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Rana S, Kaur KN, Narad P, Walia K, Saeed S, Chandra A, Shannawaz M, Singh H. Knowledge, attitudes and practices of antimicrobial resistance awareness among healthcare workers in India: a systematic review. Front Public Health 2024; 12:1433430. [PMID: 39104891 PMCID: PMC11298436 DOI: 10.3389/fpubh.2024.1433430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/05/2024] [Indexed: 08/07/2024] Open
Abstract
Objectives The study was conducted to identify and compile gaps in the Knowledge, Attitudes, and Practices (KAP) regarding Antimicrobial Resistance (AMR) among healthcare workers in India. Methods A systematic review of published literature from PubMed, Google Scholar, and Scopus databases was conducted in compliance with the PRISMA guidelines. The inclusion criteria focused on studies evaluating KAP toward AMR among various healthcare workers in India without restricting context to specific diseases. We included articles published from inception to December 2023. Results Following the inclusion criterion, 19 studies were selected for the review. The study has a cumulative sample size of 4,544 healthcare providers across India. We found that doctors and medical students have significant knowledge about AMR, followed by nurses and pharmacists. However, the attitudes toward AMR were higher among informal providers, followed by doctors and medical students. The study also observed a gap between theoretical knowledge and practical application of AMR principles among healthcare providers in India. Conclusion The study highlights the need for targeted training and policy interventions to bridge the gap between KAP regarding AMR. Healthcare providers can significantly contribute to mitigating AMR threat by improving KAP related to AMR. This systematic review provides a foundation for developing and implementing effective evidence-based strategies to enhance AMR containment in India.
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Affiliation(s)
- Shweta Rana
- Division of Development Research, Indian Council of Medical Research (ICMR), New Delhi, India
- Amity Institute of Public Health and Hospital Administration (AIPH&HA), Amity University, Noida, India
| | - Karuna Nidhi Kaur
- Division of Development Research, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Priyanka Narad
- Division of Development Research, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Kamini Walia
- Division of Descriptive Research, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Shazina Saeed
- Amity Institute of Public Health and Hospital Administration (AIPH&HA), Amity University, Noida, India
| | - Amrish Chandra
- School of Pharmacy, Sharda University, Greater Noida, India
| | - Mohd Shannawaz
- Amity Institute of Public Health and Hospital Administration (AIPH&HA), Amity University, Noida, India
| | - Harpreet Singh
- Division of Development Research, Indian Council of Medical Research (ICMR), New Delhi, India
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Abubakar U, Salman M. Antibiotic Use Among Hospitalized Patients in Africa: A Systematic Review of Point Prevalence Studies. J Racial Ethn Health Disparities 2024; 11:1308-1329. [PMID: 37157014 PMCID: PMC10166031 DOI: 10.1007/s40615-023-01610-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND There is paucity of data describing the rate and quality indices of antibiotics used among hospitalized patients at continental level in Africa. This systematic review evaluated the pooled prevalence, indications, and types of antibiotics used in hospitals across Africa. METHODS Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles. RESULTS Of the 7254 articles identified from the databases, 28 eligible articles involving 28 studies were selected. Most of the studies were from Nigeria (n = 9), Ghana (n = 6), and Kenya (n = 4). Overall, the prevalence of antibiotic use among hospitalized patients ranged from 27.6 to 83.5% with higher prevalence in West Africa (51.4-83.5%) and North Africa (79.1%) compared to East Africa (27.6-73.7%) and South Africa (33.6-49.7%). The ICU (64.4-100%; n = 9 studies) and the pediatric medical ward (10.6-94.6%; n = 13 studies) had the highest prevalence of antibiotic use. Community-acquired infections (27.7-61.0%; n = 19 studies) and surgical antibiotic prophylaxis (SAP) (14.6-45.3%; n = 17 studies) were the most common indications for antibiotic use. The duration of SAP was more than 1 day in 66.7 to 100% of the cases. The most commonly prescribed antibiotics included ceftriaxone (7.4-51.7%; n = 14 studies), metronidazole (14.6-44.8%; n = 12 studies), gentamicin (n = 8 studies; range: 6.6-22.3%), and ampicillin (n = 6 studies; range: 6.0-29.2%). The access, watch, and reserved group of antibiotics accounted for 46.3-97.9%, 1.8-53.5%, and 0.0-5.0% of antibiotic prescriptions, respectively. The documentation of the reason for antibiotic prescription and date for stop/review ranged from 37.3 to 100% and 19.6 to 100%, respectively. CONCLUSION The point prevalence of antibiotic use among hospitalized patients in Africa is relatively high and varied between the regions in the continent. The prevalence was higher in the ICU and pediatric medical ward compared to the other wards. Antibiotics were most commonly prescribed for community-acquired infections and for SAP with ceftriaxone, metronidazole, and gentamicin being the most common antibiotics prescribed. Antibiotic stewardship is recommended to address excessive use of SAP and to reduce high rate of antibiotic prescribing in the ICU and pediatric ward.
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Affiliation(s)
- Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
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Mudenda S, Chabalenge B, Daka V, Jere E, Sefah IA, Wesangula E, Yamba K, Nyamupachitu J, Mugenyi N, Mustafa ZU, Mpundu M, Chizimu J, Chilengi R. Knowledge, awareness and practices of healthcare workers regarding antimicrobial use, resistance and stewardship in Zambia: a multi-facility cross-sectional study. JAC Antimicrob Resist 2024; 6:dlae076. [PMID: 38764535 PMCID: PMC11100357 DOI: 10.1093/jacamr/dlae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
Background Antimicrobial resistance (AMR) poses a threat to public health globally. Despite its consequences, there is little information about the knowledge, awareness, and practices towards AMR among healthcare workers (HCWs). Therefore, this study assessed the knowledge, awareness and practices regarding antimicrobial use (AMU), AMR and antimicrobial stewardship (AMS) among HCWs who are involved in the implementation of AMS activities across eight hospitals in Zambia. Methods A cross-sectional study was conducted among 64 HCWs from October to December 2023 using a semi-structured questionnaire. Data were analysed using IBM SPSS version 25.0. Results Of the 64 HCWs, 59.4% were females, 60.9% were aged between 25 and 34 years, 37.5% were nurses, 18.7% were pharmacists, 17.2% were medical doctors and only one was a microbiologist. Overall, 75% of the HCWs had good knowledge, 84% were highly aware and 84% had good practices regarding AMU, AMR and AMS. Most of the HCWs (90.6%) responded that they had a multidisciplinary AMS team at their hospitals and were implementing the use of the WHO AWaRe classification of antibiotics. Conclusion This study found good knowledge levels, high awareness and good practices regarding AMU, AMR and AMS among HCWs who were involved in the implementation of AMS activities in hospitals in Zambia. Additionally, most hospitals have been conducting AMS training and implementing the use of the WHO AWaRe classification of antibiotics. However, there is still a need to address some identified gaps in AMU and AMR through the strengthening of AMS activities in hospitals.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka, Zambia
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Elimas Jere
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka, Zambia
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, PMB 31, Ho, Ghana
| | - Evelyn Wesangula
- Strengthening Pandemic Preparedness, Eastern, Central, and Southern Africa Health Community, Arusha, Tanzania
| | - Kaunda Yamba
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | | | - Nathan Mugenyi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, 11800, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, 57400, Pakistan
| | - Mirfin Mpundu
- Action on Antibiotic Resistance (ReAct) Africa, Lusaka, Zambia
| | - Joseph Chizimu
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | - Roma Chilengi
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
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Atalay YA, Abebe Gelaw K. Prevalence of knowledge, attitudes, and practices regarding antimicrobial resistance in Africa: a systematic review and meta-analysis. Front Microbiol 2024; 15:1345145. [PMID: 38585703 PMCID: PMC10996921 DOI: 10.3389/fmicb.2024.1345145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background One of the main threats to public health today is antibiotic resistance. This resistance leads to the persistence of infections in the body. It poses an increased risk of transmission to humans and animals through various routes, such as food, water, and the environment. Objectives This study aimed to ascertain the overall prevalence of knowledge, attitudes, and practices regarding antimicrobial resistance in Africa. Methods A systematic review and meta-analysis of published and unpublished studies was conducted in Africa according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted using appropriate search terms in PubMed, Web of Science, Science Direct, Google Scholar, African Journals Online, and the Cochrane Library. Data were extracted using Microsoft Excel, and STATA version 14 was used for analysis. Publication bias was checked by funnel plot, Egger, and Begg regression tests. A p-value of 0.05 was regarded to indicate potential publication bias. Using I2 statistics, the heterogeneity of the studies was evaluated. Using forest plots, the random effect model was used to present the pooled prevalence with a 95% confidence interval (CI) of meta-analysis. Results This review included 39 studies, with 18,769 study participants. Among these 39 studies, 38 were on knowledge assessment, 28 on attitude assessment, and 25 on good practice assessment towards antimicrobial resistances. The overall pooled prevalence level of knowledge regarding antimicrobial resistance in Africa was 55.33% (95% CI: 47.48, 63.18). The overall pooled prevalence of positive attitudes toward antimicrobial resistance in Africa was 46.93% (95% CI: 35.10, 58.76), and the overall pooled prevalence of good practice of antimicrobial resistance in Africa was 51.05% (95% CI: 45.24, 56.87). In addition, sub-group statistical analysis was performed in this meta-analysis, stratified by population sub-region and study design types. Conclusion In Africa, the pooled prevalence of knowledge, attitudes, and practices regarding antimicrobial drug resistance among different groups, including the general population, patients, tertiary school students, healthcare workers, and animal owners was found to be low level. Therefore, it is imperative to enhance the education and training programs regarding antibiotic resistance for various groups including the general public, patients, students, healthcare workers, and individuals responsible for the well-being of animals.
