Antimicrobial stewardship: Attitudes and practices of healthcare providers in selected health facilities in Uganda

Abstract

Though antimicrobial stewardship (AMS) programmes are the cornerstone of Uganda’s national action plan (NAP) on antimicrobial resistance, there is limited evidence on AMS attitude and practices among healthcare providers in health facilities in Uganda. We determined healthcare providers’ AMS attitudes, practices, and associated factors in selected health facilities in Uganda. We conducted a cross-sectional study among nurses, clinical officers, pharmacy technicians, medical officers, pharmacists, and medical specialists in 32 selected health facilities in Uganda. Data were collected once from each healthcare provider in the period from October 2019 to February 2020. Data were collected using an interview-administered questionnaire. AMS attitude and practice were analysed using descriptive statistics, where scores of AMS attitude and practices for healthcare providers were classified into high, fair, and low using a modified Blooms categorisation. Associations of AMS attitude and practice scores were determined using ordinal logistic regression. This study reported estimates of AMS attitude and practices, and odds ratios with 95% confidence intervals were reported. We adjusted for clustering at the health facility level using clustered robust standard errors. A total of 582 healthcare providers in 32 healthcare facilities were recruited into the study. More than half of the respondents (58%,340/582) had a high AMS attitude. Being a female (aOR: 0.66, 95% CI: 0.47–0.92, P < 0.016), having a bachelor’s degree (aOR: 1.81, 95% CI: 1.24–2.63, P < 0.002) or master’s (aOR: 2.06, 95% CI: 1.13–3.75, P < 0.018) were significant predictors of high AMS attitude. Most (46%, 261/582) healthcare providers had fair AMS practices. Healthcare providers in the western region’s health facilities were less likely to have a high AMS practice (aOR: 0.52, 95% CI 0.34–0.79, P < 0.002). In this study, most healthcare providers in health facilities had a high AMS attitude and fair AMS practice.

Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia

“…Besides, they should adhere to the guidelines when prescribing antibiotics [8] [9] [10]. Additionally, all healthcare workers (HCWs) should collaborate to address AMR and promote antimicrobial stewardship (AMS) programs [11] [12] [13] [14] [15]. This can improve the surveillance and reduction of AMR [16] [17] [18].…”

Knowledge, Attitudes, and Practices of Community Pharmacy Professionals on Poultry Antibiotic Dispensing, Use, and Bacterial Antimicrobial Resistance in Zambia: Implications on Antibiotic Stewardship and WHO AWaRe Classification of Antibiotics

“…Unfortunately, inappropriate ABU in this sector has contributed to the development of bacterial antimicrobial resistance (AMR) [ 9 , 10 , 11 ]. Bacterial AMR affects the globe negatively and now accounts for appreciable challenges in treating human infections, food security, and the healthcare system [ 12 , 13 , 14 , 15 ], leading to increased morbidity and mortality across countries [ 16 , 17 ]. Overall, there were an estimated 4.95 million deaths globally in 2019 associated with bacterial AMR, the greatest in sub-Saharan Africa, which, if unchecked, will reduce the income of countries by up to USD 3.4 trillion by 2030, equivalent to 3.8% of annual gross domestic product [ 17 , 18 , 19 ].…”

Knowledge, attitudes and practices on antimicrobial resistance among pharmacy personnel and nurses at a tertiary hospital in Ndola, Zambia: implications for antimicrobial stewardship programmes

“…These findings are similar to those obtained in other LMICs. 37 , 38 This attitude problem requires urgent attention as it may promote unnecessary use of antibiotics with the development of resistant pathogens. A recent evaluation of pathogen antibiotic susceptibility conducted at the same hospital has shown the presence of resistant bacteria in isolates from both inpatients and outpatients, 39 indicating the need to scale up interventions to prevent unnecessary antibiotic use.…”