Factors influencing receipt of an antibiotic prescription among insured patients in Tanzania: a cross-sectional study

Abstract

ObjectivesThere are limited data on factors influencing antibiotic prescription among insured patients. We assessed for correlates of an antibiotic prescription among insured patients.DesignA cross-sectional study.SettingThe study was conducted at the National Health Insurance Fund offices, Dar es Salaam, Tanzania.Data sourceWe captured data from the claim forms, containing inpatient and outpatient treatment information for insured patients, for the month of September 2019.Outcome variableReceipt of an antibiotic prescription.Exposure variablesAge, sex, diagnosis, prescriber qualification, health facility level, ownership and department were exposure variables. Predictors of receipt of an antibiotic prescription were determined by Poisson regression analysis.ResultsOf 993 analysed patients, the mean (±SD) age was 36.3 (±23.2) years, 581 (58.5%) were females and 535 (53.9%) were adults. The prevalence of antibiotic prescription was 46.4% (95% CI 42.8% to 50.0%). Strong predictors of an antibiotic prescription were being a child (1.7, 95% CI 1.3 to 2.2); acute upper respiratory tract infection (URTI) of multiple and unspecified sites (1.6, 95% CI 1.3 to 1.4); chronic rhinitis, nasopharyngitis and pharyngitis (4.0, 95% CI 2.4 to 6.4); being attended by a clinical officer (1.9, 95% CI 1.2 to 3.0); attending a health centre (1.5, 95% CI 1.1 to 2.0); attending a public facility (1.2, 95% CI 1.0 to 1.4) and visiting an inpatient department (2.0, 95% CI 1.2 to 3.4).ConclusionsAmong insured patients, being a child, acute URTI, being attended by a clinical officer or dental therapist, being attended by an assistant medical/dental officer, attending a health centre or a district hospital, attending a public health facility and visiting an inpatient department predicted an antibiotic prescription. Incorporation of these findings in revisions or establishment of targeted antimicrobial stewardship programmes may lead to better antibiotic prescribing practices that are critical for combating antibiotic resistance.

WHO/INRUD prescribing indicators among tertiary regional referral hospitals in Dar es Salaam, Tanzania: a call to strengthen antibiotic stewardship programmes

“… 9 Another study focusing on prescribing antibiotics to insured patients in Dar es Salaam reported that penicillins were the most preferred group of antibiotics, followed by nitroimidazoles. 32 The findings are further different from what was observed in tertiary care hospitals in India, where cephalosporins 37 and β-lactam antibiotics 27 were the most frequently prescribed antibiotics. Also in Pakistan, where cephalosporins were the most commonly prescribed class of antibiotics, followed by penicillins and fluoroquinolones.…”

“… 31 For example, despite the fact that viral diseases such as colds and flu cannot be treated with antibiotics, patients are nonetheless given antibiotic prescriptions for such disorders. 32 …”

A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications

“…The findings in this study highlight considerable issues and concerns regarding the current prescribing practices of antibiotics across the sectors, which can include the excessive prescription of 'Watch' antibiotics in private care settings [74,116,134,137,139]. However, encouragingly, this is generally not the case in Tanzania, with import data showing that 83.1% of imported antibiotics in recent years are from the 'Access' group versus only 10.1% from the 'Watch' group and <0.01% from the 'Reserve' group [27].…”

“…In addition, there has been a general overprovision of care, including unnecessary prescriptions of antibiotics [98,138]. Of equal concern is the high rate of prescribing of antibiotics from the 'Watch' list seen in some studies, which reached up to 33.3% of antibiotics prescribed in one study [98,139]. Having said this, Mbwasi et al (2020) found that >90% of all antimicrobial consumption in Tanzania, based on import data, was 'Access' as opposed to 'Watch' and 'Reserve' antibiotics, with the most utilization in the private versus public sectors [28].…”

“…Mean number of antibiotics prescribed per patient for a given diagnosis [63,77] % adherence to WHO/INRUD core prescribing indicators, including the number of encounters resulting in antibiotics being prescribed and whether antibiotics prescribed are on the current national EML [61,78,132] % of antibiotics prescribed adhering to current EML or STGs [116,133,134,139] % of non-recommended treatments prescribed [133] % of dosing of antibiotics within agreed ranges [133] % of patients prescribed the wrong medication [116] % of patients over-prescribed antimicrobials [98,138] % of patients prescribed antibiotics for infectious diseases including for respiratory tract infections/febrile illness (assessing over-prescribing) [91,92,[150][151][152] % of patients prescribed 'Watch' antibiotics as opposed to 'Access' antibiotics [98,137,139] Indicator-Outcome % of clinical failures in children with febrile illness [92,152] % Secondary hospitalization or death by day 30 in children aged 2-59 months with fever and cough but without life-threatening conditions [92] NB: EML = Essential Medicine List; STG = standard treatment guidelines.…”