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Affiliation(s)
- Yibeltal Assefa Atalay
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kelemu Abebe Gelaw
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Uwanibe JN, Olawoye IB, Happi CT, Folarin OA. Genomic Characterization of Multidrug-Resistant Pathogenic Enteric Bacteria from Healthy Children in Osun State, Nigeria. Microorganisms 2024; 12:505. [PMID: 38543556 PMCID: PMC10974654 DOI: 10.3390/microorganisms12030505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/01/2024] Open
Abstract
Antimicrobial resistance (AMR) is responsible for the spread and persistence of bacterial infections. Surveillance of AMR in healthy individuals is usually not considered, though these individuals serve as reservoirs for continuous disease transmission. Therefore, it is essential to conduct epidemiological surveillance of AMR in healthy individuals to fully understand the dynamics of AMR transmission in Nigeria. Thirteen multidrug-resistant Citrobacter spp., Enterobacter spp., Klebsiella pneumoniae, and Escherichia coli isolated from stool samples of healthy children were subjected to whole genome sequencing (WGS) using Illumina and Oxford nanopore sequencing platforms. A bioinformatics analysis revealed antimicrobial resistance genes such as the pmrB_Y358N gene responsible for colistin resistance detected in E. coli ST219, virulence genes such as senB, and ybtP&Q, and plasmids in the isolates sequenced. All isolates harbored more than three plasmid replicons of either the Col and/or Inc type. Plasmid reconstruction revealed an integrated tetA gene, a toxin production caa gene in two E. coli isolates, and a cusC gene in K. quasivariicola ST3879, which induces neonatal meningitis. The global spread of AMR pathogenic enteric bacteria is of concern, and surveillance should be extended to healthy individuals, especially children. WGS for epidemiological surveillance will improve the detection of AMR pathogens for management and control.
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Affiliation(s)
- Jessica N. Uwanibe
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Oshogbo 232102, Osun State, Nigeria; (J.N.U.); (I.B.O.); (C.T.H.)
- Department of Biological Sciences, College of Natural Sciences, Redeemer’s University, Oshogbo 232102, Osun State, Nigeria
| | - Idowu B. Olawoye
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Oshogbo 232102, Osun State, Nigeria; (J.N.U.); (I.B.O.); (C.T.H.)
- Department of Biological Sciences, College of Natural Sciences, Redeemer’s University, Oshogbo 232102, Osun State, Nigeria
| | - Christian T. Happi
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Oshogbo 232102, Osun State, Nigeria; (J.N.U.); (I.B.O.); (C.T.H.)
- Department of Biological Sciences, College of Natural Sciences, Redeemer’s University, Oshogbo 232102, Osun State, Nigeria
| | - Onikepe A. Folarin
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Oshogbo 232102, Osun State, Nigeria; (J.N.U.); (I.B.O.); (C.T.H.)
- Department of Biological Sciences, College of Natural Sciences, Redeemer’s University, Oshogbo 232102, Osun State, Nigeria
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Koroma AT, Bundu PM, Sheriff M, Baryon B, Gamaga B, Sillah F, Lebbie M, Ngobeh D, Moiwo MM, Morrison J, Sesay ADD, Kamara S, Jalloh M, Nyandemoh H, Massaquoi M, Kamara KN, Kanu JS, Squire JS, Hakizimana JL, Elduma AH, Gebru GN. Behavioral practices towards antibiotic use among health care workers - Sierra Leone, 2021: a facility-based cross-sectional study. Pan Afr Med J 2024; 47:63. [PMID: 38681099 PMCID: PMC11055189 DOI: 10.11604/pamj.2024.47.63.39287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/16/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction globally, antimicrobial resistance (AMR) kills around 1.27 million 700,000 people each year. In Sierra Leone, there is limited information on antibiotic use among healthcare workers (HCWs). We assessed antibiotic prescribing practices and associated factors among HCWs in Sierra Leone. Methods we conducted a cross-sectional survey among HCWs. We collected data using a questionnaire containing a Likert scale for antibiotic prescribing practices. We categorized prescribing practices into good and poor practices. We calculated adjusted odds ratios (aOR) to identify risk factors. Results out of 337 (100%) HCWs, 45% scored good practice. Out of the total, 131 (39%) of HCWS considered fever as an indication of antibiotic resistance and 280 (83%) HCWs prescribed antibiotics without performing microbiological tests and 114 (34%) prescribed a shorter course of antibiotics. Factors associated with good practice were being a doctor (aOR=1.95; CI: 1.07, 3.56), the internet as a source of information (aOR=2.00; CI: 1.10, 3.66), having a high perception that AMR is a problem in the health-facility (aOR=1.80; CI: 1.01, 3.23) and there is a connection between one´s prescription and AMR (aOR=2.15; CI: 1.07, 4.32). Conclusion this study identified a low level of good practice toward antibiotic prescription. We initiated health education campaigns and recommended continuous professional development programs on antibiotic use.
