Knowledge and Beliefs of Health Care Professionals Towards Antimicrobial Resistance in Hiwot Fana Specialized University Hospital, in Harar, Ethiopia

Figures & data

Table 1 Profiles of Health Care Professionals’ Working in HFSUH

Variables		Physician (n=35) N (%)	Nurses (n=86) N (%)	Pharmacy (n= 11) N (%)
Gender	Male	30(85.7)	55(64)	10(90.9)
	Female	5(14.3)	31(36)	1(9.1)
Age	20–29	29(82.8)	64(74.4)	9(81.8)
	30–39	5(14.3)	18(20.9)	2(18.2)
	40–49		3(3.5)
	50–59	1(2.9)	1(1.2)
Marital status	Single	27(77.1)	59(68.6)	7(63.6)
	Married	7(20)	26(30.2)	4(36.4)
	Divorced	1(2.9)	1(1.2)	0
Attended AMR training	Yes	9(25.7)	16(18.6)	3(27.3)
	No	26(74.3)	70(81.4)	8(72.7)
Exposed to use AST result	Yes	13(37.1)	23(26.7)	4(36.4)
	No	22(62.9)	63(73.3)	7(63.4)
Source of information about AMR	Book	32(91.4)	41(47.7)	4(36.4)
	Internet	0	14(16.3)	3(27.3)
	Journals	0	3(3.5)	0
	University training	2(5.7)	27(31.4)	2(18.2)
	Other	1(2.9)	1(1.2)	2(18.2)
Have up to date information on AMR	Yes	26(74.3)	41(47.7)	10(90.9)
	No	9(25.7)	45(52.3)	1(9.1)

Abbreviation: HFSUH, Hiwot Fana Specialized University Hospital.

Table 2 Health Care Professionals’ Knowledge About the Causes of Antibiotic Resistance and Antibiotic-Resistant Bacteria in HFSUH

Variables	Physicians (n = 35) Yes (%)	Nurses (n= 86) Yes (%)	Pharmacist (n =11) Yes (%)		P-value
Cause of AMR
Widespread or over use of antibiotics promotes AMR	34(97.1)	67(77.9)		11(100)	0.010
Usage of broad- spectrum antibiotics promote AMR	28(80)	48(55.8)		9(81.8)	0.019
Bacterial mutations causes AMR	35(100)	70(81.4)		11(100)	0.008
Poor hand washing practice in hospitals spread AMR	28(80)	70(81.4)		4(36.4)	0.003
Poor infection control in hospital spread AMR	35(100)	76(88.4)		10(90.9)	0.110
Patient poor adherence promote AMR	34(97.1)	80(93)		11(100)	0.469
Sub standard quality of antibiotic promote AMR	35(100)	74(86)		10(90.9)	0.065
Examples of antibiotic-resistant bacteria in hospitals
MRSA	26(74.3)	51(59.3)		7(63.6)	0.306
MDR-TB	8(22.9)	32(37.2)		4(36.4)	0.308
P. aeruginosa	1(2.9)	1(1.2)		0
Other	0	2(2.3)		0
Local factors for the development of AMR
Self-prescription by patients	28(80)	48(55.8)		8(72.7)	0.110
Prescribers’ poor awareness on AMR	4(11.4)	25((29.1)		2(18.2)	0.106
Lack of local antibiogram data	3(8.6)	13(15.1)		1(9.1)

Abbreviation: HFSUH, Hiwot Fana Specialized University Hospital.

Table 3 Belief of Health Care Professionals’ Working in HFSUH on Potential Intervention to Combat AMR

