Predictors of antibiotic use in African communities: evidence from medicines household surveys in five countries

Vialle-Valentin, Catherine; LeCates, Robert F.; Zhang, F.; Desta, A. T.; Ross‐Degnan, Dennis

doi:10.1111/j.1365-3156.2011.02895.x

Cited by 56 publications

(59 citation statements)

References 11 publications

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“…The high rate of self-medication among male respondents found in this study is contrary to previous findings [17], [18]. The ability to afford drugs from the private sector could have influenced the high rate of non-prescription use of drugs among males found in this study [20] as majority of the medicines used in self-medication were purchased from the private sector. In most of the communities in Africa men are more economically empowered compared to females [21].…”

Section: Discussioncontrasting

confidence: 99%

Patterns and Predictors of Self-Medication in Northern Uganda

et al. 2014

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Self-medication with antimicrobial agents is a common form of self-care among patients globally with the prevalence and nature differing from country to country. Here we assessed the prevalence and predictors of antimicrobial self-medication in post-conflict northern Uganda. A cross-sectional study was carried out using structured interviews on 892 adult (≥18 years) participants. Information on drug name, prescriber, source, cost, quantity of drug obtained, and drug use was collected. Households were randomly selected using multistage cluster sampling method. One respondent who reported having an illness within three months in each household was recruited. In each household, information was obtained from only one adult individual. Data was analyzed using STATA at 95% level of significance. The study found that a high proportion (75.7%) of the respondents practiced antimicrobial self-medication. Fever, headache, lack of appetite and body weakness were the disease symptoms most treated through self-medication (30.3%). The commonly self-medicated antimicrobials were coartem (27.3%), amoxicillin (21.7%), metronidazole (12.3%), and cotrimoxazole (11.6%). Drug use among respondents was mainly initiated by self-prescription (46.5%) and drug shop attendants (57.6%). On average, participants obtained 13.9±8.8 (95%CI: 12.6–13.8) tablets/capsules of antimicrobial drugs from drug shops and drugs were used for an average of 3.7±2.8 days (95%CI: 3.3–3.5). Over half (68.2%) of the respondents would recommend self-medication to another sick person. A high proportion (76%) of respondents reported that antimicrobial self-medication had associated risks such as wastage of money (42.1%), drug resistance (33.2%), and masking symptoms of underlying disease (15.5%). Predictors of self-medication with antimicrobial agents included gender, drug knowledge, drug leaflets, advice from friends, previous experience, long waiting time, and distance to the health facility. Despite knowledge of associated risks, use of self-medication with antimicrobial drugs in management of disease symptoms is a common practice in post-conflict northern Uganda.

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Section: Discussioncontrasting

confidence: 99%

Patterns and Predictors of Self-Medication in Northern Uganda

et al. 2014

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“…The extensive antibiotic prescription/use rates during hospitalization could, in part, be driven by uncertainties in working diagnoses due to the lack of rapid point-of-care tests in our setting. 13 As reported elsewhere, 3,21,29 respiratory conditions ranked among the most frequent diagnoses linked to antibiotic prescribing.…”

Section: Antibiotic Prescription and Consumptionmentioning

confidence: 83%

Extensive Antibiotic Prescription Rate among Hospitalized Patients in Uganda: But With Frequent Missed-dose Days