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Affiliation(s)
| | | | - Musa Sheriff
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Brima Baryon
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Brima Gamaga
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Foday Sillah
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Munis Lebbie
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Daniel Ngobeh
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | | | - Jefery Morrison
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Abu Dim Din Sesay
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Samba Kamara
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Mustapha Jalloh
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Haurace Nyandemoh
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Momoh Massaquoi
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Kadijatu Nabie Kamara
- African Field Epidemiology Network, Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- African Field Epidemiology Network, Field Epidemiology Training Program, Freetown, Sierra Leone
- Department of Community Health, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - James Sylvester Squire
- African Field Epidemiology Network, Field Epidemiology Training Program, Freetown, Sierra Leone
- Department of Community Health, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jean Leonard Hakizimana
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
- National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Adel Hussein Elduma
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
- National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gebrekrstos Negash Gebru
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
- National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
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Mudenda S, Chilimboyi R, Matafwali SK, Daka V, Mfune RL, Kemgne LAM, Bumbangi FN, Hangoma J, Chabalenge B, Mweetwa L, Godman B. Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications. JAC Antimicrob Resist 2024; 6:dlae023. [PMID: 38389802 PMCID: PMC10883698 DOI: 10.1093/jacamr/dlae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Background Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics, especially those from the 'watch' and 'reserve' antibiotic lists. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the 'access, watch and reserve' (AWaRe) classification system post-COVID pandemic at a faith-based hospital in Zambia. Methods A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis' Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool. Results Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4%-access), metronidazole (17.1%-access), ciprofloxacin (8%-watch) and ceftriaxone (7.4%-watch), with 77.1% overall from the 'access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List. Conclusions There were high rates of antibiotic prescribing, including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programmes, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Robert Chilimboyi
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
- Department of Pharmacy, Saint Francis' Hospital, Private Bag 11, Katete, Zambia
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | - Ruth Lindizyani Mfune
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | | | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, P.O. Box 30226, Lusaka, Zambia
| | - Jimmy Hangoma
- Department of Pharmacy, School of Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, P.O. Box 31890, Lusaka, Zambia
| | - Larry Mweetwa
- Department of Science and Technology, Ministry of Technology and Science, Maxwell House, Los Angeles Boulevard, P. O. Box 50464, Lusaka, Zambia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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Ahmed S, Tareq AH, Ilyas D. The Impact of Antimicrobial Resistance and Stewardship Training Sessions on Knowledge of Healthcare Students of Wah Cantonment, Pakistan. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241228443. [PMID: 38339805 PMCID: PMC10859065 DOI: 10.1177/00469580241228443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 02/12/2024]
Abstract
Promoting awareness regarding antimicrobial resistance (AMR) and stewardship (AMS) is crucial as it results in treatment failures and an economic burden on a country. This study was conducted to determine the baseline knowledge of healthcare students and the impact of conducting training sessions regarding AMR and AMS on the knowledge of healthcare students. This study was conducted using a quasi-experimental design at Wah Medical College, Pakistan, and its subsidiary institutes in 4 months. Two hundred twenty-six healthcare students were selected via stratified sampling through a proportional allocation from 3 academic student groups. Training sessions were conducted and data were collected using a structured questionnaire. Data analysis was done using Statistical Package for the Social Sciences version 23. The median age of the participants was 22 while most were females (54.9%). There was a significant difference in means of AMR score between BScN and AD-BTM student groups and among AD-BTM and MBBS student groups. In the case of AMS scores, the difference in means was significant among all student groups. The training sessions were found effective as the mean AMR and AMS knowledge scores among all the student groups increased significantly after the intervention.
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Affiliation(s)
- Saleh Ahmed
- Wah Medical College, National University of Medical Sciences, Rawalpindi, Pakistan
| | | | - Doua Ilyas
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Endale H, Mathewos M, Abdeta D. Potential Causes of Spread of Antimicrobial Resistance and Preventive Measures in One Health Perspective-A Review. Infect Drug Resist 2023; 16:7515-7545. [PMID: 38089962 PMCID: PMC10715026 DOI: 10.2147/idr.s428837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/24/2023] [Indexed: 07/04/2024] Open
Abstract
Antimicrobial resistance, referring to microorganisms' capability to subsist and proliferate even when there are antimicrobials is a foremost threat to public health globally. The appearance of antimicrobial resistance can be ascribed to anthropological, animal, and environmental factors. Human-related causes include antimicrobial overuse and misuse in medicine, antibiotic-containing cosmetics and biocides utilization, and inadequate sanitation and hygiene in public settings. Prophylactic and therapeutic antimicrobial misuse and overuse, using antimicrobials as feed additives, microbes resistant to antibiotics and resistance genes in animal excreta, and antimicrobial residue found in animal-origin food and excreta are animals related contributive factors for the antibiotic resistance emergence and spread. Environmental factors including naturally existing resistance genes, improper disposal of unused antimicrobials, contamination from waste in public settings, animal farms, and pharmaceutical industries, and the use of agricultural and sanitation chemicals facilitatet its emergence and spread. Wildlife has a plausible role in the antimicrobial resistance spread. Adopting a one-health approach involving using antimicrobials properly in animals and humans, improving sanitation in public spaces and farms, and implementing coordinated governmental regulations is crucial for combating antimicrobial resistance. Collaborative and cooperative involvement of stakeholders in public, veterinary and ecological health sectors is foremost to circumvent the problem effectively.
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Affiliation(s)
- Habtamu Endale
- School of Veterinary Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mesfin Mathewos
- School of Veterinary Medicine, Wachemo University, Wachemo, Ethiopia
| | - Debela Abdeta
- College of Veterinary Medicine and Agriculture, Addis Ababa University, Bishoftu, Ethiopia
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Acampora M, Guasconi M, Schiroli C, Coschignano C, Cassinari N, Cipolla R, Artioli G, Bonacaro A, Sarli L, Barello S. Uncovering doctors' perceived barriers and facilitators of antibiotic prescribing behaviours: a qualitative study using the theoretical domains framework. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023265. [PMID: 38054668 PMCID: PMC10734243 DOI: 10.23750/abm.v94i6.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIM OF THE WORK Uncovering the barriers and facilitators of antibiotic prescribing is crucial in order to develop effective strategies for promoting responsible and evidence-based antibiotic use, thereby combating antibiotic resistance and enhancing patient care. This qualitative study, informed by the Theoretical Domains Framework (TDF) - specifically designed to understand and analyze the factors that influence human behavior, with a focus on identifying barriers and facilitators to behavior change, was aimed to explore the determinants (barriers and facilitators) of antibiotic prescribing behaviors from the perspective of doctors. RESEARCH DESIGN AND METHODS Semi-structured interviews were conducted with healthcare professionals, and data analysis followed a theory-driven approach guided by the TDF. RESULTS The analysis identified eight TDF domains influencing antibiotic prescribing, including memory, attention, and decision processes; knowledge; skills; belief about capabilities; goals; belief about consequences; emotions; and environmental context and resources. These domains were clustered into three overarching themes according to a bottom-up logic: the decision-making prescribing process itself, intrinsic factors related to the physician, and extrinsic factors influencing the decision. CONCLUSIONS This research provides a comprehensive understanding of the complex interactions between these determinants in antibiotic prescribing. The evidence gained from the study valuable information for developing targeted interventions to improve antibiotic prescribing practices and combat antimicrobial resistance considering psychosocial and environmental variables impacting on antibiotic prescription decision making.
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Affiliation(s)
- Marta Acampora
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona (Italy); Department of Psychology, Università Cattolica del Sacro Cuore di Milano, Milan (Italy); .
| | | | | | | | | | | | | | | | | | - Serena Barello
- a:1:{s:5:"en_US";s:65:"Department of Brain and Behavioural Sciences, University of Pavia";}.
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Fuller W, Kapona O, Aboderin AO, Adeyemo AT, Olatunbosun OI, Gahimbare L, Ahmed YA. Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review. Antibiotics (Basel) 2023; 12:1613. [PMID: 37998815 PMCID: PMC10669252 DOI: 10.3390/antibiotics12111613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023] Open
Abstract
This review documents the status of AMR education and awareness in the WHO African region, as well as specific initiatives by its member states in implementing education and awareness interventions, as a strategic objective of the Global Action Plan on AMR, i.e., improve knowledge and understanding on AMR through effective communication, education, and training. A systematic search was conducted in Google Scholar, PubMed, and African Journals Online Library according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, for articles published in English. Retrieval and screening of articles was performed using a structured search protocol following a pre-set inclusion/exclusion criterion. Eighty-five published articles reporting 92 different studies from 19 Member States met inclusion criteria and were included in the final qualitative synthesis. Nigeria (21) and Ethiopia (16) had most of the studies, while the rest were distributed across the remaining 17 Member States. The majority of the articles were on knowledge, attitude, and practices with regard to AMR and antimicrobial use and most of them documented a general lack and suboptimal knowledge, poor attitude and practices, and widespread self-medication. This review shows low levels of knowledge of AMR coupled with extensive misuse of antimicrobial medicines by different target audiences. These findings underscore the urgent need for enhanced and context-specific educational and positive behavioural change interventions.
