Irrational use of antibiotics in the Moshi Municipality Northern Tanzania: a cross sectional study

Mboya, Erick Alexander; Sanga, Leah Anku; Ngocho, James Samwel

doi:10.11604/pamj.2018.31.165.15991

Cited by 89 publications

(91 citation statements)

References 26 publications

(49 reference statements)

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“…42 The relationship between the lower level of knowledge about antibiotic use and parental/caregiver SMA to under-fives is straightforward. 43 When a patient or a treatment-supporter has the correct knowledge relating to a treatment plan and type of medication, the patient is more likely to improve or to be cured.…”

Section: Discussionmentioning

confidence: 99%

<p>Prevalence and Factors Associated with Parents Self-Medicating Under-Fives with Antibiotics in Bagamoyo District Council, Tanzania: a Cross-Sectional Study</p>

Simon¹,

Kazaura²

2020

PPA

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Background: Self-medication with antibiotics (SMA) is a global problem. This extends to medication of under-fives by their parents. In particular, there is currently insufficient information for this problem. Purpose: To determine the proportion and factors associated with medication of under-fives with antibiotics by their parents. Materials and Methods: A cross-sectional study among parents/caregivers of under-fives in 30 hamlets/streets of Bagamoyo District Council, in Tanzania was conducted between July and August, 2019. Respondents were the under-fives' parents/caregivers aged at least 18 years selected from households using probability proportional to a size cluster-sampling method. Respondents were required to report whether or not the under-fives had been unwell within the past 12 months and to describe the type or specific name of any medicine administered to their child. We used descriptive and analytical procedures to analyze the data. Results: The study included 730 parents/caregivers of under-fives. Their mean age was 32.2 (SD=7.4) years. The majority 668 (91.5%) were biological mothers and 574 (78.6%) having completed primary education. The proportion of parental SMA to under-fives was 47.7% (95% CI=43.7, 51.8). Knowledge on the appropriate use of antibiotics among parents was low. The most commonly used antibiotic was amoxicillin, 181 (62.0%). Independent factors associated with parental SMA to under-fives were average household income, distance to the nearest health facility, knowledge about use of antibiotics and the parent/caregiver's awareness of prescription-only medicines (POMs). Conclusion: Since the prevalence of SMA by parents to under-fives in Bagamoyo District is high, there is a need for health systems to enhance those measures that would control the sale of antibiotics without prescriptions. In addition, more than half of all study participants have a minimal understanding of the use of antibiotics and are unaware of POMs. Findings indicate a need to have routine continuous health education at the community level about the use of antibiotics.

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Section: Discussionmentioning

confidence: 99%

<p>Prevalence and Factors Associated with Parents Self-Medicating Under-Fives with Antibiotics in Bagamoyo District Council, Tanzania: a Cross-Sectional Study</p>

Simon¹,

Kazaura²

2020

PPA

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“…Although there may be valid reasons for treating conditions, such as upper respiratory tract infection and diarrhoea, the high percentage of prescribing suggests antibiotics were being used inappropriately, as has been observed both anecdotally and in other studies. [27][28][29] Among diagnoses, respiratory conditions had the highest percentage of antibiotic prescription. However, many children were prescribed antibiotics for conditions for which they are not usually indicated, including undifferentiated fever, diarrhoea and malaria.…”

Section: Researchmentioning

confidence: 99%

Measuring antibiotic availability and use in 20 low- and middle-income countries

Knowles

Sharland

Hsia

et al. 2020

Bull. World Health Organ.

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Objective To assess antibiotic availability and use in health facilities in low-and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys. Methods We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization's AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated. Findings The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160). Conclusion Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low-and middleincome countries. Many access antibiotics were unavailable in a majority of most health-care facilities.

