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Cited by 20Antibiotic Use and ResistanceHealthcare cost, quality, practicesAntibiotic Resistance in Bacteria

Antibiotic prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

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Opoku, Michael Mireku, Bonful, Harriet Affran, Koram, Kwadwo Ansah·2020·BMC Health Services Research
DOI 10.1186/s12913-020-05771-9PMC PMC7590657

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Abstract

BACKGROUND: Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana. METHODS: Secondary data obtained from the medical records of 2519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2015 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients' demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers' demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. RESULTS: The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR = 0.40, 95% CI: 0.32, 0.51; p < 0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. CONCLUSION: Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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  • Most high-income countries have adopted guidelines for the rational use of antibiotics, but more efforts are needed in lower-middle-income countries.

    “While most high-income countries have adopted guidelines for the rational use of antibiotics, more efforts are needed in lower-middle-income countries [9,10,11].”

    From A Systematic Review on Antimicrobial Resistance in Ghana from a One Health Perspective (2024) · cites this paper as [11]

    The Background (page not provided) says Ghana has introduced treatment guidelines and an antimicrobial-use policy, but still needs targeted stewardship efforts to address inappropriate prescribing. It does not say that most high-income countries have adopted such guidelines, and its discussion of needed efforts concerns Ghana rather than lower-middle-income countries generally. (LLM, conf=0.85)

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3 of the 48 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [4]World Health Organization, WHO Press Antimicrobial resistance: global report on surveillance 2014 Geneva World Health Organization
  2. [40]Opoku MM. Assessment of antibiotics prescribing practices at the Sunyani municipal hospital in 2015: Thesis: University of Ghana; 2017. http://ugspace.ug.edu.gh/handle/123456789/23711. Accessed 12 Nov 2019.
  3. [41]Duah NA. Prescription practices and patterns of antibiotics used in children attending the Princess Marie Louise Children’s hospital: Thesis: University of Ghana; 2018. http://ugspace.ug.edu.gh/handle/123456789/25873. Accessed 12 Nov 2019.

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Authors
Opoku, M. M., Bonful, H. A., & Koram, K. A.
Affiliations
University of Ghana (GH)
Corresponding author
Bonful, Harriet Affran
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2020-10-27
Volume
20
Issue
1
Pages
978-978
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/s12913-020-05771-9
PMC
PMC7590657
OpenAlex
W3096617897
Cited by
20
References
48
Citations by year
2026: 5 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 6
FWCI
1.19
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Deutscher Akademischer Austauschdienst
  • University of Ghana
  • Kwame Nkrumah University of Science and Technology
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Keywords
antibiotic prescribing, antibiotic resistance, antibiotic stewardship, prescribing patterns, IMNCI, laboratory testing, cough, children under five, Greater Accra Region, healthcare facilities, rational antibiotic use, malaria rapid diagnostic tests, blood film microscopy, complete blood count
MeSH terms
Antimicrobial Stewardship, Adolescent, Adult, Ambulatory Care Facilities, Anti-Bacterial Agents, Child, Child, Preschool, Drug Resistance, Microbial, Female, Fever, Ghana, Humans, Malaria, Male, Medical Records, Middle Aged, Outpatients, Practice Patterns, Physicians', Surveys and Questionnaires, Logistic Models, Young Adult

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