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Affiliation(s)
- Walter Fuller
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (L.G.); (Y.A.A.)
| | - Otridah Kapona
- Zambia National Public Health Institute, Lusaka 10101, Zambia;
| | - Aaron Oladipo Aboderin
- Department of Medical Microbiology & Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria; (A.O.A.); (A.T.A.); (O.I.O.)
| | - Adeyemi Temitayo Adeyemo
- Department of Medical Microbiology & Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria; (A.O.A.); (A.T.A.); (O.I.O.)
| | - Oluwadamilare Isaiah Olatunbosun
- Department of Medical Microbiology & Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria; (A.O.A.); (A.T.A.); (O.I.O.)
| | - Laetitia Gahimbare
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (L.G.); (Y.A.A.)
| | - Yahaya Ali Ahmed
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (L.G.); (Y.A.A.)
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12
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Adebowale OO, Jimoh AB, Adebayo OO, Alamu AA, Adeleye AI, Fasanmi OG, Olasoju M, Olagunju PO, Fasina FO. Evaluation of antimicrobial usage in companion animals at a Veterinary Teaching Hospital in Nigeria. Sci Rep 2023; 13:18195. [PMID: 37875528 PMCID: PMC10598005 DOI: 10.1038/s41598-023-44485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
This study investigated various qualitative and quantitative indices of antimicrobial use (AMU) in companion animals (CAs) at a Veterinary Teaching Hospital (VTH-A) and its annex (VTH- B) from 2019 to 2021. For 694 documented animals, antimicrobial administrations (AADs) were 5, 278 times, of which 98.8% (5217) and 1.2% (61) were in dogs and cats respectively. At the VTH- A, oxytetracycline (1185 times, 22.5%) was mostly administered in dogs and metronidazole (26 times, 0.5%) in cats. Similarly, at VTH- B, oxytetracycline was administered 895 times (17.0%) in dogs while amoxicillin was given 7 times (0.1%) in cats. The prescription diversity (PD) was estimated at 0.73 and 0.82 in VTH-A and VTH-B respectively. The quantity of antimicrobials (AMs) used was 10.1 kg (A, 6.2 kg and B, 3.9 kg). Oxytetracycline administrations and quantity of metronidazole (P < 0.0001) were higher than other Active Ingredients (AIs). Furthermore, 16.5% of AIs were classified as Critically Important Antibiotics (CIA) with the highest priority, while enrofloxacin, ciprofloxacin, and azithromycin fell under the World Health Organisation (WHO) Watch group. The In-Depth Interview (IDI) indicated that the high frequency of oxytetracycline administrations was linked with being the first choice for blood parasite treatment by the clinicians at the hospital. The quantity of metronidazole used was perceived to be higher due to the clinicians' preference for the treatment of acute gastroenteritis, its wider dose range, and the frequency of administration (bi-daily). The study provides baseline data on AMU indices in CAs, for the development of antimicrobial stewardship (AMS) and communication training, and policy modifications to enhance antimicrobial therapy optimization in tertiary veterinary hospital care in Nigeria.
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Affiliation(s)
- O O Adebowale
- Department of Veterinary Public Health and Preventive Medicine, College of Veterinary Medicine, Federal University of Agriculture Abeokuta, Abeokuta, Ogun State, Nigeria.
| | - A B Jimoh
- Department of Veterinary Public Health and Preventive Medicine, College of Veterinary Medicine, Federal University of Agriculture Abeokuta, Abeokuta, Ogun State, Nigeria
| | - O O Adebayo
- Veterinary Teaching Hospital, College of Veterinary Medicine, Federal University of Agriculture Abeokuta, Abeokuta, Ogun State, Nigeria
| | - A A Alamu
- Department of Veterinary Medicine, College of Veterinary Medicine, Federal University of Agriculture Abeokuta, Abeokuta, Ogun State, Nigeria
| | - A I Adeleye
- Veterinary Teaching Hospital, College of Veterinary Medicine, Federal University of Agriculture Abeokuta, Abeokuta, Ogun State, Nigeria
| | - O G Fasanmi
- Department of Veterinary Laboratory Technology, Federal College of Animal Health and Production Technology, Ibadan, Oyo State, Nigeria
| | - M Olasoju
- Department of Veterinary Public Health and Preventive Medicine, College of Veterinary Medicine, Federal University of Agriculture Abeokuta, Abeokuta, Ogun State, Nigeria
| | - P O Olagunju
- Department of Veterinary Public Health and Preventive Medicine, College of Veterinary Medicine, Federal University of Agriculture Abeokuta, Abeokuta, Ogun State, Nigeria
| | - F O Fasina
- ECTAD, Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
- Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa
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13
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Foxlee ND, Taleo SA, Mathias A, Townell N, McIver L, Lau CL. The Impact of COVID-19 on Knowledge, Beliefs, and Practices of Ni-Vanuatu Health Workers Regarding Antibiotic Prescribing and Antibiotic Resistance, 2018 and 2022: A Mixed Methods Study. Trop Med Infect Dis 2023; 8:477. [PMID: 37888605 PMCID: PMC10611053 DOI: 10.3390/tropicalmed8100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Antimicrobial resistance (AMR) is included in the ten most urgent global public health threats. Global evidence suggests that antibiotics were over prescribed during the early waves of the COVID-19 pandemic, particularly in low- and middle-income countries. Inappropriate use of antibiotics drives the emergence and spread of antibiotic resistance. This study aimed to examine the impact of COVID-19 on Ni-Vanuatu health worker knowledge, beliefs, and practices (KBP) regarding antibiotic prescribing and awareness of antibacterial AMR. A mixed methods study was conducted using questionnaires and in-depth interviews in 2018 and 2022. A total of 49 respondents completed both baseline (2018) and follow-up (2022) questionnaires. Knowledge scores about prescribing improved between surveys, although health workers were less confident about some prescribing activities. Respondents identified barriers to optimal hand hygiene performance. More than three-quarters of respondents reported that COVID-19 influenced their prescribing practice and heightened their awareness of ABR: "more careful", "more aware", "stricter", and "need more community awareness". Recommendations include providing ongoing continuing professional development to improve knowledge, enhance skills, and maintain prescribing competency; formalising antibiotic stewardship and infection, prevention, and control (IPC) programmes to optimise prescribing and IPC practices; and raising community awareness about ABR to support more effective use of medications.
