Antibiotic Prescribing Patterns in Ghana, Uganda, Zambia and Tanzania Hospitals: Results from the Global Point Prevalence Survey (G-PPS) on Antimicrobial Use and Stewardship Interventions Implemented.

Nikki D’Arcy,Sudaxshina Murdan,Peter Benedict,Ines Pauwels,Caoimhe Murray,Freddy Eric Kitutu,Josephyn Hoyelah,Mariyam Mirfenderesky,Omotayo Olaoye,Appiah-Korang Labi,Jacqueline Sneddon,Joseph Brayson,Ismail Musoke Kizito,Cornelius C Dodoo,Claire Brandish,William J’Pathim Olum,Zainab Akello,Daniel Ankrah,Edwin Panford-Quainoo,Yogini Jani,Ann Versporten,Derrick Mawuena Asima,Frances Garraghan,Daniel Kwame Afriyie ,David Agamemnon Banda ,Israel Abebrese Sefah ,Scott M Barrett ,Anja St Clair Jones ,Noah Obeng‐Nkrumah ,Diane Ashiru‐Oredope ,Japheth A Opintan

doi:10.3390/antibiotics10091122

Abstract

Antimicrobial resistance (AMR) remains an important global public health issue with antimicrobial misuse and overuse being one of the main drivers. The Global Point Prevalence Survey (G-PPS) of Antimicrobial Consumption and Resistance assesses the prevalence and the quality of antimicrobial prescriptions across hospitals globally. G-PPS was carried out at 17 hospitals across Ghana, Uganda, Zambia and Tanzania. The overall prevalence of antimicrobial use was 50% (30–57%), with most antibiotics prescribed belonging to the WHO ‘Access’ and ‘Watch’ categories. No ‘Reserve’ category of antibiotics was prescribed across the study sites while antimicrobials belonging to the ‘Not Recommended’ group were prescribed infrequently. Antimicrobials were most often prescribed for prophylaxis for obstetric or gynaecological surgery, making up between 12 and 18% of total prescriptions across all countries. The most prescribed therapeutic subgroup of antimicrobials was ‘Antibacterials for systemic use’. As a result of the programme, PPS data are now readily available for the first time in the hospitals, strengthening the global commitment to improved antimicrobial surveillance. Antimicrobial stewardship interventions developed included the formation of AMS committees, the provision of training and the preparation of new AMS guidelines. Other common interventions included the presentation of findings to clinicians for increased awareness, and the promotion of a multi-disciplinary approach to successful AMS programmes. Repeat PPS would be necessary to continually monitor the impact of interventions implemented. Broader participation is also encouraged to strengthen the evidence base.

Highlights

Antimicrobial resistance (AMR) is a global, public, and individual health challenge affecting the delivery of safe, effective healthcare in all settings and all countries
This paper aims to compare national data on antimicrobial use obtained from 12 hospitals across four countries (Ghana (6), Uganda (4), Zambia (1) and Tanzania (1)) and identify target points for improvement
Eight hospitals were classed as teaching hospitals, three in both Uganda and Ghana and one in both Zambia and Tanzania

Summary

Introduction

Antimicrobial resistance (AMR) is a global, public, and individual health challenge affecting the delivery of safe, effective healthcare in all settings and all countries. AMR leads to increased mortality rates [3] and duration and cost of patient care [1]. This is of particular concern in low- and middle-income countries (LMICs) due to the reduced availability of appropriate equipment and/or appropriate diagnostic tools, as well as challenges with access to quality antimicrobials [4,5,6,7]. Surveillance of antimicrobial use and resistance are core to all AMS activities and understanding how antimicrobials are used allows for a review of current practices and highlights areas for improvement. Point prevalence surveys (PPSs) are a widely recognised surveillance method requiring limited resources to collect information on antimicrobial prescribing practices and other relevant factors in hospitalized patients [8,9,10,11]

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