Prevalence and Predictors of Antibiotic Prescriptions at Primary Healthcare Facilities in the Dodoma Region, Central Tanzania: A Retrospective, Cross-Sectional Study

Abstract

Background: Accelerated by the misuse or overuse of antibiotics, antibiotic resistance remains a global public health threat. We report the prevalence and predictors of antibiotic prescriptions in primary healthcare facilities in Dodoma, Tanzania. Methods: This retrospective cross-sectional study by medical records review was conducted in the Dodoma region, Central Tanzania. Results: In this study, children < 5 years accounted for over 45% (474/1021) of the patients consulted. The majority, 76.3% (779/1021), of consultations had an antibiotic prescribed; amoxicillin and cotrimoxazole were the most prescribed. Over 98% (766/779) of the antibiotics prescribed were on the National Essential Medicines List, but only 45% (429/779) of the antibiotic prescriptions adhered to the Standard Treatment Guidelines. The prescribing of antibiotics by clinical officers was almost 2.55 times higher than that among medical doctors (Odds Ratio (OR) = 2.546; 95% Confidence Interval (CI): 1.359, 4.769; p = 0.0035). Patients with pneumonia and upper respiratory tract infection were 15.9 (OR = 15.928; 95% CI: 2.151, 17.973; p = 0.0067) and 2 (OR = 2.064; 95% CI: 1.184, 3.600; p = 0.0106) times more likely to be prescribed antibiotics, respectively. Conclusions: We, therefore, report high rates of antibiotic prescriptions, poor adherence to standard treatment guidelines and high levels of antibiotic prescribing practices among prescribers with a diploma in clinical medicine.

A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications

“…Encouragingly, when antibiotics were prescribed, these were typically from the 'Access' list as opposed to the 'Watch' list, with little or no evidence of prescriptions antibiotics from the 'Reserve' list [131,132,134,136]. This is similar to the findings of Mbwasi et al (2020), who found that >90% of all antimicrobial consumption in Tanzania, based on import data, was 'Access' as opposed to 'Watch' and 'Reserve' antibiotics [28].…”

“…The findings in this study highlight considerable issues and concerns regarding the current prescribing practices of antibiotics across the sectors, which can include the excessive prescription of 'Watch' antibiotics in private care settings [74,116,134,137,139]. However, encouragingly, this is generally not the case in Tanzania, with import data showing that 83.1% of imported antibiotics in recent years are from the 'Access' group versus only 10.1% from the 'Watch' group and <0.01% from the 'Reserve' group [27].…”

“…Wiedenmayer et al ( 2021), in their study among 120 public facilities, emphasized the importance of managing patients with infectious diseases appropriately in Tanzania with only a limited number of patients (1.2%) presenting with non-communicable diseases (NCDs) [116]. This may be why there has been appreciable prescribing of antibiotics in public ambulatory care facilities in Tanzania (Table 3) despite often limited evidence for their appropriateness [60,[130][131][132][133][134]. However, in their study, Acam et al (2023) ascertained that overall only 40% of patient encounters resulted in an antimicrobial being prescribed [78], which was lower than that among healthcare facilities in Ethiopia (63%), Sudan (62%), and Kenya (54%).…”

“…These are contained in Table 6. Documented prescribing and quality indicators can be part of future ASPs in Tanzania, with for example adherence to guidelines increasingly seen as providing good quality care in Tanzania and beyond [34,133,134]. Table 6.…”

“…Mean number of antibiotics prescribed per patient for a given diagnosis [63,77] % adherence to WHO/INRUD core prescribing indicators, including the number of encounters resulting in antibiotics being prescribed and whether antibiotics prescribed are on the current national EML [61,78,132] % of antibiotics prescribed adhering to current EML or STGs [116,133,134,139] % of non-recommended treatments prescribed [133] % of dosing of antibiotics within agreed ranges [133] % of patients prescribed the wrong medication [116] % of patients over-prescribed antimicrobials [98,138] % of patients prescribed antibiotics for infectious diseases including for respiratory tract infections/febrile illness (assessing over-prescribing) [91,92,[150][151][152] % of patients prescribed 'Watch' antibiotics as opposed to 'Access' antibiotics [98,137,139] Indicator-Outcome % of clinical failures in children with febrile illness [92,152] % Secondary hospitalization or death by day 30 in children aged 2-59 months with fever and cough but without life-threatening conditions [92] NB: EML = Essential Medicine List; STG = standard treatment guidelines.…”