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Affiliation(s)
- Nicola D. Foxlee
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 2600, Australia
| | - Siti Aishah Taleo
- Dispensary, Vila Central Hospital, Ministry of Health, Private Mail Bag, Port Vila 9009, Vanuatu
| | - Agnes Mathias
- Curative Services, Ministry of Health, Private Mail Bag, Port Vila 9009, Vanuatu
| | - Nicola Townell
- Pacific Region Infectious Diseases Association, Kenmore Hills, QLD 4069, Australia
| | | | - Colleen L. Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia;
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14
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Mittal N, Goel P, Goel K, Sharma R, Nath B, Singh S, Thangaraju P, Mittal R, Kahkasha K, Mithra P, Sahu R, Priyadarshini RP, Sharma N, Pala S, Rohilla SK, Kaushal J, Sah S, Rustagi S, Sah R, Barboza JJ. Awareness Regarding Antimicrobial Resistance and Antibiotic Prescribing Behavior among Physicians: Results from a Nationwide Cross-Sectional Survey in India. Antibiotics (Basel) 2023; 12:1496. [PMID: 37887197 DOI: 10.3390/antibiotics12101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
(1) Background: Understanding the physicians' knowledge, attitudes, and antimicrobial prescribing behavior is a crucial step towards designing strategies for the optimal use of these agents. (2) Methods: A cross-sectional online survey was conducted among clinicians across India between May and July 2022 using a self-administered questionnaire in English comprising 35 questions pertaining to demographic characteristics, knowledge, attitude, and practices domains. (3) Results: A total of 544 responses were received from 710 physicians contacted. Sixty percent of participants were males, with mean age of 34.7 years. Mean ± Standard Deviation scores for knowledge, attitude, and practices domains were 8 ± 1.6, 20.2 ± 3.5, and 15.3 ± 2.1, respectively. Higher scores were associated with basic [odds ratio (95% Confidence Interval), p value: 2.95 (1.21, 7.2), 0.02], medical and allied sciences [2.71 (1.09, 6.67), 0.03], and central zone [3.75 (1.39, 10.12), 0.009]. A substantial proportion of dissatisfactory responses were found regarding hospital antibiograms, antibiotics effective against anaerobes, WHO AWaRe (access, watch, and reserve) classification of antibiotics, and the role of infection prevention and control (IPC) measures in the containment of antimicrobial resistance (AMR). (4) Conclusions: There is a need to sensitize and educate clinicians on various issues related to antimicrobial use, such as antibiograms, double anaerobic cover, IPC practices, and guideline-based recommendations, to curb the AMR pandemic.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Parul Goel
- Department of Biochemistry, Shri Atal Bihari Vajpayee Government Medical College, Chhainsa, Faridabad 121004, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rashmi Sharma
- Department of Community Medicine, GMERS Medical College Sola, Ahmedabad 380060, India
| | - Bhola Nath
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raebareli 229405, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur 342001, India
| | | | - Rakesh Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Kahkasha Kahkasha
- Department of Biochemistry, All India Institute of Medical Sciences, Deoghar 814152, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal 575001, India
| | - Rajesh Sahu
- Department of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Raman P Priyadarshini
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal 609602, India
| | - Nikita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bilaspur 174037, India
| | - Star Pala
- Department of Community Medicine, NEIGRIHMS, Shillong 793018, India
| | - Suneel Kumar Rohilla
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Jyoti Kaushal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Sanjit Sah
- Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha 442001, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun 248007, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu 46000, Nepal
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15
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Abubakar B, Sárváry A. Knowledge, attitude, and practice on antibiotics use among healthcare workers: A cross-sectional study in Niger state, Nigeria. J Infect Prev 2023; 24:206-215. [PMID: 37736128 PMCID: PMC10510657 DOI: 10.1177/17571774231165407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/01/2023] [Indexed: 09/23/2023] Open
Abstract
Introduction Antibiotic resistance is a public health concern in Nigeria and the world, and healthcare workers contributed to the upsurge of antibiotic resistance in hospital settings. This study focused on the knowledge, attitude, and practice (KAP) of antibiotic use and the frequency of prescriptions of antibiotics from the list of WHO Model Essentials Antibiotics (AWaRe) (in the last 6 months) among healthcare workers and established the determining factors in six hospitals in Niger state, Nigeria. Methodology A KAP survey was conducted in Niger State, Nigeria, from March to June 2022. A structured self-administered, pretested questionnaire was distributed to six hospitals in the state following a stratified random sampling considering the staff capacity, the population of the city, and patients' patronage. Results A total of 350 questionnaires distributed, and 313 (89.4%) completed and returned from the six hospitals. The median scores were knowledge (75%), attitude (69%), practice (62%), and self-reported prescription (70%), and respondents with good scores were knowledge [195 (62.3%)], attitude [185 (59.1%)], practice [201 (64.2%)], and prescription [117 (37.4%)]. In multivariate analysis, older respondents are more likely to have a good prescription (p = 0.006), and prior antimicrobial training improved their knowledge (p < 0.001), attitude (p = 0.007), and prescription pattern (p = 0.009). All the study participants had prescribed one or more of the most prescribed antibiotics; Amoxicillin clavulanate (Access group, 96.5%), Amoxicillin (Access group, 95.9%), and Metronidazole (Access group, 95.7%). Conclusions The study suggests that antibiotic education for healthcare workers and antimicrobial stewardship programs are significant interventions to mitigate antibiotic overuse in the state.
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Affiliation(s)
- Bala Abubakar
- Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Attila Sárváry
- Department of Integrative Health Sciences, Faculty of Health Sciences, University of Debrecen, Nyíregyháza, Hungary
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Tusubira B, Mukisa LN, Okuuny V, Besigye I. Antibiotic prescription among children with common cold at a district hospital in Uganda. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 37526556 PMCID: PMC10476461 DOI: 10.4102/phcfm.v15i1.4106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Most childhood infections are of viral origin making antibiotics unnecessary. They are, however, the most frequently prescribed drugs dispensed to children, resulting in inappropriate antibiotic prescriptions, which are one of the main drivers of antibiotic resistance. AIM The study aimed to determine the prevalence of antibiotic prescriptions and identify its associated factors among children below 5 years with common cold who attend the outpatient department in Tororo General Hospital. SETTING The study was carried out in Tororo General Hospital, Eastern Uganda. METHODS A cross-sectional survey using consecutive sampling was performed among children below 5 years with common cold attending the outpatient department. Data were collected using an interviewer-administered, structured questionnaire and analysed using STATA version 14.0. Prevalence of antibiotic prescriptions was calculated. Bivariate analysis using chi-square test and multivariate analysis using logistic regression was performed to establish factors associated with antibiotic prescription. RESULTS The prevalence of antibiotic prescriptions for common cold among children below 5 years was 23.3%. Factors associated with antibiotic prescription for common cold were duration of symptoms of more than 5 days (OR, 95% CI: 4.49; 1.16-17.23, p = 0.029) and being attended to by a clinical officer (OR, 95% CI: 0.19; 0.04-0.91, p = 0.038). CONCLUSION There is inappropriate antibiotic prescription among children with common cold in Tororo General Hospital. There is need for antibiotic stewardship programmes to promote optimal antibiotic use in primary care facilities.Contribution: The study's findings can be used to develop context-specific antibiotic stewardship programmes tailored to promote judicious use of antibiotics in primary care.
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Affiliation(s)
- Brenda Tusubira
- Department of Family Medicine, College of Health Sciences, Makerere University, Kampala.
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Uwanibe JN, O1awoye IB, Happi CT, Folarin OA. Genomic Characterisation of Multidrug-Resistant Pathogenic Enteric Bacteria from healthy children in Osun State, Nigeria. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.19.549742. [PMID: 37503211 PMCID: PMC10370152 DOI: 10.1101/2023.07.19.549742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Antimicrobial resistance (AMR) has been established to be a significant driver for the persistence and spread of bacterial infections. It is, therefore, essential to conduct epidemiological surveillance of AMR in healthy individuals to understand the actual dynamics of AMR in Nigeria. Multi-drug resistant Klebsiella quasivariicola (n=1), Enterobacter hormaechei (n=1), and Escherichia coli (n=3) from stool samples of healthy children were subjected to whole genome sequencing using Illumina Nextseq1000/2000 and Oxford nanopore. Bioinformatics analysis reveals antimicrobial resistance, virulence genes, and plasmids. This pathogenic enteric bacteria harbored more than three plasmid replicons of either Col and/or Inc type associated with outbreaks and AMR resistant gene pmrB responsible for colistin resistance. Plasmid reconstruction revealed an integrated tetA gene responsible for tetracycline resistance, and caa gene responsible for toxin production in two of the E.coli isolates, and a cusC gene known to induce neonatal meningitis in the K. quasivariicola ST3879. The global spread of MDR pathogenic enteric bacteria is a worrying phenomenon, and close surveillance of healthy individuals, especially children, is strongly recommended to prevent the continuous spread and achieve the elimination and eradication of these infections. Molecular epidemiological surveillance using whole genome sequencing (WGS) will improve the detection of MDR pathogens in Nigeria.
