Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance

Expert Review of Anti-infective Therapy, Journal Year: 2023, Volume and Issue: 21(10), P. 1025 - 1055

Published: Sept. 23, 2023

ABSTRACTIntroduction Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR in Africa. A key driver continues be high levels of dispensing antibiotics without prescription.Areas covered need document current rates dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). narrative review was undertaken. The highest antibiotic purchasing were Eritrea (up 89.2% dispensed), Ethiopia 87.9%), Nigeria 86.5%), Tanzania 92.3%) Zambia 100% pharmacies prescription). However, considerable variation seen with no minority countries situations. Key drivers self-purchasing included co-payment for physician consultations costs, travel convenience pharmacies, patient requests, limited knowledge weak enforcement. ASPs have been introduced some African along quality targets reduce inappropriate centering on educating pharmacists patients.Expert Opinion ASP activities accelerating among community alongside targets, greater monitoring pharmacists' dispensing. Such activities, patients healthcare professionals, should enhance appropriate AMR.KEYWORDS: Africaantibioticsantimicrobial resistanceantimicrobial programmesAWaRe classificationcommunity pharmaciesover-the-counter purchasingquality indicatorsutilization patterns Article highlights There still prescription across Africa, prescriptionHowever, vary considerably both within countries. It important address typically self-limiting conditions AMR, which major issue sub-Saharan Africa (currently continent prevalence rate globally) an part National Action Plan AMRHigh are exacerbated by issues affordability (cost medicines costs as well facilities) population possible loss earnings long waiting times see professional facilities. Community more convenientEducating can antibiotics. instigation indicators also helps dispensingWith publication AWaRe book, it increasingly likely that future will based its content. Alongside this, there increasing use information technology mobile telephones monitor against agreed indicatorsThe curricula universities professionals upgraded make sure they fully competent appropriately counsel optimal management infectious disease/those children post qualification, backed up continuous development activitiesDeclaration interestA Cook C Moore funded Welcome Trust (222051/Z/20/Z) ADILA project. E Yeika, SA. Opanga, ZU Mustafa, V Marković-Peković, Kurdi, BD Anand Paramadhas, Wesangula, Hango, N Schellack, S Mudenda, I Hoxha JC Meyer either worked national or regional government agenices advisers them surrounding NAPs. In addition, Opanga received grant from Kenya AIDS Vaccine Institute -Institute Clinical Research Institut Merieux tackling GM Rwegerera works Destiny Medical Solutions Proprietary Limited, Gaborone, Botswana. authors other relevant affiliations financial involvement any organization entity interest conflict subject matter materials discussed manuscript apart those disclosed.Reviewer disclosuresPeer reviewers this relationships disclose.Supplementary materialSupplemental data article accessed online at https://doi.org/10.1080/14787210.2023.2259106Additional informationFundingThis paper not funded.

Language: Английский

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Knowledge, Attitudes, Motivations, Expectations, and Systemic Factors Regarding Antimicrobial Use Amongst Community Members Seeking Care at the Primary Healthcare Level: A Scoping Review

Antibiotics, Journal Year: 2025, Volume and Issue: 14(1), P. 78 - 78

Published: Jan. 13, 2025

Background/Objectives: Antimicrobial resistance (AMR) is a major global health challenge, particularly in low- and middle-income countries (LMICs). Understanding the knowledge, attitudes, motivations, expectations of community members regarding antimicrobial use essential for effective stewardship interventions. This scoping review aimed to identify key themes relating critical areas among primary healthcare (PHC), with particular focus on LMICs. Methods: OVID Medline, PubMed, CINAHL databases were searched using Boolean operators Medical Subject Headings (MeSH) terms relevant behaviors. The Population, Intervention, Comparison, Outcome, Study Design (PICOS) framework guided study selection, which focused seeking care PHC Data management extraction facilitated Covidence platform, Critical Appraisal Skills Programme (CASP) qualitative checklist applied studies. A narrative synthesis identified grouped sub-themes. Results: search 497 sources, 59 met inclusion criteria, 75% studies conducted outpatient settings. Four identified: (1) ’patient’ theme, highlighting beliefs, expectations, was most prominent (40.5%); (2) ’provider’ emphasizing challenges related clinical decision-making, knowledge gaps, adherence guidelines; (3) ’healthcare systems’ resource limitations, lack infrastructure, policy constraints; (4) ‘intervention/uptake’ strategies improve future antibiotic enhance access quality healthcare. Conclusions: Stewardship programs settings LMICs should be designed context-specific, community-engaged, accessible individuals varying levels understanding, involving information literacy effectively reduce AMR.