Kiguba

Karamagi

Bird

2017

Annals of Global Health

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Objectives: To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients.Methods: This was a prospective cohort of consented adult inpatients admitted on the medical and gynaecological wards of the 1790 bed Mulago National Referral Hospital.Results: Overall, 79% (603/762; 95% CI: 76% -82%) of inpatients received at least one antibiotic during hospitalization while 39% (300/762; 95% CI: 36% -43%) had used at least one antibiotic in the 4 weeks pre-admission; 1985 antibiotic DDDs, half administered parenterally, were consumed in 3741 inpatient-days. Two-fifths of inpatients who received at least one of the five frequently used hospital-initiated antibiotics (ceftriaxone, metronidazole, ciprofloxacin, amoxicillin and azithromycin) missed at least one antibiotic dose-day (44%, 243/558). The per-day risk of missed antibiotic administration was greatest on day 1: ceftriaxone (36%, 143/398), metronidazole (27%, 67/245), ciprofloxacin (34%, 39/114) and all inpatients who missed at least one dose-day of prescribed amoxicillin and azithromycin. Most patients received fewer doses than were prescribed: ceftriaxone (74%, 273/371), ciprofloxacin (90%, 94/105) and metronidazole (97%, 222/230). Of prescribed doses, only 62% of ceftriaxone doses (1178/1895), 35% of ciprofloxacin doses (396/1130) and 27% of metronidazole doses (1043/3862) were administered. Seven percent (13/188) of patients on intravenous metronidazole and 6% (5/87) on intravenous ciprofloxacin switched to oral route.Conclusions: High rates of antibiotic use both pre-admission and during hospitalization were observed, with low parenteral/oral switch of hospital-initiated antibiotics. Underadministration of prescribed antibiotics was common, especially on the day of prescription, risking loss of efficacy and antibiotic resistance.

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“…It is claimed that more than 50% of drugs prescribed, sold or dispensed without following standard protocols, and the situation is more magnified in developing countries [47]. In low income countries in particular, antibiotic use is largely relied on clinical judgment without the benefit of specific diagnostic tools, which inevitably leads to rapid evolution of drug resistant strains, which is mainly due to irrational use of antibiotics [48, 49]. Likewise, according to Sosa et al antibiotic use in most of developing countries is generally unregulated, which is a prime factor for the occurrence of resistant bacterial strains [3].…”

Section: Discussionmentioning

confidence: 99%

Methicillin resistant Staphylococcus aureus in Ethiopia: a meta-analysis

et al. 2016

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BackgroundThe burden of methicillin resistant Staphylococcus aureus is a major public health concern worldwide; however the overall epidemiology of multidrug resistant strains is neither coordinated nor harmonized, particularly in developing countries including Ethiopia. Therefore, the aim of this meta-analysis was to assess the burden of methicillin resistant Staphylococcos aureus and its antibiotic resistance pattern in Ethiopia at large.MethodsPubMed, Google Scholar, and lancet databases were searched and a total of 20 studies have been selected for meta-analysis. Six authors have independently extracts data on the prevalence of methicillin resistant Staphylococcus aureus among clinical isolates of Staphylococcus aureus. Statistical analysis was achieved by using Open meta-analyst (version 3.13) and Comprehensive meta-analysis (version 3.3) softwares. The overall prevalence of methicillin resistant Staphylococcus aureus and its antibiotic resistance pattern were pooled by using the forest plot, table and figure with 95% CI.ResultsThe pooled prevalence of methicillin resistant Staphylococcus aureus was 32.5% (95% CI, 24.1 to 40.9%). Moreover, methicillin resistant Staphylococcus aureus strains were found to be highly resistant to penicillin, ampicillin, erythromycin, and amoxicillin, with a pooled resistance ratio of 99.1, 98.1, 97.2 and 97.1%, respectively. On the other hand, comparably low levels of resistance ratio were noted to vancomycin, 5.3%.ConclusionThe overall burden of methicillin resistant Staphylococcus aureus is considerably high, besides these strains showed extreme resistance to penicillin, ampicillin, erythromycin and amoxicillin. In principle, appropriate use of antibiotics, applying safety precautions are the key to reduce the spread of multidrug resistant strains, methicillin resistant Staphylococcus aureus in particular.

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Predictors of antibiotic use in African communities: evidence from medicines household surveys in five countries

Cited by 56 publications

References 11 publications

Patterns and Predictors of Self-Medication in Northern Uganda

Patterns and Predictors of Self-Medication in Northern Uganda

Extensive Antibiotic Prescription Rate among Hospitalized Patients in Uganda: But With Frequent Missed-dose Days

Methicillin resistant Staphylococcus aureus in Ethiopia: a meta-analysis

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