Ongoing initiatives to improve the use of antibiotics in Botswana: University of Botswana symposium meeting report

Tiroyakgosi, Celda; Matome, Matshediso; Summers, Emily J.; Mashalla, Yohana; Paramadhas, Bene Anand; Souda, Sajini; Malone, Brighid; Sinkala, Fatima; Kgatlwane, Joyce; Godman, Brian; Mmopi, Keneilwe; Massele, Amos

doi:10.1080/14787210.2018.1467756

Cited by 30 publications

(41 citation statements)

References 14 publications

(15 reference statements)

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“…This is again very different to high income countries where typically expenditure on pharmaceuticals is 15% or less of total healthcare expenditure and there is often universal healthcare 176,177 . There can also be long waiting times to see physicians in primary healthcare centres (PHCs) in LMICs, as well as long distances to travel to PHCs, putting time pressures on physicians as well as patients to seek alternative approaches including community pharmacists and private physicians 49,69,98,[178][179][180][181][182] .…”

Section: Methodsmentioning

confidence: 99%

“…Successful initiatives typically target all key stakeholder groups, are usually country specific, take into account issues of culture as well as the availability, access and affordability to physicians and medicines, and are evidence based 29,52,243 . Given continuing concerns with AMR rates, activities and strategies to improve future prescribing and dispensing of antibiotics for URTIs will grow in all countries, including LMICs, as they develop and monitor their antibiotic prescribing as part of their national action plans (NAPs) 66,180,240,242,[249][250][251][252] , with 'essential medicine' policies typically associated with lower antibiotic prescribing in LMICs 119 .…”

Section: Ongoing and Potential Strategies To Reduce Inappropriate Prementioning

confidence: 99%

“…Typical activities include documenting current antibiotic utilization and resistance rates alongside planning educational, monitoring and other activities among all key stakeholder groups. Such LMICs include Botswana, Ghana (Table 2), Kenya, Kosovo, Malaysia, Nigeria, Pakistan, Swaziland, Vietnam and Zimbabwe 72,180,251,252,[254][255][256][257] .…”

Section: Malaysiamentioning

confidence: 99%

“…There are also planned activities in Botswana and Namibia to develop pertinent quality indicators for assessing the quality of prescribing of antibiotics in ambulatory care given concerns with the WHO/INRUD (International Network for the Rational Use of Drugs) indicators as well as concerns with the extent of prescribing of antibiotics for URTIs among private general practitioners in Botswana 180,232,270,271 . This builds on discussions of possible quality indicators to influence future prescribing of antibiotics in other LMICs 272 .…”

Section: Malaysiamentioning

confidence: 99%

“…Prescribing practices for patients with respiratory tract infections among LMICs. under five in eight LMICs were reported to have either a cough or fever in the past two weeks, with 86% of young children attending health facilities being prescribed an antibiotic (amoxicillin -38.0%, cotrimoxazole 27.8%) for their respiratory infection183 Botswana 72.9% of ambulatory care patients in the private sector had at least one antibiotic dispensed for a URTI180,232 .ChinaAmong physicians working in rural China, the antibiotic prescription rate for children with URTIs was 84% before multiple interventions to reduce inappropriate prescribing 88 Ghana…”

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confidence: 99%

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Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Godman

Haque

McKimm

et al. 2019

Current Medical Research and Opinion

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170

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Section: Methodsmentioning

confidence: 99%

Section: Ongoing and Potential Strategies To Reduce Inappropriate Prementioning

confidence: 99%

Section: Malaysiamentioning

confidence: 99%

Section: Malaysiamentioning

confidence: 99%

mentioning

confidence: 99%

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Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Godman

Haque

McKimm

et al. 2019

Current Medical Research and Opinion

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126

170

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Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

et al. 2020

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Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.

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Snapshot of antimicrobial stewardship programs in the hospitals of Pakistan: findings and implications

Saleem

Hassali

Hashmi

et al. 2019

Heliyon

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Objective We are unaware of the extent of antimicrobial stewardship programs (ASPs) among hospitals in Pakistan, which is a concern given the population size, high use of antibiotics across sectors and increasing antimicrobial resistance (AMR) rates. Consequently, we sought to address this by undertaking a comprehensive survey. Method In this cross-sectional observational study in Punjab, an instrument of the measure was developed based on health care facility characteristics and ASPs after an extensive literature review . The questionnaire was circulated by mail or through drop off surveys to medical superintendents or directors/heads of pharmacy departments of hospitals. Results Out of 254, a total of 137 hospitals fully completed the questionnaire - 11 primary, 65 secondary, 46 tertiary and 15 specialized hospitals. The use of antimicrobial prescribing guidelines (68.7%), provision of infectious diseases consultation services (66.4%), clinical pharmacy service (65.7%), use of drug and therapeutics committees to approve antimicrobial prescribing (65.5%), regular audit by doctors on antimicrobial prescribing (54.1%) and use of a restricted formulary for antimicrobial (50.4%) were the most common ASPs. However, most of these activities were only somewhat or moderately successful. Whereas, electronic antimicrobial prescribing approval systems (15.3%), using a sticker to notify prescribers regarding the need to obtain approval for the antimicrobial prescribed (16.1%) and participation in the national antimicrobial utilization surveillance program (19.7%) were only seen in a few hospitals. Conclusion Study inferred that there are inadequate ASPs in the hospitals of Pakistan. A multidisciplinary approach, clinical leadership and availability of motivated and trained individuals are essential elements for the success of future ASPs.

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Ongoing initiatives to improve the use of antibiotics in Botswana: University of Botswana symposium meeting report

Abstract: A number of issues and concerns regarding antibiotic use were highlighted. Activities are ongoing across sectors to address identified concerns.

Cited by 30 publications

References 14 publications

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

Snapshot of antimicrobial stewardship programs in the hospitals of Pakistan: findings and implications

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