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Affiliation(s)
- Jessica N. Uwanibe
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun State, Nigeria
- Department of Biological Sciences, College of Natural Sciences, Redeemer’s University, Ede, Osun State, Nigeria
| | - Idowu B. O1awoye
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun State, Nigeria
- Department of Biological Sciences, College of Natural Sciences, Redeemer’s University, Ede, Osun State, Nigeria
| | - Christian T. Happi
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun State, Nigeria
- Department of Biological Sciences, College of Natural Sciences, Redeemer’s University, Ede, Osun State, Nigeria
| | - Onikepe A. Folarin
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun State, Nigeria
- Department of Biological Sciences, College of Natural Sciences, Redeemer’s University, Ede, Osun State, Nigeria
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Davwar P, Bitrus N, Nyam D, Ioramo K, Zawaya K, Agboghoroma O. Knowledge, Attitudes, and Practice of Doctors in Nigeria Regarding Antimicrobial Resistance. Niger Med J 2023; 64:492-502. [PMID: 38952878 PMCID: PMC11214715 DOI: 10.60787/nmj-64-4-296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/03/2024] Open
Abstract
Background Infectious disease treatment and prevention are threatened by antimicrobial resistance (AMR) globally. The knowledge and attitudes of doctors regarding AMR and the responsible use of antibiotics are critical to improving prescribing behaviours and mitigating the danger that AMR poses. This study aims to assess the knowledge attitudes and practices of doctors in Nigeria regarding AMR. Methodology This was an online survey of doctors in Nigeria. A 31-item self-administered questionnaire was distributed via an online forum for doctors. The questionnaire consisted of knowledge, attitudes, and practices sections. Demographic and practice data were also collected from respondents. Data were analyzed using IBM-SPSS and were mainly descriptive. Bivariate correlation was used to determine the relationship between knowledge attitudes and practices. Results Two hundred and fifty -two doctors completed the survey. There were 105 (42%) resident doctors who participated in the study. Good knowledge and fair knowledge of AMR were shown by 95(41%) and 146(58%) doctors, respectively. There were few respondents with good attitudes and practices: 40 (16%) and 16 (6%), respectively. A large proportion of respondents had fair attitudes and practices -204(81%) and 185(73%) respectively. The relationship between practice, knowledge, and attitude was negligible. (r<1, p>0.05). Conclusion Most doctors in this study showed fair to good knowledge, attitudes, and practices regarding AMR. Efforts to reduce the incidence of AMR should leverage the perceptions and behaviours of these healthcare workers.
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Affiliation(s)
- Pantong Davwar
- Department of Internal Medicine, Jos University Teaching Hospital, Plateau State Nigeria
| | - Nandom Bitrus
- Department of Internal Medicine, Federal Medical Centre, Nguru Yobe State, Nigeria
| | - David Nyam
- Department of Internal Medicine, Jos University Teaching Hospital, Plateau State Nigeria
| | - Kajo Ioramo
- Department of Internal Medicine, Jos University Teaching Hospital, Plateau State Nigeria
| | - Kefas Zawaya
- Department of Internal Medicine, Federal Teaching Hospital, Gombe, Nigeria
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Woldegeorgis BZ, Kerbo AA, Obsa MS, Mokonnon TM. A systematic review and meta-analysis of antimicrobial resistance knowledge, attitudes, and practices: Current evidence to build a strong national antimicrobial drug resistance narrative in Ethiopia. PLoS One 2023; 18:e0287042. [PMID: 37294747 PMCID: PMC10256206 DOI: 10.1371/journal.pone.0287042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/29/2023] [Indexed: 06/11/2023] Open
Abstract
Antimicrobial resistance (AMR) is a silent pandemic that has claimed millions of lives, and resulted in long-term disabilities, limited treatment options, and high economic costs associated with the healthcare burden. Given the rising prevalence of AMR, which is expected to pose a challenge to current empirical antibiotic treatment strategies, we sought to summarize the available data on knowledge, attitudes, and practices regarding AMR in Ethiopia. Articles were searched in international electronic databases. Microsoft Excel spreadsheet and STATA software version 16 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 checklist was followed. The methodological quality of the studies included was assessed by the Joana Briggs Institute critical appraisal checklists. The random-effect meta-analysis model was used to estimate Der Simonian-Laird's pooled effect. Statistical heterogeneity of the meta-analysis was checked through Higgins and Thompson's I2 statistics and Cochran's Q test. Publication bias was investigated by funnel plots, and the regression-based test of Egger for small study effects with a P value < 0.05 was considered to indicate potential reporting bias. In addition, sensitivity and subgroup meta-analyses were performed. Fourteen studies with a total of 4476 participants met the inclusion criteria. Overall, the pooled prevalence of good AMR knowledge was 51.53% [(95% confidence interval (CI): 37.85, 65.21), I2 = 99.0%, P <0.001]. The pooled prevalence of favorable attitudes and good practices were 63.43% [(95% CI: 42.66, 84.20), I2 = 99.6, P <0.001], and 48.85% [(95% CI: 38.68, 59.01), I2 = 93.1, P <0.001] respectively. In conclusion, there is a significant knowledge and practice gap on AMR among the general public, patients, and livestock producers. As a result, we call for greater educational interventions to raise awareness and build a strong national AMR narrative.
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Affiliation(s)
| | - Amene Abebe Kerbo
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Francis F, Robertson RC, Bwakura-Dangarembizi M, Prendergast AJ, Manges AR. Antibiotic use and resistance in children with severe acute malnutrition and human immunodeficiency virus infection. Int J Antimicrob Agents 2023; 61:106690. [PMID: 36372343 DOI: 10.1016/j.ijantimicag.2022.106690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/12/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
Severe acute malnutrition (SAM) and human immunodeficiency virus (HIV) infection underlie a major proportion of the childhood disease burden in low- and middle-income countries. These diseases commonly co-occur and lead to higher risk of other endemic infectious diseases, thereby compounding the risk of mortality and morbidity. The widespread use of antibiotics as treatment and prophylaxis in childhood SAM and HIV infections, respectively, has reduced mortality and morbidity but canlead to increasing antibiotic resistance. Development of antibiotic resistance could render future infections untreatable. This review summarises the endemic co-occurrence of undernutrition, particularly SAM, and HIV in children, and current treatment practices, specifically WHO-recommended antibiotic usage. The risks and benefits of antibiotic treatment, prophylaxis and resistance are reviewed in the context of patients with SAM and HIV and associated sub-populations. Finally, the review highlights possible research areas and populations where antibiotic resistance progression can be studied to best address concerns associated with the future impact of resistance. Current antibiotic usage is lifesaving in complicated SAM and HIV-infected populations; nevertheless, increasing baseline resistance and infection remain a significant concern. In conclusion, antibiotic usage currently addresses the immediate needs of children in SAM and HIV endemic regions; however, it is prudent to evaluate the impact of antibiotic use on resistance dynamics and long-term child health.
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Affiliation(s)
- Freddy Francis
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | | | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, U.K; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe..
| | - Amee R Manges
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.
