My training institution, University of California, San Francisco (UCSF), has a strong partnership with Muhimbili National Referral Hospital (MNH) in Dar es Salaam, Tanzania to address rising antimicrobial resistance as antibiotic use in low- and middle-income countries, including Tanzania, is steadily increasing, with concern for rising rates of antimicrobial resistance. As a Pediatric resident at UCSF, I have worked on a research project to study antibiotic prescribing patterns among providers in the Pediatric Emergency Department at MNH and create a pediatric-specific antibiogram. Now that the antibiogram has been finalized, I plan to travel to Dar es Salaam, Tanzania in February 2025 to collaborate with the antimicrobial stewardship team at MNH to distribute the antibiogram and train healthcare providers on interpreting the antibiogram. This will ensure that the providers utilize the antibiogram as a tool to guide their clinical decisions on antibiotic use and further deepen their understanding of antimicrobial resistance. Additionally, I plan to provide direct patient care in the Pediatric Emergency Department at MNH. Working alongside local providers will help me understand what challenges they face and how to implement the antibiogram in a way that would be practical and useful for them.
Throughout my residency training, I have been fortunate to work with physicians and researchers at MNH, one of the four tertiary hospitals in Tanzania where patients across the country are referred to. Given the high volume of patients and the complexity of medical conditions seen at MNH, it is critical to promote the responsible and appropriate use of antibiotics. For these reasons, it will be informative and educational to share with providers at MNH the findings of my project, including the pediatric-specific antibiogram and antibiotics with the highest resistance rates at MNH. Ultimately, effective antimicrobial stewardship will benefit patients at MNH by reducing rates of treatment failure and preserving the efficacy of antibiotics for future generations.
In a country like Tanzania where infectious diseases remain a leading cause of morbidity and mortality among children, prioritizing antimicrobial stewardship is essential for safeguarding both the current and future health of children. By distributing the antibiogram and educating providers on how to interpret it, I hope to raise awareness of the threat of antimicrobial resistance, encourage local healthcare professionals to prescribe antibiotics judiciously, and ultimately improve patient outcomes.
My career goal is to become a global pediatric neonatologist and continue to do research with global health partners. Therefore, this experience would be an incredible opportunity to learn how to collaborate with healthcare professionals from different cultural backgrounds and how to implement decision-making tools in ways that are applicable and feasible in their unique clinical settings. Additionally, providing patient care in the pediatric emergency department will allow me to encounter diverse clinical cases that may be rarely seen in the United States, broadening my clinical knowledge and skills that would serve my future patients. Lastly, I firmly believe this trip will further solidify my sense of purpose and commitment to addressing global health disparities.
My rotation in the pediatric emergency department at Muhimbilia National Hospital (MNH) in Dar es Salaam, Tanzania, was a unique opportunity to bridge clinical care with research in antimicrobial stewardship. By immersing myself in both aspects, I gained a deeper understanding of the implications of antimicrobial resistance in a resource-limited setting.
One of the most valuable aspects of my experience was working with research assistants at MNH to review electronic medical records and paper charts, meticulously tracking antibiotic use at different points in a patient’s care. Sitting at the corner of the computer station in the emergency department, we documented antibiotics prescribed at outside hospitals before referral, those given in the emergency department, and those continued or changed upon admission. This process provided insight into prescribing patterns and allowed us to correlate them with culture results, helping to identify resistance patterns.
The data collection process itself was an eye-opening experience. Given the limitations of electronic medical records, our team spent countless hours reviewing paper charts to fill in missing data. The dedication of the research assistants was remarkable, as they combed through extensive records to ensure data accuracy. Sometimes the internet connection was disrupted for hours. Sometimes we waited several hours from the medical records office to receive paper charts. This experience underscored the realities of conducting global health research—requiring persistence, collaboration, and adaptability to navigate system constraints. It also reinforced the importance of working closely with local research teams, who provided invaluable insight into the nuances of data collection and healthcare delivery in the region.
Beyond research, observing the pediatric emergency department was a crucial complement to my work. Since my research focused on antibiotic use in this setting, I wanted to understand the clinical decision-making process firsthand. It was humbling to witness children presenting with critical conditions from diseases that are often detected and managed earlier in high-resource settings (e.g., congenital heart disease). The experience deepened my appreciation for providers at MNH who are faced with making tough clinical decisions with limited diagnostic tools and management options.
This rotation reinforced my passion for antimicrobial stewardship and global pediatric care. It highlighted the importance of integrating research with clinical practice to develop sustainable solutions that would ultimately improve pediatric healthcare outcomes. The lessons I learned at MNH in Dar es Salaam will serve as a guiding framework for my future work in global health, through research, clinical practice, and policy advocacy to improve pediatric care worldwide.