Variables		Very Useful (%)	Useful (%)	Not Useful (%)	Not Sure (%)
Antimicrobial usage policy	Physicians	28(80)	7(20)	0	0
	Nurses	68(79.1)	17(19.8)	0	1(1.2)
	Pharmacist	9(81.8)		2(18.2)	0
	Total	105 (79.54)	24 (18.2)	2 (1.5)	1 (0.76)
Reduction of antibiotic use for the outpatient setting	Physicians	13(37.1)	14(40)	8(22.9)	0
	Nurses	48(55.8)	26(30.2)	10(11.6)	2(2.3)
	Pharmacist	7(63.6)	3(27.3)	1(9.1)	0
	Total	68 (51.5)	43 (32.6)	19 (14.4)	2 (1.5)
Establish national AMR surveillance	Physicians	28(80)	7(20)	0	0
	Nurses	68(79.1)	16(18.6)	0	2(2.3)
	Pharmacist	9(81.8)	1(9.1)	1(9.1)	0
	Total	105 (79.54)	24 (18.2)	1(0.76)	2 (1.5)
Establish a hospital infection control committee	Physicians	27(77.1)	7(20)	1(2.9)	0
	Nurses	68(79.1)	16(18.6)	1(1.2)	1(1.2)
	Pharmacist	9(81.8)	1(9.1)	1(9.1)	0
	Total	104 (78.8)	24 (18.2)	3 (2.3)	1 (0.76)
Develop an institutional guideline for antimicrobial use	Physicians	28(80)	7(20)	0	0
	Nurses	65(75.6)	18(20.9)	0	3(3.5)
	Pharmacist	9(81.8)	1(9.1)	1(9.1)	0
	Total	102 (77.3)	26 (19.7)	4 (3)	0
Education on antimicrobial therapy for prescribers	Physicians	26(74.3)	9(25.7)	0	0
	Nurses	68(79.1)	16(18.6)	2(2.3)	0
	Pharmacist	9(81.8)	1(9.1)	0	1(9.1)
	Total	103 (78.03)	26 (19.7)	2 (1.51)	1 (0.76)
Establish microbiology diagnostic services	Physicians	28(80)	7(20)	0	0
	Nurses	58(67.4)	23(26.7)	2(2.3)	3(3.5)
	Pharmacist	8(72.7)	2(18.2)	0	1(9.1)
	Total	94 (71.2)	32 (24.2)	2 (1.5)	4 (3)

Abbreviations: HFSUH, Hiwot Fana Specialized University Hospital; AMR, antimicrobial resistance.

Table 4 Percentage of Health Care Professionals’ Working in HFSUH Rating the Scope of AMR

Variables		Strongly Agree (%)	Agree (%)	Disagree (%)	Strongly Disagree (%)	Do Not Know (%)
AMR is a worldwide problem	Physicians	19(54.3)	16(45.7)	0	0	0
	Nurses	45(52.3)	33(38.4)	3(3.5)	1(1.2)	4(4.7)
	Pharmacist	9(81.8)	2(18.2)	0	0	0
	Total	73 (55.3)	51 (38.6)	3 (2.3)	1 (0.76)	4 (3.03)
AMR is a problem Ethiopia	Physicians	19(54.3)	16(45.7)	0	0	0
	Nurses	53(61.6)	28(32.6)	2(2.3)	2(2.3)	1(1.2)
	Pharmacist	7(63.6)	4(36.4)	0	0	0
	Total	79 (59.8)	48 (36.4)	2 (1.52)	2 (1.52)	1 (0.76)
AMR is a problem in your hospital	Physicians	16(45.7)	15(42.9)	2(5.7)	0	2(5.7)
	Nurses	36(41.9)	38(44.2)	7(8.1)	1(1.2)	4(4.7)
	Pharmacist	2(18.2)	8(72.7)	0	0	1 (9.1)
	Total	54 (40.9)	61 (46.2)	9 (6.82)	1 (0.76)	7 (5.3)

Abbreviations: HFSUH, Hiwot Fana Specialized University Hospital; AMR, Antimicrobial Resistance.

Table 5 Belief of Health Care Professionals’ Working in HFSUH on Causes of Unnecessary Antibiotic Prescriptions

Variables	Physicians (%)	Nurses (%)	Pharmacist (%)	P-value
Which factor do you consider is the cause of unnecessary antimicrobial prescription
Patient influence on the prescriber	14(40)	28(32.6)	7(63.6)	0.122
Failure of previous treatment	11(31.4)	42(48.8)	4(36.4)	0.192
Critically ill or immune-compromised patient	4(11.4)	7(8.1)	0
Profit of hospital	4(11.4)	4(4.7)	0
Other	2(5.7)	5(5.8)	0
For which infections do you think unnecessary antibiotics would be prescribed?
Upper respiratory tracts	20(57.1)	37(43)	9(81.8)	0.043
Unknown febrile illness	13(37.1)	33(38.4)	2(18.2)	0.421
Urinary tract infections	1(2.9)	6(7)	0
Diarrhoea	1(2.9)	5(5.8)	0
Other	0	5(5.8)	0

Abbreviation: HFSUH, Hiwot Fana Specialized University Hospital.