Burden of upper respiratory tract infections in primary care facilities and excessive antimicrobial over-prescription: A community-oriented primary care project in rural Kenya.

Nelson Nyamu,Michaela Mantel,Fleur O De Meijer,Pieter Van Den Hombergh,Felix Agoi,Jacob Shabani,Simone Jaarsma,Florence Mbatia

doi:10.4102/phcfm.v13i1.3107

Abstract

During their community oriented primary care (COPC) rotation in rural coastal Kenya, residents of the Family Medicine programme at the Aga Khan University–Nairobi, identified a high burden of upper respiratory tract infections (URTI) in the dispensaries with high prescription of antimicrobials (AMs) in over 80% of the patients presenting with URTI. An interactive participatory education intervention, designed based on principles of community participation and capacity building, reduced AM prescription in the under 5-year age group with 44% in the 2 weeks after the intervention, and with 18% at week 8 and 9. In the over 5-year age group, this was reduced with 18% and 8%, respectively. Key challenges for upholding AM stewardship after the intervention included the high patient workload in the clinics, difficulties in addressing patient’s concerns regarding the prognosis, inaccessibility to ingredients for home therapies, and easy availability of AMs without prescription at local chemists. Interventions addressing improper prescription at the facility level should include provision of continuous training, including communication training, for health facility staff, as well as audits on prescription practices. Collaboration with Community Health Volunteers (CHVs) can help in increasing community awareness on antimicrobial resistance (AMR). This study demonstrates the value of family physicians in clinical governance and improving the quality of care through implementation of guidelines and training. Joint action with the Kilifi county Ministry of Health and the private sector is needed to address mal-regulated access to AMs beyond health facility control.

Highlights

Antimicrobial resistance (AMR) is a global health problem with dire consequences for African countries as many first-line treatments for diseases, such as malaria, tuberculosis (TB) and human immunodeficiency virus (HIV)-related opportunistic infections, will no longer be effective and will inevitably increase the cost of care with second-line agents.[1]
To evaluate whether patients presenting with upper respiratory tract infections (URTI) could be managed conservatively, family medicine residents and supervising faculty participated in the care of patients during a period of 6 weeks
Factors known to influence prescribing practices for URTI in primary care (PC) include varied knowledge on AMR amongst lower level healthcare workers working at first line facilities, absence of diagnostic tests to guide clinical decision-making, and shortage of healthcare personnel.[4,5,6]

Summary

Introduction

Antimicrobial resistance (AMR) is a global health problem with dire consequences for African countries as many first-line treatments for diseases, such as malaria, tuberculosis (TB) and human immunodeficiency virus (HIV)-related opportunistic infections, will no longer be effective and will inevitably increase the cost of care with second-line agents.[1]. To evaluate whether patients presenting with URTI could be managed conservatively, family medicine residents and supervising faculty participated in the care of patients during a period of 6 weeks.

Results

Conclusion