Survey Manager, data collectors, and support staff.
• 260 patients were surveyed across multiple wards (Medicine, Pediatrics, Neonatology, Surgery, ICU, and Obstetrics & Gynecology).
• 242 antimicrobial prescriptions were entered and analyzed using the NAPS digital platform.
• Despite the challenges of a busy tertiary care environment, the hospital staff and data collection team maintained high levels of cooperation and efficiency throughout the audit period.
• Hands-on use of the web-based data collection tool. 

Faridpur Medical College Hospital (FMCH) 

Picture: Initial Visit at the FMCH, Date: 27 November 2024

The FMCH is affiliated with Faridpur Medical College, a 500-bed public medical institution established in 1992 by the Government of Bangladesh (https://mapcarta.com/N9692137610). The college is a constituent medical college under the University of Dhaka, dedicated to providing high-quality medical education. Its mission is to prepare students with the knowledge, clinical competencies, and ethical principles necessary to serve humanity. Over the years, FMCH has earned notable recognition within Bangladesh’s public medical education sector for its commitment to academic excellence and community service.

Picture: Meeting with the Director of the Hospital after local level refresher training, Date: 27 November 2024

Key highlights:

• Team Involvement: Active participation from the Director, Survey Manager, data collectors, and support staff.
• 110 patients were surveyed across multiple wards (Medicine, Pediatrics, Surgery, ICU, and Obstetrics & Gynecology).
• 101 antimicrobial prescriptions were entered and analyzed using the NAPS digital platform.
• First hands-on application of NAPS tools in Bangladesh’s clinical setting.
• Full support and active participation from hospital leadership and clinical teams.

Chattogram General Hospital (CGH)

Chattogram General Hospital is a 250-bed government-run public hospital located in Chattogram, Bangladesh (https://mapcarta.com/N1962572816). It is one of the oldest healthcare institutions in the region, playing a crucial role in providing affordable medical services to the local population. The hospital offers a wide range of services, including general medicine, surgery, pediatrics, obstetrics and gynecology, and emergency care. With its long-standing commitment to public health, CGH remains a key pillar of the healthcare system in southeastern Bangladesh.

Picture: Data Collection and Initial Visit, Date: 05 January 2025

Key highlights:

• The successful implementation of NAPS at CGH was made possible by the excellent collaboration between hospital superintendents, clinical teams, and trained data collectors. Support from national health authorities was instrumental in ensuring smooth coordination and execution.
• 108 patients were surveyed across key clinical areas, including Medicine, Pediatrics, Surgery, Emergency Care, and Obstetrics & Gynecology, providing insight into antimicrobial prescribing practices in diverse settings.
• 81 antimicrobial prescriptions were entered and analyzed using the NAPS tool
• The audit was conducted during the winter season, a time typically associated with lower patient admissions, which impacted the number of eligible patient records available for inclusion. Despite this, the team achieved meaningful data collection and analysis.

Picture: Data Collection, Date: 06 January 2025

Daudkandi Upazila Health Complex (DUHC)

The Daudkandi Upazila Health Complex is a 50-bed government-run primary healthcare facility located in Gouripur, Daudkandi Upazila, under Cumilla District in Bangladesh (https://mapcarta.com/N2382257863). It plays a crucial role in delivering essential health services to the local population, including outpatient care, maternal and child health, immunization, and basic emergency services. As part of the national public health system, the health complex operates under the Ministry of Health and Family Welfare and serves as a key access point for rural communities to receive affordable and quality healthcare. The facility also participates in various public health programs and national health initiatives, contributing to disease prevention, health promotion, and community-based healthcare delivery.

Picture: Initial Site visit and meeting with the Upazila Health and Family Planning Officer, Date: 28 November 2024

Key highlights

1. Team involvement: Active participation from Upazila Health and Family Planning Officer (UHFPO), Medical officers, Survey Manager, nurses, data collector appointed by CAPTURA, and support staff.
2. 28 patients were surveyed across all the ward.s
3. 22 antimicrobial prescriptions were entered and analyzed using the NAPS digital platform.
4. The audit at DUHC was conducted during the winter season, a period generally characterized by lower patient admissions, which in turn affected the number of eligible patient records available for inclusion.

