Drivers of irrational use of antibiotics among children: a mixed-method study among prescribers and dispensers in Tanzania

Abstract

Background Misuse of antibiotics has been associated with poor knowledge, attitude and practice (KAP). Therefore, this study aimed to assess if KAP of prescribers and dispensers could drive irrational use of antibiotics among children in Tanzania. Methods A convergent parallel mixed-methods study design that employed quantitative and qualitative approaches was conducted in 14 regional referral hospitals (RRHs). A total of 108 participants, prescribers [54] and dispensers [54] working with the pediatric population in the respective regions participated in a quantitative survey, by filling the standard questionnaire while 28 key informant interviews were conducted with in-charges of units from the pharmacy and pediatric departments. Two key informants (prescriber and dispenser) were selected from each RRH. Results Overall, among prescribers and dispensers, there was adequate knowledge; 81.5% and 79.6%, p = 0.53, those with positive attitudes were 31.5% and 81.5%, p < 0.001 and poor practices were among 70.4% and 48% p = 0.0312 respectively. Among prescribers, 14.8% agreed and strongly agreed that prescribing antibiotics that a patient did not need does not contribute to resistance. Moreover 19% disagreed to prescribe antibiotics according to local guidelines. Among dispensers, a-quarter of the dispensers thought individual efforts to implement antibiotic stewardship would not make a difference, 17% agreed and strongly agreed that antibiotics can treat viral infection and 7% agreed and strongly agreed antibiotics can be stopped upon resolution of symptoms. From qualitative interviews, both participants displayed an adequate understanding of multi-contributors of antibiotic resistance (AR) including polypharmacy, community self-medication, among others. Regardless, both professions declared to prescribed and dispensed antibiotics according to the antibiotics available in stock at the facility. Furthermore, prescribers perceived laboratory investigation took a long time, hence wasting their time. On the other hand, Dispensers reported not to provide adequate instruction to the patients, after dispensing antibiotics. Conclusions Both prescribers and dispensers had adequate knowledge, few prescribers had positive attitudes and the majority had poor practices. Few dispensers had poor attitude and practice. These findings highlight the need to provide adequate training on antimicrobial stewardship and enforce regulation that foster appropriate medical practice.

Implementation of antibiotic stewardship programmes in paediatric patients in regional referral hospitals in Tanzania: experience from prescribers and dispensers

“…It is known that successful implementation of stewardship activities requires unwavering commitment from senior leadership, 33 to ensure evidence-based treatment, proper planning to avoid expiry of medications, accessibility of the required stock of antimicrobials, establishment of hospital therapeutic committees and conducting of regular audits of antibiotic use, all of which are requirements of ASP activities as per NAPAR. 17 Like other studies, 22,34 findings from this study support the notion that implementation of an ASP without the commitment of senior leadership is likely to fail.…”

“…The patients' rigid attitude regarding not conforming to the instructions provided by the healthcare workers is also reported elsewhere, and mass education is observed to reduce these practices. 22,38 Lastly, one of the activities to be performed in ASPs is training and capacity building of the healthcare workers, and according to the NAPAR this has been an ongoing activity since its launch in 2017. However, findings from the current study have shown limited training opportunities, in terms of who can access this training and selective CME, where most do not focus on ASP.…”

Factors Driving Antimicrobial Resistance in Rural Bangladesh: A Cross-Sectional Study on Antibiotic Use-Related Knowledge, Attitude, and Practice Among Unqualified Village Medical Practitioners and Pharmacy Shopkeepers

“…Patients’ attitudes and socioeconomic status also contribute to the spread of AMR [ 34 ]. Recent studies indicate that knowledge of antibiotic use and resistance could be better among Bangladeshi people.…”

Prevalence of Antibiotic Use and Disposal at Household Level in Informal Settlements of Kisumu, Kenya

“…Antibiotic misuse has been categorized as both community-and healthcare-providerdriven owing to a lack of understanding and awareness of the dangers of antibiotic abuse in the community, availability of antibiotics without a prescription, and consumption of leftover medications, even though prescibers and dispensers were found to have adequate knowledge on antibiotic use [7,21]. The leftover antibiotics are available because patients are unable to complete the medication provided to them for a variety of reasons that vary from person to person, such as adverse effects, feeling better, or drug expiry [22,23].…”

“…The leftover antibiotics are available because patients are unable to complete the medication provided to them for a variety of reasons that vary from person to person, such as adverse effects, feeling better, or drug expiry [22,23]. Predictors of antibiotic misuse among healthcare providers include pharmacists' and prescribers' knowledge, attitude, and practice, patient/doctor contact, a lack of rapid diagnostic tests, pharmaceutical promotion, and a lack of adequate antibiotic education for healthcare professionals [7,21].…”