Determinants of antibiotic prescription pattern and appropriateness in paediatric care in Ghana: a generalized
Abena Kaare Aduful1, Mame Yaa Nyarko2, Margaret L Neizer1
1Princess Marie Louise Hospital, Accra, Ghana.
Insights
Antibiotic prescribing in children in Ghana is influenced by patient and prescriber factors. Understanding these links is key to improving antibiotic use and combating resistance.
Area of Science:
- Paediatric Infectious Diseases
- Antimicrobial Stewardship
- Global Health
Background:
- Antibiotic resistance is a growing global threat, particularly in low- and middle-income countries.
- Optimizing antibiotic use is crucial for effective antimicrobial stewardship.
- Limited data exists on prescribing patterns in Ghanaian paediatric outpatient settings.
Purpose of the Study:
- To investigate patient-related factors associated with antibiotic prescribing in children.
- To identify prescriber-related factors influencing antibiotic appropriateness.
- To analyze factors affecting antibiotic use in paediatric outpatient care in Ghana.
Main Methods:
- Retrospective analysis of 16,555 outpatient records (April-June 2022) at Princess Marie Louise Children's Hospital, Ghana.
- Logistic regression and generalized estimating equations used to assess associations.
- Factors examined included patient demographics, fever status, prescriber rank, and prior antibiotic use.
Main Results:
- 20% of consultations (3,244/16,555) received antibiotic prescriptions.
- Male sex linked to inappropriate prescribing; older children and fever cases less likely to receive unindicated antibiotics.
- Specialized nurses and physician assistants showed higher inappropriate use but lower use of higher-tier antibiotics compared to house officers.
Conclusions:
- Patient and prescriber characteristics significantly impact antibiotic prescribing patterns and appropriateness.
- Findings highlight the need for targeted interventions to enhance prescribing practices.
- Strengthening antimicrobial stewardship in paediatric care is essential.
Background:
Rising antibiotic resistance threatens to reverse health gains from antibiotic access, especially in low- and middle-income countries. Identifying factors influencing prescribing patterns and appropriateness is vital to optimising antibiotic use and strengthening antimicrobial stewardship. However, evidence on this in paediatric outpatient care in Ghana is limited.
Objectives:
To identify patient-related and prescriber-related factors associated with antibiotic prescribing patterns and the appropriateness of antibiotic use among paediatric patients.
Methods:
A retrospective review of outpatient records at the Princess Marie Louise Children's Hospital in Ghana was conducted from 1 April to 30 June 2022. Logistic regression and generalised estimating equations analyses were used, where appropriate, to assess associations between patient age and sex, prescriber rank, prior antibiotic use, fever status and the appropriateness of antibiotic prescribing by indication, choice, dosage, duration, antibiotic tier and multiple-antibiotic use.
Results:
Among 16 555 outpatient consultations, 3244 (20%) resulted in an antibiotic prescription, of which 2862 records were analysed. Most patients were male (54%). Male sex was associated with antibiotic prescribing when not indicated (p=0.007), whereas older children (p=0.030) and patients presenting with fever (p=0.036) were less frequently prescribed antibiotics when not indicated. Compared with house officers, specialised nurses and physician assistants were associated with inappropriate use of antibiotics (p<0.001 and p=0.005, respectively); however, they were less likely to prescribe multiple or higher-tier antibiotics. Medical officers and residents were associated with appropriate antibiotic dosing and duration (p=0.004 and p=0.005, respectively), and prior antibiotic use doubled the odds of receiving higher-tier antibiotics (p<0.001).
Conclusion:
Patient and prescriber characteristics were significantly associated with antibiotic prescribing patterns and appropriateness. Targeted interventions leveraging these findings are needed to improve prescribing and strengthen antimicrobial stewardship.
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