Antimicrobial resistance and rational use of medicine: knowledge, perceptions, and training of clinical health professions students in Uganda

Combatting Antibiotic Resistance: Identifying Gaps in Knowledge, Attitude, and Practice Among Medical Interns

INTRODUCTION

Antibiotic resistance presents a significant global health threat to modern medicine. The awareness and attitude of future doctors undergoing training may play a crucial role in addressing this important issue, influencing the control of resistance and promoting responsible antibiotic stewardship. This study aimed to estimate knowledge, attitudes, and practices regarding antibiotic usage and antimicrobial resistance among tertiary care teaching hospital medical interns.

METHODOLOGY

The questionnaire-based cross-sectional study was conducted on 123 MBBS interns from multiple medical institutions. Intern's knowledge, attitudes, and self-reported practices regarding antibiotic use were recorded.

RESULTS

Based on survey responses from 123 participants, 116 (94.31%) were aware of the adverse effects of indiscriminate antibiotic use, recognizing the risks of ineffective treatment, increased adverse effects, prolonged illness, bacterial resistance, and higher medical costs. Most (106, 86.18%) acknowledged the challenges of treating antibiotic-resistant infections, and 69 (56.10%) correctly identified that bacteria are not a cause of the common cold and flu. Most (115, 93.5%) recognized antibiotic resistance as a significant global health problem. In attitude, 90 (73%) believed antibiotics should be avoided for colds, but 80 (65%) thought they hastened fever recovery. Only 48 (39%) recognized that antibiotics contribute to resistance, while 102 (83%) agreed skipping doses fosters resistance. Most support hospital policies (118, 96%) and curriculum courses (112, 91%) for rational antibiotic use. Regarding practice, 12 (9.76%) interns admitted to overusing antibiotics, 68 (55.28%) consulted a doctor before starting antibiotics, and 87 (70.73%) checked expiry dates. Additionally, 62 (50.41%) preferred antibiotics for cough and sore throat symptoms.

CONCLUSIONS

The study highlights that while interns have a good knowledge and awareness of the harms of antibiotic misuse, they are not translating this knowledge into practice. This indicates a disconnect between understanding and application. Therefore, there is a need to add a rational antibiotic prescription and stewardship module to the medical curriculum to ensure that knowledge is effectively translated into changing beliefs and practices.

Prevalence of knowledge, attitudes, and practices regarding antimicrobial resistance in Africa: a systematic review and meta-analysis

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.

Addressing gaps in AMR awareness in the public: an evidence-based policy brief to guide school curriculum review in Uganda

The government of Uganda, through its Ministry of Health, previously adopted curriculum review as a mechanism to respond to public health threats such as HIV/AIDS and include content in primary and secondary schools. This approach contributes to raising public awareness, a key strategy recommended by the World Health Organization to support the global response to the threat of antimicrobial resistance (AMR). This policy brief, developed for policymakers related to school curricula, aims to advocate for and support integration of AMR content in Uganda's primary and secondary level school curricula. The policy brief supports efforts by the multisectoral National AMR Subcommittee to create awareness on this issue as part of its role in facilitating the operationalization of Uganda's National Action Plan on AMR.

Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review

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.

Antimicrobial resistance and rational prescription practices: knowledge, perceptions and confidence of health profession interns in Uganda

Background

Antimicrobial resistance (AMR) is significantly driven by misuse and overuse of antibiotics. Graduate health profession interns often prescribe antimicrobials under minimum supervision.

Objectives

This study explored the knowledge, perceptions and confidence of health profession interns in Uganda regarding AMR and rational prescription practices.

Methods

This was a cross-sectional survey employing quantitative techniques carried out between October and November 2022 at six tertiary hospitals in Uganda. Health profession interns including doctors, nurses, midwives and pharmacists were recruited as study participants. Data were collected using online Kobo toolbox software. Data analysis was performed using STATA (StataCorp) version 16. Bivariate analysis and multivariable logistic regression were performed. P < 0.05 was considered statistically significant.

Results

We recruited 281 participants with a mean age of 27 ± 3.8 years, of which few (n = 53; 19%) had good knowledge about AMR and rational prescription. The use of professional organization guidelines as a source of information was significantly associated with good knowledge (adjusted OR = 1.9; 95% CI: 1.0-3.5; P = 0.046). Nurses had the least knowledge compared with doctors and pharmacists. Continuous medical education (99%) and availability of clinical guidelines (98%) were identified as the most helpful intervention to improve knowledge. Most participants were confident about accurately diagnosing infections and sepsis and selecting appropriate antimicrobials.

Conclusions

Continuous medical education and availability of clinical and professional organization guidelines should be leveraged to improve the knowledge of AMR and rational prescription among health profession interns. Their high confidence in rational prescription practices should be pivotal to the fight against AMR.

Comparison of health care professionals' and laypeople's knowledge, attitudes, and practices on the use of antimicrobial and antimicrobial resistance

BACKGROUND

The discovery of antimicrobials is a pioneering step in health sciences concerning preventive care and early management for infectious diseases. However, with advancements in health sciences, inappropriate knowledge, practices, and over-the-counter medications were often used by the general population in underdeveloped nations like India without thinking about its consequences which leads to the use of antimicrobials excessively or inadequately, which is also a factor for antimicrobial resistance. This quantitative study determines the awareness of healthcare professionals and laypersons about usage and resistance of antimicrobials.

METHODS AND MATERIALS

Research was carried out in rural tertiary teaching hospital of study participants were 106 nurses, 115 interns, 107 junior residents, and 97 laypersons using a "self-administered WHO questionnaire". SPSS version 27.0 software was used to analyze the data. The P value cut-off for significance was established at <.05.

RESULTS

Forty seven percent of nurses and 44% of interns consumed antimicrobials in the last month, more than interns and junior residents. Fourteen percent of interns and 13% of laypersons did not get any prescription for lastly taken antimicrobial. The majority of participants obtain prescribed antimicrobials from medical stores and pharmacies. Fifty five percent of laypersons and 59% of nurses stop taking antimicrobials when they feel better. Only 13% of nurses were aware of the proper indications of antimicrobials for the same illness. Only 22% of respondents know the term superbugs, significantly less than the other key terms related to the antimicrobials. Nurses and laypersons had some misconceptions related to the mechanism of development of antimicrobial resistance.

CONCLUSIONS

The analysis revealed that a significant lack of knowledge and various misconceptions were primarily seen in the nurses and laypersons. In contrast, medical graduates such as interns and junior residents lacked the right attitude and perspective regarding the use of antimicrobials and their resistance.