Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo

Abstract

ObjectivesThe objective of this study was to address the knowledge gap regarding antibiotic use in Medecins Sans Frontiéres (MSF) projects located in Africa by exploring antibiotic prescription and consumption habits and their drivers at different healthcare levels.DesignThis study used an exploratory study design through thematic analysis of semistructured, in-depth interviews, focus group discussions (FGDs) and field observations in order to understand the main drivers influencing current antibiotics prescription habits and consumption habits of patients in different geographical settings.SettingThe study took place in MSF centres and towns across four countries: Guinea-Bissau, Central African Republic (CAR), Democratic Republic of Congo (DRC) and Sudan.Participants384 respondents participated in the study, which includes project staff, prescribers, community members, patients, among other groups.ResultsTreatment protocols were physically present in all countries except DRC, but compliance to protocols varied across contexts. A failing health system and barriers to accessing healthcare were perceived as major drivers of overuse and inconsistent prescription practices. Patient demands influenced prescription decisions, and self-medication was commonly reported in the context of failing health systems. Additionally, there was a strong demand for quick cures and communities preferred injections over pills. Patients tended to stop antibiotic treatment once symptoms abated and had major gaps in understanding antibiotic intake instructions and functions.ConclusionsWhile there were specific findings in each context, the larger trend from these four MSF projects in Africa indicates widespread use of antibiotics based on unclear assumptions, which are often influenced by patient demands. There needs to be a broader focus on the balance between access and excess, especially in such fragile contexts where access to healthcare is a real challenge.

Access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda: a qualitative study

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Exploring factors for antibiotic over-prescription in children with acute upper respiratory tract infections in Assiut, Egypt: a qualitative study

“…In that study, healthcare providers acknowledged consciously prescribing higher-than-recommended amounts of antibiotics due to the scarcity of follow-up visits, which were typically conducted just when patients were in critical condition. This difficulty in adopting a “wait-and-see” approach was attributed to the limited availability of follow-up care [ 41 , 42 ].…”

Determinants of clinician and patient to prescription of antimicrobials: Case of Mulanje, Southern Malawi

“…In Africa, factors that influence the prescribing of antibiotics by general practitioners (GPs) include patients' demands for antibiotics, prescribing antibiotics to save time due to the perception that it takes longer to explain why antibiotics are not needed, concerns that the patient may not return for follow up, uncertainty in the diagnosis where antibiotics may be warranted, concerns about possible complications, preservation of the doctor-patient relationship, and knowledge and attitudes to AMR [10,11].…”