Antibiotic prescription practices among prescribers for children under five at public health centers III and IV in Mbarara district

Abstract

Introduction Rational use of medicines requires that patients receive medications appropriate to their clinical needs. Irrational prescription of antibiotics has been reported in many health systems across the world. In Uganda, mainly nurses and assistant medical officers (Clinical officers) prescribe for children at level III and IV primary care facilities (health center II and IV). Nurses are not primarily trained prescribers; their antibiotic prescription maybe associated with errors. There is a need to understand the practices of antibiotic prescription among prescribers in the public primary care facilities. We therefore determined antibiotic prescription practices of prescribers for children under five years at health center III and IV in Mbarara district, South Western Uganda. Methods This was a retrospective descriptive cross-sectional study. We reviewed outpatient records of children <5 years of age retrospectively. Information obtained from the outpatient registers were captured in predesigned data abstraction form. Health care providers working at health centers III and IV were interviewed using a structured questionnaire. They provided information on socio-demographic, health facility, antibiotic prescription practices and availability of reference tools. Data was analyzed using STATA software version 13∙0. Results There were 1218 outpatients records of children under five years reviewed and 35 health care providers interviewed. The most common childhood illness diagnosed was upper respiratory tract infection. It received the most antibiotic prescription (53%). The most commonly prescribed oral antibiotics were cotrimoxazole and amoxicillin, and ceftriaxone and benzyl penicillin were the commonest prescribed injectable antibiotics. Up to 68.4% of the antibiotic prescription was irrational. No prescriber or facility factors were associated with irrational antibiotic prescription practices. Conclusion Upper respiratory tract infection is the most diagnosed condition in children under five years with Cotrimoxazole and Amoxicillin being the most commonly prescribed antibiotics. Antibiotics are being prescribed irrationally at health centers III and IV in Mbarara District. Training and support supervision of prescribers at health centers III and IV in Mbarara district need to be prioritized by the district health team.

Inappropriate Use of Antibiotics and Their Predictors in Pediatric Patients Admitted at the Hospital Central De Nampula, Mozambique

“…Description of antibiotic use errorsThis research observed 36.5% of medical prescriptions containing errors, with a total of 34.5% of antibiotics being improper prescribed.Iftikhar et al, and Denny et al, observed convergent rates of 40.8% and 22.9% improper prescriptions, respectively (47,48). A survey by Santander et al found a convergent rate of 51.9 % of improper medical prescriptions, Okello et al, (68.4%)(49,50). In this research, 57.1%, 27.7%, 11.6% and 3.6% of the prescriptions presented a, two, three and four errors respectively.…”

Inappropriate use of antibiotics and its predictors in pediatric patients admitted at the Central Hospital of Nampula, Mozambique

“…Iftikhar et al [ 15 ], and Denny et al [ 31 ], observed convergent rates of 40.8% and 22.9% improper prescriptions, respectively. A survey by Santander et al found a similar rate of 51.9% of improper medical prescriptions [ 32 ], while Okello et al found a rate of 68.4% [ 33 ]. In the present research, 57.1%, 24.1%, 10.7%, and 8.0% of the prescriptions presented one, two, four, and three errors, respectively.…”

An Evaluation of Antibiotic Prescription Rationality at Lower Primary Healthcare Facilities in Three Districts of South-Western Uganda

“…These findings are comparable with those of studies conducted in Mbarara and Bushenyi districts. 23 , 29 …”

“…20,21 Nurses made half the evaluated prescriptions, a similar finding to other studies conducted in Ghana and Uganda. [21][22][23] This can be attributed to the fact that primary care facilities in Uganda serve majority of the population and are mainly managed by nurses with a few clinical officers at HC IIIs and HC IVs, plus one or two medical officers at HC IVs. 15 Reforms authorising nurses to prescribe medicines have gained momentum in the recent past globally.…”