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21
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Abdu-Aguye SN, Barde KG, Yusuf H, Lawal BK, Shehu A, Mohammed E. Investigating Knowledge of Antibiotics, Antimicrobial Resistance and Antimicrobial Stewardship Concepts Among Final Year Undergraduate Pharmacy Students in Northern Nigeria. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2022; 11:187-195. [PMID: 36582301 PMCID: PMC9793721 DOI: 10.2147/iprp.s385692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Well trained, knowledgeable and competent pharmacists are indispensable in the fight against antimicrobial resistance (AMR), which is a current global public health problem. The aim of this work was to assess knowledge of antibiotics, antimicrobial resistance and antimicrobial stewardship of fifth year pharmacy students at three universities in Northern Nigeria. Methods A descriptive cross-sectional study that used a paper-based questionnaire to collect data from July to September 2021 was conducted. The questionnaire was self-administered and divided into four sections. The first section collected information about the demographic data of respondents, while section B explored their knowledge of antibiotics and AMR. Section C contained six questions assessing knowledge of various aspects of antimicrobial stewardship (AMS), while the final part assessed respondents' preparedness to work with antibiotics and perceptions of their current knowledge of these concepts. Descriptive statistics were used to report the results obtained. Results A total of 164 questionnaires were retrieved. Majority of respondents were male (58.3%) and aged between 21 and 25 years (53.4%). Most of them had some knowledge of antibiotics and AMR, however several misconceptions with respect to these concepts were identified. Only 80 (48.8%) of respondents indicated that they knew what AMS was, although most of these students were correctly knowledgeable about the goals and scope of AMS and composition of the AMS team. Generally, less than half of respondents agreed that their current knowledge of antibiotics, AMR or AMS was adequate for their future careers, and over 90% of them agreed that they would like more education about these topics. Conclusion Many of the study's' respondents were somewhat knowledgeable about these concepts, although several knowledge gaps were also observed. Improving undergraduate pharmacy education with respect to these concepts is recommended.
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Affiliation(s)
- Samirah N Abdu-Aguye
- Department of Clinical Pharmacy & Pharmacy Practice, Ahmadu Bello University, Zaria, Nigeria,Correspondence: Samirah N Abdu-Aguye, Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria, Tel +234 803 201 9135, Email
| | - Kromdi G Barde
- Department of Clinical Pharmacy & Pharmacy Practice, Ahmadu Bello University, Zaria, Nigeria
| | - Hadiza Yusuf
- Department of Clinical Pharmacy & Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria
| | - Basira Kankia Lawal
- Department of Clinical Pharmacy & Pharmacy Management, Kaduna State University, Kaduna, Nigeria
| | - Aishatu Shehu
- Department of Pharmacology & Therapeutics, Ahmadu Bello University, Zaria, Nigeria
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22
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Showande SJ, Ikuomola IF. Pharmacists’ involvement with and pharmacy clients’ awareness of adverse drug reaction reporting in Nigeria – a mixed-methods approach. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
Adverse drug reactions are one of the leading causes of death, yet they are under-reported. This study assessed the involvement of community pharmacists in the identification, documentation, and reporting of adverse drug reactions and pharmacy clients’ awareness of the adverse drug reaction reporting system.
Methods
A cross-sectional questionnaire-guided survey was conducted among 780 pharmacy clients in six selected community pharmacies, and seven mystery clients visited 125 community pharmacies in Ibadan, Nigeria. Information on pharmacy clients’ experience of adverse drug reactions, to whom and how they were reported, was obtained. Female and male mystery clients’ performed two scripted scenarios, complaining of black patches on their thighs and blood in their faeces, respectively. The proportion of pharmacists who identified the complaints as adverse drug reactions, documented and reported them, was described.
Key findings
The response rate for the pharmacy clients’ survey was 98.5%. Some pharmacy clients, 385 (50.1%), had experienced adverse drug reactions; 49 (12.7%) of these pharmacy clients were hospitalised and 73 (19.0%) of them reported the adverse drug reactions to physicians or pharmacists. Most of the pharmacy clients, 706 (91.9%), did not use the available reporting system. A total of 218 mystery client visits were made. The proportion of pharmacists who recognised the mystery client complaints as adverse drug reactions was 4.9–60.3% depending on the scenario presented and up to two pharmacists documented and supposedly reported the adverse drug reactions.
Conclusions
Some of the pharmacy clients reported experiencing adverse drug reactions to healthcare professionals, but most did not report through the existing reporting scheme. Community pharmacists could identify adverse drug reactions but most failed to document or report them.
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Affiliation(s)
- Segun Johnson Showande
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan , Ibadan , Nigeria
| | - Iretomiwa Faith Ikuomola
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan , Ibadan , Nigeria
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23
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Tembo N, Mudenda S, Banda M, Chileshe M, Matafwali S. Knowledge, attitudes and practices on antimicrobial resistance among pharmacy personnel and nurses at a tertiary hospital in Ndola, Zambia: implications for antimicrobial stewardship programmes. JAC Antimicrob Resist 2022; 4:dlac107. [PMID: 36226225 PMCID: PMC9549736 DOI: 10.1093/jacamr/dlac107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a global public health problem that has led to increased morbidity and mortality, especially in low- and middle-income countries such as Zambia. This study evaluated AMR knowledge, attitudes and practices among pharmacy personnel and nurses at Ndola Teaching Hospital, Zambia's second-largest hospital. Methods A descriptive cross-sectional study was conducted among 263 participants using a structured questionnaire. Data analysis was performed with IBM SPSS version 23.0. All statistical tests were conducted at a 95% confidence level. Univariate analysis was used to determine differences in knowledge, attitudes and practices on AMR between pharmacy personnel and nurses. Results Of the 263 participants, 225 (85.6%) were nurses and 38 (14.4%) were pharmacy personnel. Compared with nurses, pharmacy personnel had better knowledge of the spread of resistant bacteria from one person to another (P = 0.001) and the use of antibiotics in livestock as a contributing factor to AMR (P = 0.01). Pharmacy personnel had better attitudes towards AMR as a public health problem (P = 0.001) and the use of antibiotics in livestock as a source of resistant pathogens (P = 001). Lastly, more pharmacy personnel than nurses participated in awareness campaigns (P = 0.029), continued professional development (P = 0.001) and courses on the use of antibiotics and AMR (P = 0.028). Conclusions The study showed that most participants had adequate knowledge, a positive attitude and good practices towards AMR. Significant differences in knowledge, attitudes and practices were observed between pharmacy personnel and nurses in AMR, highlighting a need for increased educational programmes for these healthcare personnel.
