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High Prevalence of Antimicrobial Prescribing Among Public Health Facilities in Central Uganda: Findings from Point
Herbert Bush Aguma1, David Musoke2, Grace Biyinzika Lubega2
1Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
Insights
Antimicrobial resistance is a global crisis, with Sub-Saharan Africa heavily impacted. This study in Uganda found high antimicrobial prescribing rates, indicating a need for better stewardship and adherence to treatment guidelines to combat resistance.
Area of Science:
- Global health security
- Infectious disease epidemiology
- Pharmacovigilance
Background:
- Antimicrobial resistance (AMR) poses a significant global health threat, disproportionately affecting Sub-Saharan Africa.
- Uganda faces high rates of antimicrobial prescribing and inappropriate use in healthcare facilities.
- Targeted interventions are crucial to address the drivers of AMR.
Purpose of the Study:
- To assess antimicrobial prescribing patterns in central Ugandan health facilities.
- To identify areas for improvement in antimicrobial stewardship.
- To evaluate compliance with standard treatment guidelines.
Main Methods:
- Utilized the Global Point Prevalence Survey (GPPS) methodology.
- Collected data from eight public health facilities (3 hospitals, 5 lower-level) in central Uganda (Feb-Apr 2024).
- Gathered data on patient demographics, antimicrobial therapy, and guideline compliance.
Main Results:
- High inpatient antimicrobial use (87.2%), with ceftriaxone most common.
- Prophylactic use dominated (30.7%), especially for obstetric/gynecological surgery.
- Outpatient antimicrobial use was 60.7%, with amoxicillin most frequent for upper respiratory tract infections (45.1%).
- Standard treatment guideline compliance was 50.5% in hospitals.
Conclusions:
- High antimicrobial prescribing necessitates enhanced stewardship practices.
- Compliance with guidelines varied, being lower in hospitals than lower-level facilities.
- Interventions should target broad-spectrum antibiotic use, prolonged prophylaxis, and inappropriate prescriptions for URTI.
Background:
Antimicrobial resistance (AMR) is the number one cause of death globally, and Sub-Saharan Africa bears the most significant burden. Previous studies conducted in Uganda have revealed high rates of antimicrobial prescribing in hospitals, with evidence of widespread inappropriate use, which necessitates the development of targeted interventions. The inappropriate use of antimicrobials is a driver of AMR. We conducted point-prevalence surveys of antimicrobial prescribing in selected health facilities in central Uganda to identify areas for improvement.
Methods:
The study utilised the Global Point Prevalence Survey (GPPS) to collect data on antimicrobial prescribing among eight public health facilities in Central Uganda from February to April 2024. Both inpatient and outpatient data were collected in three hospitals and five lower-level health facilities, respectively. The data collection tools adopted from GPPS were employed. Data were collected on patient demographics, antimicrobial therapy details, and compliance with standard treatment guidelines.
Results:
The overall prevalence of antimicrobial use among inpatients at the hospitals was 87.2%, and ceftriaxone was the most frequently prescribed antimicrobial, accounting for 30.6% of the prescriptions. Prescriptions for prophylactic use were the most predominant, with prophylaxis for obstetric and gynaecological surgery accounting for 30.7% of the prescriptions. The prevalence of antimicrobial use among outpatients at lower-level health facilities was 60.7%. Amoxicillin was the most prescribed antimicrobial across the sites, accounting for 39.1% of the prescriptions. Upper respiratory tract infections accounted for most prescriptions (45.1%). Standard treatment guideline compliance was nearly half (50.5%) among hospitals, with variations observed among the different study sites.
Conclusion:
A high prevalence of antimicrobial prescribing was observed, highlighting the need to enhance antimicrobial stewardship practices in health facilities. Compliance with standard treatment guidelines was average among hospitals but high among the lower-level health facilities. Some of the potential areas for stewardship interventions include broad-spectrum antibiotic prescriptions, prolonged antibiotic prophylactic courses, and inappropriate prescription of antibiotics for upper respiratory tract infections.
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