An Evaluation of Antibiotic Prescription Rationality at Lower Primary Healthcare Facilities in Three Districts of South-Western Uganda

Abstract

Purpose

Antimicrobial resistance is now one of the leading five causes of death globally. This study evaluated the rationality of antibiotic prescriptions at lower primary care levels in three districts of Southwestern Uganda.

Methods

This prospective cross-sectional study reviewed 9899 antibiotic prescriptions at 39 health centers following a drug delivery cycle by National Medical Stores in three phases (19 days each on average). Phase 1 started 3 days after delivery, mid-way (Phase 2) and towards the end (Phase 3). The proportion of rationally prescribed antibiotics was determined using a modified criterion by Badar and in reference to Uganda Clinical Guidelines (UCG). Using multivariate logistic regression, the factors associated with rational prescription were determined with 95% confidence intervals.

Results

Seven of every 10 antibiotic prescriptions were irrational. Half the prescriptions were made by unauthorized personnel (nurses) and many of the pediatric prescriptions (916, 46.5%) did not bear body weight measurements to guide appropriate dosing. Also, the proportion of rational prescriptions in reference to UCG, 2016 was very low (3387, 34.2%). However, a high proportion of antibiotic prescriptions were legibly written (9462, 95.7%), prescribed by generic names (9083, 91.8%) and had a diagnosis (9677, 97.8%) indicated. Multivariate logistic analysis showed that; availability of medicines (phase 1) (phase 2 AOR=1.14, 95% CI:1.02–1.28, phase 3, AOR=1.23, 95% CI:1.1–1.38), legibly written prescription (AOR=0.61, 95% CI: 0.47–0.78), indication of a date on the prescription (AOR=0.56, 95% CI0.38–0.81) and being a medical officer were factors associated with rational antibiotic prescription.

Conclusion

We observed a high rate of irrational prescription in the study sites and the majority of these were by unauthorized personnel. A review of antibiotic use policies and focused interventions is crucial in these settings.

Keywords:

• inappropriate
• antibiotic prescriptions
• antibiotic resistance

Ethics Approval and Consent to Participate

Ethical clearance was obtained from School of Biomedical Sciences Research Ethics committee (SBS-REC-564) and the Uganda National Council for Science and Technology (HS 2495). Permission to conduct the study was sought from the District Health Officers and in-charges of individual health facilities. The data can be accessed with relevant data protection and privacy regulations.

Acknolwedgement

We acknowledge the contribution of all district health officers in the studied districts, in-charges of health facilities, health workers and research assistants to this work.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors declared no potential conflicts of interest.

Additional information

Funding

This study was funded in part by the Swedish International Development Cooperation Agency (Sida) and Makerere University under Sida contribution No: 51180060.