A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana
Identifieur interne : 000400 ( Main/Exploration ); précédent : 000399; suivant : 000401A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana
Auteurs : Mary-Anne Ahiabu [Ghana, Danemark] ; Britt P. Tersb L [Danemark] ; Richard Biritwum [Ghana] ; Ib C. Bygbjerg [Danemark] ; Pascal Magnussen [Danemark]Source :
- Health Policy and Planning [ 0268-1080 ] ; 2015.
Abstract
Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and ‘no malaria drug’ on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support of rational drug use.
Url:
DOI: 10.1093/heapol/czv048
PubMed: 26045328
PubMed Central: 4748131
Affiliations:
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O. Box KB 493, Accra, Ghana,</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Disease Control and Prevention Department, Ghana Health Service, Ministry of Health, P. O. Box KB 493, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="czv048-AFF2">Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark,</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K</wicri:regionArea><wicri:noRegion>1014 Copenhagen K</wicri:noRegion></affiliation></author><author><name sortKey="Tersb L, Britt P" sort="Tersb L, Britt P" uniqKey="Tersb L B" first="Britt P" last="Tersb L">Britt P. Tersb L</name><affiliation wicri:level="1"><nlm:aff id="czv048-AFF2">Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark,</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K</wicri:regionArea><wicri:noRegion>1014 Copenhagen K</wicri:noRegion></affiliation></author><author><name sortKey="Biritwum, Richard" sort="Biritwum, Richard" uniqKey="Biritwum R" first="Richard" last="Biritwum">Richard Biritwum</name><affiliation wicri:level="3"><nlm:aff wicri:cut=" and" id="czv048-AFF3">Department of Community Health, College of Health Sciences, University of Ghana P. O. Box KB 4236, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Community Health, College of Health Sciences, University of Ghana P. O. Box KB 4236, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Bygbjerg, Ib C" sort="Bygbjerg, Ib C" uniqKey="Bygbjerg I" first="Ib C" last="Bygbjerg">Ib C. Bygbjerg</name><affiliation wicri:level="1"><nlm:aff id="czv048-AFF2">Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark,</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K</wicri:regionArea><wicri:noRegion>1014 Copenhagen K</wicri:noRegion></affiliation></author><author><name sortKey="Magnussen, Pascal" sort="Magnussen, Pascal" uniqKey="Magnussen P" first="Pascal" last="Magnussen">Pascal Magnussen</name><affiliation wicri:level="1"><nlm:aff id="czv048-AFF2">Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark,</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K</wicri:regionArea><wicri:noRegion>1014 Copenhagen K</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="czv048-AFF4">Centre for Medical Parasitology, University of Copenhagen, CSS Building 22/23, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen K, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Centre for Medical Parasitology, University of Copenhagen, CSS Building 22/23, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen K</wicri:regionArea><wicri:noRegion>1014 Copenhagen K</wicri:noRegion></affiliation></author></analytic><series><title level="j">Health Policy and Planning</title><idno type="ISSN">0268-1080</idno><idno type="eISSN">1460-2237</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and ‘no malaria drug’ on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support of rational drug use.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Amabile Cuevas, Cf" uniqKey="Amabile Cuevas C">CF Amábile-Cuevas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arhinful, Dk" uniqKey="Arhinful D">DK Arhinful</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baiden, F" uniqKey="Baiden F">F Baiden</name></author><author><name sortKey="Owusu Agyei, S" uniqKey="Owusu Agyei S">S Owusu-Agyei</name></author><author><name sortKey="Bawah, J" uniqKey="Bawah J">J Bawah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bjerrum, L" uniqKey="Bjerrum L">L Bjerrum</name></author><author><name sortKey="Cots, Jm" uniqKey="Cots J">JM 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Cashin</name></author><author><name sortKey="Saleh, K" uniqKey="Saleh K">K Saleh</name></author><author><name sortKey="Lavado, R" uniqKey="Lavado R">R Lavado</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schwarz, Ng" uniqKey="Schwarz N">NG Schwarz</name></author><author><name sortKey="Sarpong, N" uniqKey="Sarpong N">N Sarpong</name></author><author><name sortKey="Hunger, F" uniqKey="Hunger F">F Hünger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Spaan, E" uniqKey="Spaan E">E Spaan</name></author><author><name sortKey="Mathijssen, J" uniqKey="Mathijssen J">J Mathijssen</name></author><author><name sortKey="Tromp, N" uniqKey="Tromp N">N Tromp</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van De Sande Bruinsma, N" uniqKey="Van De Sande Bruinsma N">N van de Sande-Bruinsma</name></author><author><name sortKey="Grundmann, H" uniqKey="Grundmann H">H Grundmann</name></author><author><name sortKey="Verloo, D" uniqKey="Verloo D">D Verloo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="West, Lj" uniqKey="West L">LJ West</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Williams, Eo" uniqKey="Williams E">EO Williams</name></author><author><name sortKey="Stock, Em" uniqKey="Stock E">EM Stock</name></author><author><name sortKey="Zeber, Je" uniqKey="Zeber J">JE Zeber</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Witter, S" uniqKey="Witter S">S Witter</name></author><author><name sortKey="Garshong, B" uniqKey="Garshong B">B Garshong</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wurthwein, R" uniqKey="Wurthwein R">R Würthwein</name></author><author><name sortKey="Gbangou, A" uniqKey="Gbangou A">A Gbangou</name></author><author><name sortKey="Sauerborn, R" uniqKey="Sauerborn R">R Sauerborn</name></author><author><name sortKey="Schmidt, Cm" uniqKey="Schmidt C">CM Schmidt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zwart, S" uniqKey="Zwart S">S Zwart</name></author><author><name sortKey="Voorhoeve, Hwa" uniqKey="Voorhoeve H">HWA Voorhoeve</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Danemark</li><li>Ghana</li></country><region><li>Région du Grand Accra</li></region><settlement><li>Accra</li></settlement></list><tree><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Ahiabu, Mary Anne" sort="Ahiabu, Mary Anne" uniqKey="Ahiabu M" first="Mary-Anne" last="Ahiabu">Mary-Anne Ahiabu</name></region><name sortKey="Biritwum, Richard" sort="Biritwum, Richard" uniqKey="Biritwum R" first="Richard" last="Biritwum">Richard Biritwum</name></country><country name="Danemark"><noRegion><name sortKey="Ahiabu, Mary Anne" sort="Ahiabu, Mary Anne" uniqKey="Ahiabu M" first="Mary-Anne" last="Ahiabu">Mary-Anne Ahiabu</name></noRegion><name sortKey="Bygbjerg, Ib C" sort="Bygbjerg, Ib C" uniqKey="Bygbjerg I" first="Ib C" last="Bygbjerg">Ib C. Bygbjerg</name><name sortKey="Magnussen, Pascal" sort="Magnussen, Pascal" uniqKey="Magnussen P" first="Pascal" last="Magnussen">Pascal Magnussen</name><name sortKey="Magnussen, Pascal" sort="Magnussen, Pascal" uniqKey="Magnussen P" first="Pascal" last="Magnussen">Pascal Magnussen</name><name sortKey="Tersb L, Britt P" sort="Tersb L, Britt P" uniqKey="Tersb L B" first="Britt P" last="Tersb L">Britt P. Tersb L</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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