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Affiliation(s)
- Nanji Tembo
- Department of Clinical Sciences, Copperbelt University, School of Medicine, Ndola, Zambia
| | - Steward Mudenda
- Department of Pharmacy, University of Zambia, School of Health Sciences, Lusaka, Zambia
| | - Michelo Banda
- Department of Pharmacy, University of Zambia, School of Health Sciences, Lusaka, Zambia
| | - Mwitwa Chileshe
- Department of Pharmacology, Eden University, School of Pharmacy, Lusaka, Zambia
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Godman B, Egwuenu A, Wesangula E, Schellack N, Kalungia AC, Tiroyakgosi C, Kgatlwane J, Mwita JC, Patrick O, Niba LL, Amu AA, Oguntade RT, Alabi ME, Ncube NBQ, Sefah IA, Acolatse J, Incoom R, Guantai AN, Oluka M, Opanga S, Chikowe I, Khuluza F, Chiumia FK, Jana CE, Kalemeera F, Hango E, Fadare J, Ogunleye OO, Ebruke BE, Meyer JC, Massele A, Malande OO, Kibuule D, Kapona O, Zaranyika T, Bwakura-Dangarembizi M, Kujinga T, Saleem Z, Kurdi A, Shahwan M, Jairoun AA, Wale J, Brink AJ. Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future. Expert Opin Drug Saf 2022; 21:1089-1111. [PMID: 35876080 DOI: 10.1080/14740338.2022.2106368] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a concern as this increases morbidity, mortality, and costs, with sub-Saharan Africa having the highest rates globally. Concerns with rising AMR have resulted in international, Pan-African, and country activities including the development of national action plans (NAPs). However, there is variable implementation across Africa with key challenges persisting. AREAS COVERED Consequently, there is an urgent need to document current NAP activities and challenges across sub-Saharan Africa to provide future guidance. This builds on a narrative review of the literature. EXPERT OPINION All surveyed sub-Saharan African countries have developed their NAPs; however, there is variable implementation. Countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; though there are concerns with implementation. South Africa appears to have made the greatest strides with implementing its NAP including regular monitoring of activities and instigation of antimicrobial stewardship programs. Key challenges remain across Africa. These include available personnel, expertise, capacity, and resources to undertake agreed NAP activities including active surveillance, lack of focal points to drive NAPs, and competing demands and priorities including among donors. These challenges are being addressed, with further co-ordinated efforts needed to reduce AMR.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Abiodun Egwuenu
- AMR Programme, Nigeria Centre for Disease Control, Jabi, Abuja, Nigeria
| | - Evelyn Wesangula
- Patient and Health Workers Safety Division, AMR Focal Point, Ministry of Health, Nairobi, Kenya
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | | | - Joyce Kgatlwane
- Department of Pharmacy, University of Botswana, Gaborone, Botswana
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences, University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Nondumiso B Q Ncube
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Israel Abebrese Sefah
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Anastasia Nkatha Guantai
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis K Chiumia
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Collins Edward Jana
- Division of Biochemistry, Biomedical Sciences Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Ester Hango
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bernard E Ebruke
- International Foundation Against Infectious Disease in Nigeria (IFAIN), Abuja, Nigeria
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Oliver Ombeva Malande
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Tororo, Uganda
| | | | - Trust Zaranyika
- Department Of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Iraq
| | - Moyad Shahwan
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Adrian J Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
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Oyejobi GK, Sule WF, Akinde SB, Khan FM, Ogolla F. Multidrug-resistant enteric bacteria in Nigeria and potential use of bacteriophages as biocontrol. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 824:153842. [PMID: 35183626 DOI: 10.1016/j.scitotenv.2022.153842] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Enteric bacterial pathogens have been implicated in many cases of gastroenteritis in Nigeria, a West African country. This situation is worsened by some reports of the high prevalence of multidrug-resistant enteric bacteria. To better prepare for situations in which even antibiotics of last resort would fail to treat infections caused by these pathogens, attention should be paid to alternative antimicrobial strategies. Here, we summarize existing reports of multidrug-resistant enteric bacterial infections in Nigeria, and importantly present the use of bacteriophages (viruses of bacteria) as an attractive antimicrobial alternative to combat these pathogens. It is hoped that this review will encourage research into the use of lytic bacteriophages against multidrug-resistant enteric bacteria in Nigeria.
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Affiliation(s)
- Greater Kayode Oyejobi
- Department of Microbiology, Faculty of Basic and Applied Sciences, Osun State University, Osogbo 230212, Osun State, Nigeria; Key Laboratory of Special Pathogens and Biosafety, Center for Biosafety Mega-Science, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China; International College, University of Chinese Academy of Sciences, Beijing, China; Organization of African Academic Doctors, Off Kamiti Road, P.O. Box 25305-00100, Nairobi, Kenya.
| | - Waidi Folorunso Sule
- Department of Microbiology, Faculty of Basic and Applied Sciences, Osun State University, Osogbo 230212, Osun State, Nigeria
| | - Sunday Babatunde Akinde
- Department of Microbiology, Faculty of Basic and Applied Sciences, Osun State University, Osogbo 230212, Osun State, Nigeria
| | - Fazal Mehmood Khan
- Key Laboratory of Special Pathogens and Biosafety, Center for Biosafety Mega-Science, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China; Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen, China; Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen, China
| | - Faith Ogolla
- Key Laboratory of Special Pathogens and Biosafety, Center for Biosafety Mega-Science, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China; International College, University of Chinese Academy of Sciences, Beijing, China; Organization of African Academic Doctors, Off Kamiti Road, P.O. Box 25305-00100, Nairobi, Kenya; Sino-Africa Joint Research Center, Nairobi, Kenya
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Karasneh RA, Al-Azzam SI, Ababneh M, Al-Azzeh O, Al-Batayneh OB, Muflih SM, Khasawneh M, Khassawneh ARM, Khader YS, Conway BR, Aldeyab MA. Prescribers' Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan. Antibiotics (Basel) 2021; 10:antibiotics10070858. [PMID: 34356779 PMCID: PMC8300611 DOI: 10.3390/antibiotics10070858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.
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Affiliation(s)
- Reema A. Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Sayer I. Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.I.A.-A.); (M.A.); (S.M.M.)
| | - Mera Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.I.A.-A.); (M.A.); (S.M.M.)
| | - Ola Al-Azzeh
- Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia;
| | - Ola B. Al-Batayneh
- Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Suhaib M. Muflih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.I.A.-A.); (M.A.); (S.M.M.)
| | - Mohammad Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | | | - Yousef S. Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD13DH, UK;
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD13DH, UK
| | - Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD13DH, UK;
- Correspondence: ; Tel.: +44-01484-472825
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Achi CR, Ayobami O, Mark G, Egwuenu A, Ogbolu D, Kabir J. Operationalising One Health in Nigeria: Reflections From a High-Level Expert Panel Discussion Commemorating the 2020 World Antibiotics Awareness Week. Front Public Health 2021; 9:673504. [PMID: 34136458 PMCID: PMC8203202 DOI: 10.3389/fpubh.2021.673504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/04/2021] [Indexed: 11/14/2022] Open
Abstract
Antimicrobial resistance (AMR) poses an important One Health challenge for all countries of the world. As human, animal and environmental health are closely linked, it is essential that interventions targeted at reducing the spread of AMR and those promoting antimicrobial stewardship are conducted with all sectors in mind. Tackling this global slow-moving pandemic (AMR) also requires action and strong commitment from all countries of the world. Nigeria, like many other countries, have made considerable progress in implementing the National Action Plan on Antimicrobial Resistance. The accomplishments and ongoing work led by the National Technical Working Group on AMR is commendable. However, gaps still exist in terms of operationalising One Health interventions for AMR, especially regarding rational antimicrobial use and antimicrobial stewardship. The 2020 World Antimicrobial Awareness Week presented an opportunity to convene a multi-sectoral expert panel from national government agencies, research, academia and the World Health Organisation across the Nigerian One Health space. The panel discussion analysed the progress made so far and identified the barriers and the opportunities for operationalising One Health interventions on AMR. The discussion highlighted poor awareness and the fear phenomenon, driven by technical and socio-economic factors, as a common cross-sectoral denominator at the heart of inappropriate antibiotic use within the country. At the system level, suboptimal use of antimicrobials fuelled by the ease of purchase, poor regulations and insufficient enforcement of prescription-only access to antimicrobials, and limited infection prevention and biosecurity measures resonated as drivers of AMR across One Health sectors in Nigeria. Looking forward, the panel discussion identified substantial investment in the governance of the existing One Health component structures, inclusive bottom-up institutional antimicrobial stewardship that fosters community participation and multi-level cross-sectoral collaborations as the next level strategic imperatives. In this respect is the need for a strengthened One Health infrastructure, including an operational workforce, educational strategies to elevate AMR and rational antimicrobial use into public consciousness, and the use of improved data systems as countermeasures to the challenge of AMR.
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Affiliation(s)
- Chioma R. Achi
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Veterinary Public Health and Preventive Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Olaniyi Ayobami
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Godwin Mark
- Department of Internal Medicine, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Abiodun Egwuenu
- National AMR Programme, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - David Ogbolu
- Medical Microbiology Unit, Department of Medical Science, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
| | - Junaidu Kabir
- Department of Veterinary Public Health and Preventive Medicine, Ahmadu Bello University Zaria, Zaria, Nigeria
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