Abstract
BackgroundAntimicrobial resistance (AMR) is a global problem compromising the effective treatment of infectious diseases. The World Health Organization (WHO) is encouraging and promoting awareness creation among health workers as one of its strategies to reduce the rate of emergence and transmission of AMR. Available data on the prescribing behavior of healthcare workers (HCWs) in Nigeria remains incomplete. This study was designed to provide an up-to-date estimate of the knowledge, attitude and antibiotic prescribing behavior of HCWs in Nigeria.MethodsThis is a cross-sectional study. Self-administered questionnaires were distributed to healthcare workers selected from six states, one each from the 6 geopolitical zones in Nigeria. A multi-stage sampling technique was used to reflect the three tiers of healthcare: primary, secondary and tertiary levels. Quantitative data was summarized using descriptive statistics. All data analysis was done using the Statistical package for social sciences version 26.0.ResultsOf the 420 questionnaires distributed, 358 (85.2%) responded. The mean year of practice of the respondents was 9.32 ± 7.8 years. About a half (50.3%) agreed that their prescribing behavior could promote antimicrobial resistance. 49.2% had a good knowledge of AMR and physicians had significantly better knowledge than other HCWs (X2 = 69.59, P < 0.001). Several participants prescribed antibiotics for common viral infections such as sore throats (75.7%), measles (37.7%), common cold and flu (21.2%). Over 60.3% admitted prescribing antibiotics just to be on the safe side. In general, 70.9% of the respondents frequently or moderately use practice guidelines while 25.7% often apply the delayed antibiotic prescription (DAP) strategy to reduce antimicrobial prescription.ConclusionThis study reveals an overall moderate level of knowledge of AMR and attitude towards minimizing the emergence of antimicrobial resistance though this did not translate significantly to practice. Further efforts must be made in order to improve rational prescription of antimicrobials among HCWs in Nigeria.
Highlights
Improving awareness and understanding of antimicrobial resistance (AMR) among the public, health professionals, policy makers and agricultural professionals is one of the key strategies of the global and national action plans to combat Antimicrobial resistance (AMR) and delay further emergence and spread of resistance [1]
Allied healthcare professionals (Others) were less likely to agree that the topic of antimicrobial resistance was relevant to their daily work (Table 2) while Healthcare workers in SHCs were more likely to believe that the subject of antimicrobial resistance was highly or moderately relevant to their daily work than their colleagues in tertiary health care centers (THC) (Table 2), When assessed for the level of knowledge on AMR, 176 (49.2%) and 169(47.2%) had good and fair knowledge respectively while 13(3.6%) had poor knowledge
Using a multi-selection approach, majority of the respondents identified Antibiotic intake by patients (83.2%) and Antibiotic prescription by doctors (82.4%) as the major sectors to be targeted to slow down the development of AMR (Fig. 1)
Summary
Improving awareness and understanding of antimicrobial resistance (AMR) among the public, health professionals, policy makers and agricultural professionals is one of the key strategies of the global and national action plans to combat AMR and delay further emergence and spread of resistance [1]. Delayed prescribing is encouraged especially in primary care, and involves the prescription of antibiotics for a patient, to be taken only when the patient is not feeling better or feels worse several days after hospital visit [7, 8]. The paucity of information on how healthcare professionals prescribe and dispense antimicrobials in LMICs is a significant research gap [14] and how this relates to AMR awareness should be understood in the Nigerian context, if successful strategies to contain AMR are to be developed and implemented. This study was designed to provide an up-to-date estimate of the knowledge, attitude and antibiotic prescribing behavior of HCWs in Nigeria
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