Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria.

Autor: Ogoina D; Dimie Ogoina Infectious Disease Unit, Department of Internal Medicine, Niger Delta University/Niger Delta University Teaching Hospital, Yenagoa, Bayelsa State, Nigeria. dimieogoina@gmail.com., Iliyasu G; Infectious Disease Unit, Department of Internal Medicine, Aminu Kano University Teaching Hospital, Kano, Nigeria., Kwaghe V; Infectious Disease Unit, Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Gwagwadala, Nigeria., Otu A; Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria., Akase IE; Department of Internal Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria., Adekanmbi O; Department of Medicine, University College Hospital/University of Ibadan, Ibadan, Oyo State, Nigeria., Mahmood D; Nigeria Centre for Disease Control (NCDC), African Field Epidemiology Network (AFENET), Abuja, Nigeria., Iroezindu M; Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Ituku, Enugu State, Nigeria., Aliyu S; Department of Medical Microbiology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria., Oyeyemi AS; Department of Community Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria., Rotifa S; Department of Community Medicine, Federal Medical Centre Yenagoa, Yenagoa, Bayelsa State, Nigeria., Adeiza MA; Department of Internal Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria., Unigwe US; Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Ituku, Enugu State, Nigeria., Mmerem JI; Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Ituku, Enugu State, Nigeria., Dayyab FM; Infectious Disease Hospital, Kano, Nigeria.; Department of Medicine, Federal Medical Center, Nguru, Yobe State, Nigeria., Habib ZG; Infectious Disease Unit, Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Gwagwadala, Nigeria., Otokpa D; Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria., Effa E; Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria., Habib AG; Infectious Disease Unit, Department of Internal Medicine, Aminu Kano University Teaching Hospital, Kano, Nigeria.
Jazyk: angličtina
Zdroj: Antimicrobial resistance and infection control [Antimicrob Resist Infect Control] 2021 Apr 30; Vol. 10 (1), pp. 73. Date of Electronic Publication: 2021 Apr 30.
DOI: 10.1186/s13756-021-00940-9
Abstrakt: Background: As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR.
Methods: In this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert's scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score < 80%). Independent predictors of good knowledge, attitude, and practice (KAPPr) were ascertained using an unconditional logistic regression model.
Results: A total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77%, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior 6 months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr.
Conclusions: Our study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria's NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.
Databáze: MEDLINE
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