## 1 Introduction  
Antimicrobial resistance (AMR) is a global, public, and individual health challenge affecting the delivery of safe, effective healthcare in all settings and all countries. The ability of microorganisms to become resistant to the effect of antimicrobials is an inevitable evolutionary process; however, misuse and over-use of antimicrobial agents hastens the development and spread [1; 2]. AMR leads to increased mortality rates [3] and duration and cost of patient care [1]. This is of particular concern in low- and middle-income countries (LMICs) due to the reduced availability of appropriate equipment and/or appropriate diagnostic tools, as well as challenges with access to quality antimicrobials [4; 5; 6; 7]. The rise in incidence of AMR has led to an increased global focus on antimicrobial stewardship (AMS). Surveillance of antimicrobial use and resistance are core to all AMS activities and understanding how antimicrobials are used allows for a review of current practices and highlights areas for improvement. Point prevalence surveys (PPSs) are a widely recognised surveillance method requiring limited resources to collect information on antimicrobial prescribing practices and other relevant factors in hospitalized patients [8; 9; 10; 11]. PPS are a key resource when planning and supporting national and local stewardship interventions in a range of settings, offering a standardised method for comparing data on antimicrobial use across hospitals and countries. The Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (G-PPS; www.global-pps.com/, accessed on 15 May 2021) aims to assess the global prevalence of antimicrobial prescribing and resistance, with an emphasis on countries with low resources, support, and expertise and supports antimicrobial stewardship programs in order to enhance appropriate antimicrobial prescribing [12]. Alongside the evaluation of antimicrobial prescribing practices in hospitals, PPS can identify targets for quality improvement of antimicrobial prescribing and implement and monitor the impact of interventions through repeated surveys. One of the main aims in strengthening global AMS is to reduce the use of antimicrobials that are in the World Health Organization's (WHO) 'Watch' and 'Reserve categories' and 'Not Recommended' group of their AWaRe framework [13; 14]. The framework recommends preferredantimicrobial choice for treating common infections--the 'Access' category, based on consideration of benefits versus risks to patients and the potential for resistance. An additional classification--Not recommended' was added to the framework more recently to include fixed-dose combinations of broad-spectrum antibiotics for which use is not evidence-based [15]. Similarly, the Anatomic Therapeutic Chemical (ATC) classification categorizes drugs active substances into different groups and subgroups according to their therapeutic, pharmacological and chemical properties. WHO endorses the ATC classification as the standard for drug utilization monitoring and research [16]. The Commonwealth Partnerships for Antimicrobial Stewardship programme (CwPAMS), managed by the Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET), is a health partnerships programme funded by the UK Official Development Assistance (ODA), through the Department of Health and Social Care's Fleming Fund to address AMR globally [17]. The aim of the programme is to enhance the implementation of protocols and evidenced-based decision making to support antimicrobial prescribing and the capacity for surveillance of antimicrobial consumption and stewardship. The CwPAMS programme included 12 partnerships between UK health institutions and counterparts in four African Commonwealth countries: Ghana (GH), Uganda (UG), Zambia (ZM), and Tanzania (TZ). The partnerships consisted of volunteer health workers and experts from the five countries who shared skills and knowledge to co-develop strategies to address AMR and AMS.