Abstract
Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.
Highlights
Antimicrobial resistance (AMR) is a threat to global health and sustainable development, with adverse health and economic consequences, unless evidence-based efforts are implemented to control its emergence and spread [1,2]
66% of the included patients were in public hospitals and 34% were in private not-for-profit hospitals
Contrary to the general view that inappropriate antibiotic prescribing with respect to indication and quantity is higher in the private sector and based on a situational analysis [13], our findings showed no difference in prevalence of ceftriaxone prescribing, the percentage of guideline compliance, and mean number of antibiotics per patient, which was approximately the same when comparing the public and private-not-for-profit hospitals
Summary
Antimicrobial resistance (AMR) is a threat to global health and sustainable development, with adverse health and economic consequences, unless evidence-based efforts are implemented to control its emergence and spread [1,2]. Numerous factors contribute to the emergence of AMR [10,11,12] Among these factors is the irrational use of antibiotics in health care facilities. A key aspect of the Global Action Plan is the surveillance of antibiotic use and consumption [16]. Recognizing the importance of antibiotic use surveillance, the Uganda National Action Plan on AMR (2018–2023) includes a strategic objective on surveillance of antibiotic use and consumption [17]. A key barrier to implementing this National Action Plan is the lack of current data and surveillance processes to monitor antibiotic use throughout the country, within health facilities. To further strengthen antibiotic use surveillance at health facilities in resource-constrained countries, the WHO developed a standardized point prevalence survey (PPS) template and an associated package of tools which permit uniform collection and comparison of data within and among countries [18]
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