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“…It has been documented that the Enteroccoci are intrinsically resistant to clindamycin, which could explain the observed resistant pattern (8,28). Being normal flora of the gastrointestinal tract with frequent contact to antibiotics which are, in high rate misused, could increase the proportion of resistant Enterococci (9,29,30). Also, the previous use of clindamycin as additive drug to quinine for treatment of uncomplicated malaria in pregnant could have accelerated the resistance of this antibiotic (31).…”

Section: Discussionmentioning

confidence: 99%

“…The high proportion of resistant Gram negative bacteria to fourth generation cephalosporin (cefepime) could be suggestive of bacteria adaptive mechanisms by cross-resistance between generations of the same antibiotic class (32). The overuse and irrational use of antibiotics especially third generation cephalosporin (ceftriaxone) could contribute to failure of subsequent cephalosporin generations (29,30,33).…”

Section: Discussionmentioning

confidence: 99%

The high resistance of bacteria to clindamycin and cefepime: a call to revisit antibiotics reserved for use at tertiary hospitals in Tanzania

Mikomangwa

Bwire

Kilonzi

et al. 2020

Preprint

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Background Antibiotic resistance poses burden to the community and health care services. Efforts are being made at local, national and global level to combat the rise of antibiotic resistance including antibiotic stewardship. Surveillance to antibiotic resistance is of importance to aid in planning and implementing infection prevention and control measures. The study was conducted to assess the resistance pattern to cefepime, clindamycin and meropenem, which are reserved antibiotics for use at tertiary hospitals in Tanzania Methods A Hospital-based antibiotic resistance surveillance was conducted between July and November 2019 using 201 consecutively selected clinical isolates at Muhimbili National Hospital and Bugando Medical Center, Tanzania. All organisms isolated were identified based on colony morphology, Gram staining and relevant biochemical tests. Antibiotic susceptibility testing was performed on Muller-Hinton agar using Kirby-Bauer disc diffusion method. Antibiotic susceptibility on the selected antibiotic discs (cefepime, clindamycin and meropenem) was performed according to the protocol by National Committee for Clinical Laboratory Standards. Results A total of 201 clinical samples were tested in this study. Urine (39.8%, n=80) and blood (35.3%, n=71) accounted for most of the collected samples followed by pus (16.9%, n=34). The overall bacterial resistance to clindamycin, cefipime and meropenem was 70.1%, 72.4% and 8.5% respectively. Most (88.9%) of Enterococcus spp were resistant to clindamycin. About 68.4% Staphylococcus aureus isolates were resistant to clindamycin whereby 56.3%, 75.6%, 93.8% and 100% of the tested Escherichia coli , Klebsiella spp , Pseudomonas aeruginosa and Enterobacter cloacae respectively, were cefepime resistant. About 8.5% of isolated Klebsiella spp were resistant and 6.4% had intermediate susceptibility to meropenem. Also , Pseudomonas aeruginosa was resistant by 31.2% and 25% had intermediate susceptibility to meropenem. All Acinetobacter baumannii and Proteus spp (both 100.0%, n=4) were susceptible to meropenem. Conclusion The overall bacterial resistance to clindamycin and cefepime is high and low in meropenem. Henceforth, culture and susceptibility results should be used to guide the use of these antibiotics. Antibiotics with low resistance rate should be introduced to the reserve category and continuous antibiotic surveillance is warranted.

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Irrational use of antibiotics in the Moshi Municipality Northern Tanzania: a cross sectional study

Cited by 89 publications

References 26 publications

<p>Prevalence and Factors Associated with Parents Self-Medicating Under-Fives with Antibiotics in Bagamoyo District Council, Tanzania: a Cross-Sectional Study</p>

<p>Prevalence and Factors Associated with Parents Self-Medicating Under-Fives with Antibiotics in Bagamoyo District Council, Tanzania: a Cross-Sectional Study</p>

Measuring antibiotic availability and use in 20 low- and middle-income countries

The high resistance of bacteria to clindamycin and cefepime: a call to revisit antibiotics reserved for use at tertiary hospitals in Tanzania

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