Nurse- and Midwife-Led Antimicrobial Stewardship Interventions in Low- and Middle-Income Countries: A Systematic Review Protocol

Background: Antimicrobial resistance poses a major global health threat. Low- and middle-income countries are disproportionately affected due to high infectious disease burden, limited diagnostic capacity, and weak antimicrobial stewardship systems. Nurses and midwives constitute the largest proportion of the healthcare workforce and play critical roles in antimicrobial use, infection prevention, and patient education. However, evidence on nurse- and midwife-led antimicrobial stewardship interventions in low and middle income countries has not been systematically synthesized. Objective: This systematic review aims to identify, appraise, and synthesize evidence on nurse- and midwife-led antimicrobial stewardship interventions in low and middle income countries, focusing on intervention characteristics, effectiveness, outcomes, and implementation facilitators and barriers. Methods: This protocol follows the PRISMA-P 2015 guidelines. The completed systematic review will adhere to PRISMA 2020 reporting standards. A systematic search will be conducted in MEDLINE/PubMed, Embase, CINAHL, Scopus, Web of Science, Cochrane CENTRAL, and Global Index Medicus, with no date restrictions. Eligible studies will include empirical research reporting nurse- or midwife-led antimicrobial stewardship interventions implemented in low and middle income countries. Outcomes of interest include appropriateness of antimicrobial prescribing, antibiotic consumption, patient outcomes, and implementation-related measures. Study selection, data extraction, and risk-of-bias assessment will be conducted using standardized tools, including ROBINS-I and CASP, as appropriate. Due to anticipated heterogeneity, findings will be synthesized narratively. Ethics and Dissemination: Ethical approval is not required as this review will use published data only. Findings will be disseminated through peer-reviewed publication and academic and policy forums to inform antimicrobial stewardship practice, policy, and future research in resource-limited settings.