Adherence to standard treatment guidelines among prescribers in primary healthcare facilities in the Dodoma region of Tanzania

Abstract

Background Tanzania’s primary healthcare system suffers from a scarcity of financial and human resources that impedes its effectiveness to deliver dependable and uniform quality healthcare. Adherence to standard treatment guidelines (STG) can help provide more consistent and correct diagnoses and treatments and limit the irrational use of medicines and the negative health consequences that can occur as a result. The purpose of this study was to investigate prescribers’ adherence of their diagnoses and respective treatments to national STG and to identify potential areas for planning interventions. Methods A cross-sectional study on prescribers’ adherence to diagnosis and treatment, according to national STG, was conducted in 2012 in public primary healthcare facilities (HCF) in the Dodoma region of Tanzania. Information on 2886 patients was collected, prospectively and retrospectively, from 120 HCF across the Dodoma region using a structured questionnaire. Twenty-five broadly defined main illness groups were recorded and the nine most prevalent and relevant conditions were statistically analysed in detail. Results Diagnoses and related treatments were recorded and analysed in 2872 cases. The nine most prevalent conditions were upper respiratory tract infections (25%), malaria (18%), diarrhoea (9.9%), pneumonia (6.1%), skin problems (5.8%), gastrointestinal diagnoses (5%), urinary tract infections (4%), worm infestations (3.6%) and eye problems (2.1%). Only 1.8% of all diagnoses were non-communicable diseases. The proportion of prescribers’ primary diagnoses that completely adhered to national STG was 599 (29.9%), those that partially adhered totalled 775 (38.7%), wrong medication was given in 621 cases (30.9%) and no diagnosis or medication was given in nine cases (0.5%). Sixty-one percent of all patients received an antibiotic regardless of the diagnoses. Complete adherence was highest when worms were diagnosed and lowest for diarrhoea. The proportion of cases that did not adhere to STG was highest with patients with skin problems and lowest for malaria. Conclusion Prescribers’ general adherence to national STG in primary HCF in the public sector in Dodoma region is sub-optimal. The reasons are multifaceted and focused attention, directed at improving prescribing and pharmacotherapy, is required with a view of improving patient care and health outcomes.

Prevalence and Predictors of Antibiotic Prescriptions at Primary Healthcare Facilities in the Dodoma Region, Central Tanzania: A Retrospective, Cross-Sectional Study

“…Additionally, even though the Tanzanian STG recommends that PID be treated with a combination of antibiotics, 60% of the PID cases in this study were not prescribed antibiotics. This is supported by the previous study in primary healthcare facilities in Dodoma, Tanzania, where 25% of malaria cases were also prescribed antibiotics against STG [ 25 ]. This finding was further supported by a study conducted in Cameroon, where uncomplicated malaria was treated with antibiotics against treatment guidelines [ 14 ].…”

“…In a review on antibiotic prescriptions in primary healthcare facilities involving 48 studies from 27 low- and middle-income countries, the prevalence proportion of antibiotic prescriptions was also reported at 56% [ 24 ]. The findings of this current study show alarmingly high levels of antibiotic prescriptions, an observation likely to be influenced by poor adherence to standard treatment guidelines among primary healthcare prescribers [ 25 ] and the absence of laboratory facilities in these lower-level healthcare facilities [ 25 ].…”

Understanding of Future Prescribers About Antimicrobial Resistance and Their Preparedness Towards Antimicrobial Stewardship Activities in Pakistan: Findings and Implications

“…The presence of and adherence to institution-based standard treatment guidelines (STGs) is integral in managing infections as they have proven benefits in reducing mortality, morbidity, and therapy cost ( Wiedenmayer et al, 2021 ). Besides, STGs also minimize the probability of AMR emergence.…”

Knowledge, attitudes and practices towards malaria diagnostics among healthcare providers and healthcare-seekers in Kondoa district, Tanzania: a multi-methodological situation analysis

“…This behaviour could be a reflection of conformity to much older and more confusing malaria diagnosis and treatment guidelines from 2006 that suggested using clinical judgement when a test result was negative [36,53,54]. However, given the many challenges HCPs face adhering to treatment guidelines in Tanzania [11,19,55], a complexity of other more tangible reasons could be considered more compelling, such as a need to provide a diagnosis and treatment and patient pressure to provide one [15,19]. In cases where HCPs could confirm RDT results with a blood film, the majority would do so, particularly if the RDT result was negative (68%).…”