Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria

Abstract

BackgroundAs part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR. MethodsIn this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior six months was assessed using a Likert’s scale. KAP and prescription (Pr) scores were classified as good (score≥80%) or average/poor (score<80%). Independent predictors of good knowledge, attitude, and practice (KAPPr) were ascertained using an unconditional logistic regression model. ResultsA total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77 %, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior six months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization (WHO) reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr.ConclusionsOur study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria’s NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.

Knowledge, attitudes, and behavior regarding antibiotics, antibiotic use, and antibiotic resistance in students and health care professionals of the district of Barranquilla (Colombia): A cross-sectional survey

“…The least frequent reason being to maintain the relationship with the patient. Both indulgence and fear have been the most frequent attitudes found to influence the improper prescription of antibiotics in previous studies both in Colombia and other countries of the world [ 6 , 11 , 12 , 13 ]. It is important to note that most prescribers in the present study were general practitioners with little professional experience, which could explain this type of attitudes that influence these behaviors.…”

Antimicrobial stewardship among Nigerian children: A pilot study of the knowledge, attitude, and practices of prescribers at two tertiary healthcare facilities in Bayelsa State

“…Empirical prescribing, making antibiotic choices based on experience and not on AST, is the predominant mode of prescribing in this setting, similar to findings previously reported (30). While efforts to change this practice towards more evidence-based prescribing are established or expanding in many countries in the northern hemisphere (31,32), uptake in the southern hemisphere is low. In Nigeria, one study found that none out of 12 surveyed tertiary hospitals had a formal AMS structure (33).…”

Prevalence of knowledge, attitudes, and practices regarding antimicrobial resistance in Africa: a systematic review and meta-analysis

“…This systematic review and meta-analysis included 39 (Thriemer et al, 2013;Abera et al, 2014;Pereko et al, 2015;Simba et al, 2016;Asante et al, 2017;Farley, 2017;Genga et al, 2017;Tafa et al, 2017;El Sherbiny et al, 2018;Seid and Hussein, 2018;Mate et al, 2019;Sunusi et al, 2019;Fetensa et al, 2020;Gemeda et al, 2020;Kabba et al, 2020;Mengesha et al, 2020;Nisabwe et al, 2020;Sindato et al, 2020;Wesangula et al, 2020;Zulu et al, 2020;Aworh et al, 2021;Babatola et al, 2021;Chukwu et al, 2021;Gebeyehu et al, 2021;Geta and Kibret, 2021;Mostafa et al, 2021;Ogoina et al, 2021;Russom et al, 2021;Adegbite et al, 2022;Belachew et al, 2022;Dejene et al, 2022;Kanyike et al, 2022;Mudenda et al, 2022;Paye and McClain, 2022;Tembo et al, 2022;Abubakar and Sárváry, 2023;Davwar et al, 2023;Maarouf et al, 2023;Otieku et al, 2023) published studies involving 18,769 study subjects. The review included primary studies with a remarkably varied sample size, ranging from just 47 (Adegbite et al, 2022) to 2,477…”

“…Of the included studies, 33 were cross-sectional (Thriemer et al, 2013;Abera et al, 2014;Pereko et al, 2015;Simba et al, 2016;Asante et al, 2017;Farley, 2017;Genga et al, 2017;Tafa et al, 2017;El Sherbiny et al, 2018;Seid and Hussein, 2018;Mate et al, 2019;Fetensa et al, 2020;Gemeda et al, 2020;Mengesha et al, 2020;Nisabwe et al, 2020;Sindato et al, 2020;Zulu et al, 2020;Aworh et al, 2021;Babatola et al, 2021;Chukwu et al, 2021;Gebeyehu et al, 2021;Geta and Kibret, 2021;Mostafa et al, 2021; FIGURE 1 PRISMA flow diagram explaining selection of primary studies in Africa. 10.3389/fmicb.2024.1345145 Frontiers in Microbiology 05 frontiersin.org Ogoina et al, 2021;Russom et al, 2021;Adegbite et al, 2022;Dejene et al, 2022;Kanyike et al, 2022;Mudenda et al, 2022;Paye and McClain, 2022;Abubakar and Sárváry, 2023;Davwar et al, 2023;Maarouf et al, 2023), while six studies followed a cohort study design (Sunusi et al, 2019;Kabba et al, 2020;Wesangula et al, 2020;Belachew et al, 2022;Tembo et al, 2022;O...…”

“…10.3389/fmicb.2024.1345145 Frontiers in Microbiology 05 frontiersin.org Ogoina et al, 2021;Russom et al, 2021;Adegbite et al, 2022;Dejene et al, 2022;Kanyike et al, 2022;Mudenda et al, 2022;Paye and McClain, 2022;Abubakar and Sárváry, 2023;Davwar et al, 2023;Maarouf et al, 2023), while six studies followed a cohort study design (Sunusi et al, 2019;Kabba et al, 2020;Wesangula et al, 2020;Belachew et al, 2022;Tembo et al, 2022;Otieku et al, 2023). The study participants for the primary studies were selected by the author from various groups including health workers (Abera et al, 2014;Asante et al, 2017;Genga et al, 2017;Tafa et al, 2017;Kabba et al, 2020;Babatola et al, 2021;Chukwu et al, 2021;Ogoina et al, 2021;Adegbite et al, 2022;Kanyike et al, 2022;Mudenda et al, 2022;Paye and McClain, 2022;Tembo et al, 2022;Abubakar and Sárváry, 2023;Davwar et al, 2023), patients (Farley, 2017;El Sherbiny et al, 2018;Geta and Kibret, 2021;Otieku et al, 2023), Tertiary school students (Thriemer et al, 2013;Seid and Hussein, 2018;Sunusi et al, 2019;Fetensa et al, 2020;Nisabwe et al, 2020;…”