No abstract

Developing and fostering professional confidence should be nurtured and valued to the same extent as professional competence, as the former underpins the latter, and both are linked to professional identity.

BackgroundMozambique classifies but does not yet enforce antibiotics as prescription-only-medicine (POM) allowing the public access to a variety of antibiotics that otherwise are provided on prescription. This contributes to the growing practice of self-medication with antibiotics (SMA) which systematically exposes individuals to the risk of developing antibiotic resistance, antibiotic side effects and increases the health service costs and morbidity. This study aimed at describing the patterns of SMA among Maputo city pharmacy customers.MethodsA qualitative study conducted between October 2018 and March 2019 was developed with thirty-two pharmacy customers and seventeen pharmacists. Using convenience sampling, customers were recruited after buying antibiotics without prescription from nine private pharmacies. Of the thirty-two participants, twenty participated in in-depth interviews and twelve in two focus groups discussions (FGD) with six participants each. Purposive sampling and a snowball technique were used to recruit pharmacists. The transcripts were coded and analyzed using latent content analysis. Nvivo 11 was used to store and retrieve the data. The COREQ (Tong, 2007) checklist for interviews and FGD was performed.ResultsCustomers admitted practices of SMA, pharmacists admitted dispensing a variety of antibiotics without prescription. Non-prescribed antibiotics (NPA) were obtained through five different patterns including; using the generic name, describing the physical appearance and using empty package, describing symptoms or health problem to pharmacists, using old prescriptions and sharing antibiotics with family, friends, and neighbors.ConclusionDifferent patterns of SMA are contributing to the indiscriminate use of antibiotics among customers. The NPA utilization is perceived as an expression of self-care where participants experience self-perceived symptoms and indulge in self-treatment as a method of caring for themselves. Moreover, antibiotics are mostly used to treat diseases that do not necessarily need antibiotics. Strong and effective public health education and promotion initiatives should be implemented to discourage inappropriate utilization of antibiotics and SMA practices.

BackgroundAntibiotic stewardship, the proper management of antibiotics to ensure optimal patient outcomes, is based on quality improvement. Evidence-based guidelines and protocols have been developed to improve this process of care. Safe and timely patient care also requires optimal coordination of staff, resources, equipment, schedules and tasks. However, healthcare workers encounter barriers when implementing these standards and engage in workarounds to overcome these barriers. Workarounds bypass or temporarily ‘fix’ perceived workflow hindrances to achieve a goal more readily. This study examines workaround behaviours that nurses and doctors employ to address the challenges encountered during their antibiotic stewardship efforts and their impact, at a tertiary hospital in Malawi.MethodsThis was a qualitative descriptive case study design and is part of a large mixed methods study aimed at understanding nurses’ role in antibiotic stewardship and identifying barriers that informed the development of nurse-focused interventions. For this study, we conducted interviews with staff and observations of nurses antibiotic stewardship practices on two adult medical wards. We convened three focus group discussions with doctors, pharmacists and laboratory technologists (n = 20), focusing on their attitudes and experiences with nurses’ roles in antibiotic stewardship. We also observed nurses’ antibiotic stewardship practices and interactions duringfour events: shift change handovers (n = 10); antibiotic preparation (n = 13); antibiotic administration (n = 49 cases); and ward rounds (n = 7). After that, the researcher conducted follow up interviews with purposively selected observed nurses (n = 13).ResultsUsing inductive and deductive approaches to thematic analysis, we found that nurses established their ways of overcoming challenges to achieve the intended task goals with workarounds. We also found that nurses’ practices influenced doctors’ workarounds. We identified six themes related to workarounds and grouped them into two categories: “Taking shortcuts by altering a procedure” and “Using unauthorized processes”. These behaviors may have both positive and negative impacts on patient care and the health care system.ConclusionThe study provided insight into how nurses and doctors work around workflow blocks encountered during patient antibiotic management at a tertiary hospital in Malawi. We identified two categories of workaround namely taking shortcuts by altering a procedure and using unauthorized processes. Addressing the blocks in the system by providing adequate resources, training, improving multidisciplinary teamwork and supportive supervision can minimize workarounds.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-3900-0) contains supplementary material, which is available to authorized users.

Background The global increase in the utilization of non - prescribed antibiotics (NPA), is concerning, with high persistence within the low and middle-income countries (LMICs). With a negative impact on the health of individuals and communities the use of NPA paves the way to the  propagation of superbugs that potentially predisposes to changes in bacterial resistance patterns, antibiotic resistance (AR) and antimicrobial resistance (AMR). This study aimed at estimating through a systematic review and meta-analysis, the prevalence of NPA utilisation and describe its primary sources in LMICs. Methods The study is a systematic review and meta-analysis which study protocol was registered in PROSPERO (CRD42017072954). The review used The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.  The studies searched in databases were deemed eligible if reported evidence of practices of self-medication with antibiotics (SMA) and the prevalence of NPA utilisation within adult participants from LMICs, published between 2007 to 2017. The pooled analyses were carried out using Meta XL statistical software. The pooled prevalence was calculated with a 95% confidence interval (CI). The risk of bias of the included studies was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results The review included a total of 11 cross-sectional studies, involving 5080 participants and conducted in LMICs from Asia (India, Laos, Nepal, Pakistan, Sri Lanka and Yemen), Latin America (Guatemala), Africa (Nigeria). All studies reported existing  practices of SMA, with reported prevalence ranging from 50% to 93,8%. The pooled prevalence of SMA was 78% (95% CI: 65–89%). The main sources of NPA were; pharmacies, family and friends, old prescriptions, home cabinet and leftover antibiotics. Conclusion This study revealed a high prevalence of utilisation of NPA in the studied LMICs, these were found to be twice as high in women than men and those participants aged between 18 and 40 years old. The review suggests f considering broader qualitative and comprehensive contextuallized research to better understand the nuances of NPA use. These would be benefitial to uncover uncover gray areas, inform decisions, support the (re) design and implementation of multifaceted interventions towards antibiotic stewardship and conservancy in LMICs.