Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria

Stella Rotifa,Daniel Otokpa,Micheal Iroezindu,Uche Sonny Unigwe,Zaiyad Garba Habib,Abisoye Sunday Oyeyemi,Dalhat Mahmood,Emmanuel Effa,Garba Iliyasu,Akan Otu,Mukhtar Abdulmajid Adeiza,Abdulrazaq Garba Habib,Iorhen Ephram Akase,Olukemi Adekanmbi,Farouq Muhammad Dayyab,Dimie Ogoina,Shamsudin Aliyu,Vivian Kwaghe,Juliet Ijeoma Mmerem

doi:10.1186/s13756-021-00940-9

Abstract

BackgroundAs part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR.MethodsIn this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert’s scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score < 80%). Independent predictors of good knowledge, attitude, and practice (KAPPr) were ascertained using an unconditional logistic regression model.ResultsA total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77%, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior 6 months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr.ConclusionsOur study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria’s NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.

Highlights

The discovery of antibiotics has completely revolutionized medical practice and led to a decrease in the morbidity and mortality due to infectious diseases across the globe [1]
At the 68th World Health Assembly, which held in May 2015, member countries endorsed a Global Action Plan (GAP) against antimicrobial resistance (AMR) [5]
We aimed to determine the KAP of antibiotic prescriptions (APR) and AMR, and identify sociodemographic, educational, institutional, and professional factors that may be associated with good KAP of APR and AMR among physicians in tertiary hospitals across all six geopolitical zones of Nigeria

Summary

Introduction

The discovery of antibiotics has completely revolutionized medical practice and led to a decrease in the morbidity and mortality due to infectious diseases across the globe [1]. At the 68th World Health Assembly, which held in May 2015, member countries endorsed a Global Action Plan (GAP) against AMR [5]. This plan required all countries to develop and implement a National Action Plan for Antimicrobial Resistance (NAPAR). The World Health Organization (WHO) is advocating that member countries adopt and implement the revised Model List of Essential Medicines which grouped antibiotics into the Access, Watch and Reserve (AWaRe) categories [6]. As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR

Objectives

Methods

Results

Discussion

Conclusion