Language: Английский

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Ecological Consequences of Antibiotics Pollution in Sub-Saharan Africa: Understanding Sources, Pathways, and Potential Implications

Emerging contaminants, Journal Year: 2025, Volume and Issue: unknown, P. 100475 - 100475

Published: Jan. 1, 2025

Language: Английский

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Tackling antimicrobial resistance in sub-Saharan Africa: challenges and opportunities for implementing the new people-centered WHO guidelines

Expert Review of Anti-infective Therapy, Journal Year: 2024, Volume and Issue: 22(6), P. 379 - 386

Published: May 29, 2024

Introduction Antimicrobial drugs form an essential component of medical treatment in human and animal health. Resistance associated with their use has posed a global public health threat. Multiple efforts have been made at the level directed by World Health Organization partners to develop policies aimed combatting antimicrobial resistance.

Language: Английский

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Antibiotic use and adherence to the WHO AWaRe guidelines across 16 hospitals in Zambia: a point prevalence survey

JAC-Antimicrobial Resistance, Journal Year: 2024, Volume and Issue: 6(5)

Published: Sept. 3, 2024

The inappropriate use of antibiotics in hospitals contributes to the development and spread antimicrobial resistance (AMR). This study evaluated prevalence antibiotic adherence World Health Organization (WHO) Access, Watch Reserve (AWaRe) classification across 16 Zambia.

Language: Английский

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Impact of a hub-and-spoke approach to hospital antimicrobial stewardship programmes on antibiotic use in Zambia

JAC-Antimicrobial Resistance, Journal Year: 2024, Volume and Issue: 6(6)

Published: Oct. 30, 2024

Antimicrobial stewardship programmes (ASPs) aim to optimize antibiotic use and prevent antimicrobial resistance.

Language: Английский

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Assessment of challenges and opportunities in antibiotic stewardship program implementation in Northwest Ethiopia

Heliyon, Journal Year: 2024, Volume and Issue: 10(11), P. e32663 - e32663

Published: June 1, 2024

BackgroundIndiscriminate use of antibiotics leads to antibiotic resistance (AMR) and results in mortality, morbidity, financial burden. Antibiotic stewardship programs (ASPs) with education can resolve a number barriers recognized the implementation successful ASPs. The aim this study was assess health professionals' perceptions status ASPs hospitals 2022.MethodsA cross-sectional conducted from September 1, 2022 October 30, 2022. A total 181 professionals were included, self-administered questionnaire used collect data. assessed using checklist. data analyzed SPSS version 23, descriptive statistics Chi-square tests (X2) at P-value <0.05 used.ResultsOf respondents, 163 (90.1 %), 161 (89.0 %) believed that AMR is significant problem Ethiopia globally, respectively. Easy access 155 (85.6 inappropriate 137 (75.7 perceived as key contributors AMR. Antibiotics be prescribed/dispensed without laboratory 86 (47.5 susceptibility patterns not considered guide empiric therapy 81 (44.8 %). ASP reduce duration hospital stays associated costs improve quality patient care 133 (73.5 whereas 151 (83.4 143 (79 142 (78.5 suggested education, institutional guidelines, prospective audits feedback interventions combat their hospitals, There differences perception among based on professional category attempts by implement Although functioning according standard, there have been it three hospitals. issue had never heard general Currently, feasible four hospitals.ConclusionThe very poor. Despite lack prior knowledge ASPs, most respondents do positive Pharmacist-led guidelines for better implemented Involvement representatives infection prevention control, collaboration will help establish strong area.

