Barriers, facilitators, and opportunities for hospital antimicrobial stewardship in low and lower middle – income countries in the Eastern Mediterranean region: results from a mixed methods study

A mixed-methods study examined barriers and opportunities for implementing antimicrobial stewardship programmes (ASPs) in low- and lower-middle-income countries of the Eastern Mediterranean Region (EMR). Seven key themes emerged: stewardship capacity varies widely across countries; expertise is limited and requires upscaling; mentorship and centres of excellence are needed; existing tools should be adapted to local contexts; collaboration is hindered by the absence of a regional platform; national accreditation and mandates could drive progress; and more locally driven research is essential. The study concludes that many ASP components can be achieved using existing resources, provided there is coordinated support from regional and global partners.