https://orcid.org/0000-0002-5081-1480
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Abstract
Background
Adherence to evidence-based standard treatment guidelines (STGs) enable healthcare providers to deliver consistently appropriate diagnosis and treatment. Irrational use of antimicrobials significantly contributes to antimicrobial resistance in sub-Saharan Africa (SSA). The best available evidence is needed to guide healthcare providers on adherence to evidence-based implementation of STGs. This systematic review and meta-analysis aimed to determine the pooled prevalence of adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in SSA.
Methods
The review followed the JBI methodology for systematic reviews of prevalence data. CINAHL, Embase, PubMed, Scopus, and Web of Science databases were searched with no language and publication year limitations. STATA version 17 were used for meta-analysis. The publication bias and heterogeneity were assessed using Egger’s test and the I 2 statistics. Heterogeneity and publication bias were validated using Duval and Tweedie's nonparametric trim and fill analysis using the random-effect analysis. The summary prevalence and the corresponding 95% confidence interval (CI) of healthcare professionals’ compliance with evidence-based implementation of STG were estimated using random effect model. The review protocol has been registered with PROSPERO code CRD42023389011. The PRISMA flow diagram and checklist were used to report studies included, excluded and their corresponding section in the manuscript.
Results
Twenty-two studies with a total of 17,017 study participants from 14 countries in sub-Saharan Africa were included. The pooled prevalence of adherence to evidence-based implementation of antimicrobial treatment guidelines in SSA were 45%. The pooled prevalence of the most common clinical indications were respiratory tract (35%) and gastrointestinal infections (18%). Overall prescriptions per wards were inpatients (14,413) and outpatients (12,845). Only 391 prescribers accessed standard treatment guidelines during prescription of antimicrobials.
Conclusions
Healthcare professionals’ adherence to evidence-based implementation of STG for antimicrobial treatment were low in SSA. Healthcare systems in SSA must make concerted efforts to enhance prescribers access to STGs through optimization of mobile clinical decision support applications. Innovative, informative, and interactive strategies must be in place by the healthcare systems in SSA to empower healthcare providers to make evidence-based clinical decisions informed by the best available evidence and patient preferences, to ultimately improving patient outcomes and promoting appropriate antimicrobial use.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00634-0.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00634-0.
Acknowledgements
We would like to acknowledge the Ethiopian Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, and the Armauer Hansen Research Institute for proving the training on comprehensive systematic review, meta-analysis, and access to databases.
Author contributions
MTB, SM and VS; was involved in a principal role in the conception of ideas, developing methodologies, writing the manuscript. MTB and VS, were involved in the analysis while MW, YS, and ZEK participated in the analysis, interpretation and writing. YS and ZEK involved in proofreading, and writing. All authors read and approved the final version of the manuscript.
Funding
Not applicable.
Availability of data and materials
The data sets during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Not applicable. Unlike primary studies, systematic reviews does not include the collection of deeply personal, sensitive, and confidential information from the study participants. Systematic reviews involves the use of publicly accessible data as evidence and are not required to seek an institutional ethics approval before commencement.
Consent for publication
Not applicable.
Competing interests
The authors declare that this study is free of any competing financial and non-financial interests.
Supplementary Information
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