Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Abstract

Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.

Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia

“…The prevalence of antibiotic use in the present study was high. Our findings are in line with a study that was conducted in Iraq though a higher prevalence (93.7%) was reported [57], 88.2% in Eswatini [58], slightly lower prevalence (82.3%) in Pakistan [35], 74% in Uganda [59], and 60.6% in Ethiopia [60]. These findings are higher than the reference value of less than 30% recommended by the WHO [31] [32].…”

“…Ghana [28], and Uganda [59]. On the contrary, In China, a study revealed that most antibiotics consumed in healthcare facilities belonged to the Watch group [67].…”

Antibiotic Prescribing Patterns in adult patients according to the WHO AWaRe Classification: A multi-facility cross-sectional study in primary healthcare hospitals in Zambia

“…Our study revealed that most prescribed antibiotics belonged to the Access group. These ndings corroborate reports from a point prevalence survey across six hospitals in Tanzania that revealed that most patients received antibiotics from the Access group [61], similar to what was reported in Eswatini [53], Ghana [26], and Uganda [54]. On the contrary, In China, a study revealed that most antibiotics consumed in healthcare facilities belonged to the Watch group [62].…”

“…Similar ndings were reported in other surveys where the overall compliance with the outlined prescribing guidelines was suboptimal [52,64,65]. Lower adherence to treatment guidelines was reported in Uganda [54]. Non-adherence to the standard treatment guidelines of infectious diseases may be due to the absence of these guidelines in healthcare facilities [33,54], out of stock of key antibiotics [55], prescriber preferences, lack of e cient laboratory services and lack of proper diagnostic stewardship [54].…”

Identifying and Addressing Challenges to Antimicrobial Use Surveillance in Low- and Middle-Income Countries: Experiences & Lessons Learned from Tanzania and Uganda

“…Non-prescribed antibiotics are known to increase inappropriate of antibiotics and increase global use and misuse (34), with the highest non-prescription use found in LMICs, at between 19-100% in some cases (35). Coupled with poor adherence to treatment guidelines in Uganda (17), this practice compounds access to unauthorized parallel markets for antibiotics (36), making AMU surveillance more problematic. Uganda has recently assessed policies and regulations on antibiotic stewardship -a key WHO Benchmark activity, with the activity ongoing in Tanzania.…”