Language: Английский

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Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis

Antimicrobial Resistance and Infection Control, Journal Year: 2025, Volume and Issue: 14(1)

Published: Feb. 3, 2025

Bacterial infection has been estimated to become the leading cause of death by 2050, causing 10 million deaths across globe due surge in antibiotic resistance. Despite western sub-Saharan Africa being identified as one major hotspots antimicrobial resistance (AMR) with highest mortality, a comprehensive regional analysis magnitude and key drivers AMR human use not conducted. We carried out systematic review conducting search various databases including PubMed Scopus for eligible articles published English Language between 1 January 2000 14 February 2024. Five domains were focused on: (1) consumption; (2) appropriate prescription; (3) indicators or use; (4) stewardship (AMS) interventions; (5) knowledge, attitudes perceptions consumers providers. Data extracted from papers all five under consideration random-effects model meta-analysis was consumption. Out 2613 records obtained, 64 which unevenly distributed region inclusion our study. These reported on consumption (5), prescription (10), AMS interventions 31 studies perceptions. Antibiotic inpatients pooled estimate 620.03 defined daily dose (DDD) per 100 bed-days (confidence interval [CI] 0.00–1286.67; I2 = 100%) after accounting outliers while prescribing appropriateness ranged 2.5% 93.0% 50.09 ([CI: 22.21–77.92%], 99.4%). Amoxicillin, gentamicin, amoxicillin-clavulanate, metronidazole, ceftriaxone commonly consumed antibiotics. Community-acquired infection, hospital-acquired prophylaxis use. effective varying degrees bundled gamified decision support application most effective. Healthcare workers demonstrated acceptable knowledge but individuals formal informal settings self-medicate antibiotics had moderate low This gaps highlighted areas where prompt actions are required, it further guides future research endeavors policy development. The findings underscore need implementation programs West African enhance understanding patterns, practices, factors influencing them region.

Language: Английский

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Point Prevalence Survey of Antibiotic Use in Level 1 hospitals in Zambia: Future Prospects for Antimicrobial Stewardship Programs

Infection and Drug Resistance, Journal Year: 2025, Volume and Issue: Volume 18, P. 887 - 902

Published: Feb. 1, 2025

The inappropriate prescribing and use of antibiotics have contributed to the emergence spread antimicrobial resistance (AMR). In Zambia, there is a paucity information on patterns among hospitalized patients in level 1 hospitals. This study investigated antibiotic five hospitals Lusaka, Zambia. cross-sectional utilized World Health Organization (WHO) Point Prevalence Survey (PPS) methodology in-patients admitted before 08:00 a.m. survey day August 2024. Data were analysed using IBM SPSS version 23.0. prevalence inpatients was 59.0%, with ceftriaxone being most prescribed. Antibiotics prescribed mainly for paediatrics male inpatients. found that 53.0% from Access group while 38.2% Watch Access, Watch, Reserve (AWaRe) classification. Adherence national treatment guidelines 36.0%, empirically without evidence culture sensitivity tests. high low adherence findings this demonstrate need establish strengthen stewardship programs laboratory capacity aid clinicians diagnosing, treating, managing across

Language: Английский

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Antimicrobial Stewardship Impact on Antibiotic Use in Three Tertiary Hospitals in Zambia: A Comparative Point Prevalence Survey

Antibiotics, Journal Year: 2025, Volume and Issue: 14(3), P. 284 - 284

Published: March 10, 2025

Introduction: Antimicrobial stewardship (AMS) can improve the rational use of antibiotics in hospitals. This study assessed impact a multifaceted AMS intervention on antibiotic and prescribing patterns at three tertiary hospitals Zambia. Methods: Point Prevalence Surveys (PPS) were conducted August 2022 October 2023. It was part 3-year demonstration project that aimed to optimize treating urinary tract infections (UTIs) bloodstream (BSIs) various health sector settings Up 170 medical records 265 2023 included assessment. Results: Overall, prevalence this PPS 75%. Eighty-one percent (81%) 71% patients least one 2023, respectively, indicating decrease 10%. Similarly, ceftriaxone, most prescribed antibiotic, declined from an average 48% 38% Adherence Standard Treatment Guidelines (STGs) slightly increased 42% 45% Additionally, reduced 1.38 1.21. Conclusions: had early positive adherence Guidelines.

Language: Английский

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