Picture: Data Collection, Date: 15 January 2025

Collaboration and commitment

The successful completion of the NAPS audit across the four pilot sites was a direct result of the strong collaboration and unwavering commitment of all involved stakeholders. The data collection teams, comprising healthcare professionals, focal persons, and trained data collectors, demonstrated remarkable teamwork, adaptability, and dedication throughout the process.

This effort was actively supported by key national stakeholders, CDC, IEDCR, and technical experts from the NCAS, Australia. Their guidance, encouragement, and oversight ensured adherence to standardized methods and facilitated smooth coordination across all participating facilities.

Despite facing challenges such as incomplete clinical documentation, high patient volumes, and resource constraints, the data collection teams worked diligently to complete the audits within the planned time frame. Their resilience and problem-solving abilities were key to capturing accurate and meaningful data. The insights gathered through this collaborative effort will not only inform future AMS initiatives but also contribute to building a sustainable foundation for ongoing AMU surveillance and quality improvement in Bangladesh’s healthcare system.

Early audit insights:

The initial round of data collection under the NAPS pilot in Bangladesh revealed several important findings that will inform future AMS interventions:

• Incomplete clinical documentation, particularly regarding diagnosis and indication for antibiotic use, was a common challenge. This limited the ability to fully assess prescription appropriateness and highlighted a critical area for improvement in medical recordkeeping.
• Variability in antibiotic dosing practices was observed across departments, underscoring the need for standardisation of prescribing behavior in line with national or international guidelines.
• The audit helped map prescribing patterns, including a high rate of empirical use of broad-spectrum antibiotics, which may contribute to antimicrobial resistance if not adequately monitored and rationalised.
• Encouragingly, hospital staff expressed strong interest in using the audit findings to enhance clinical practice. There was a clear willingness to improve compliance with treatment guidelines and promote more rational, evidence-based prescribing.

These early insights emphasize the value of routine AMU surveillance and reinforce the importance of continued training, institutional support, and data-driven decision-making in combating AMR.

Why this matters

AMR is one of the most pressing global health threats of our time, undermining the effectiveness of antibiotics and jeopardizing decades of medical progress. In low- and middle-income countries like Bangladesh, where surveillance systems are still evolving, strategic interventions are crucial to monitor and improve AMU in healthcare settings.

NAPS tool implementation provides a structured and standardized approach to AMU surveillance. It delivers actionable data that supports national efforts to combat AMR.

Key reasons why this initiative matters include:

• Identify prescribing trends and improve clinical decision-making.
• Support evidence-based policy development.
• Empower healthcare workers.
• Reinforce the importance of rational antibiotic use.
• Enhance capacity for local surveillance and future audits.

Setting the stage for national AMU surveillance

The successful implementation of the NAPS audit in four key hospitals marks a significant milestone in Bangladesh’s journey toward establishing a sustainable national system for AMU surveillance. This pilot phase not only provided valuable data on prescribing practices but also served as proof of concept for wider implementation.

Importantly, the audit demonstrated the feasibility of deploying a standardized and digital AMU surveillance tool, even within high-volume, resource-constrained hospital settings. It also showcased the capability of local healthcare facilities and hospital teams to adopt and implement international methodologies with strong fidelity when supported by targeted training and cross-institutional collaboration.

Key takeaways

• Reinforces responsible prescribing behavior.
• Builds capacity for future stewardship interventions.
• Highlights the diversity of antimicrobial use across healthcare tiers.
• Supports informed policy and guideline development.

Acknowledgments

The successful organization of the NAPS Central Training and NAPS implementation in Bangladesh was made possible through the collaborative efforts and dedication of multiple organizations and individuals. We thank all national stakeholders (CDC, IEDCR, FFCGBD), hospital participants, survey managers, data collectors, the NCAS team, and the Bangladesh CAPTURA team for their tireless efforts, active engagement, dedication, and support in making this central training a success. Their contribution is pivotal to advancing evidence-based stewardship and protecting the effectiveness of antimicrobials for future generations.

Together, we are taking meaningful steps toward a healthier, more informed future in the fight against AMR.

Written by: Hridika Talukder Barua (Consultant, CAPTURA Bangladesh) and Mohammad Julhas Sujan (Data Science Engineer, IVI)

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