Behavioural interventions to address rational use of antibiotics in outpatient settings of low‐income and lower‐middle‐income countries

Abstract

objectives To explore the current evidence on interventions to influence antibiotic prescribing behaviour of health professionals in outpatient settings in low-income and lower-middle-income countries, an underrepresented area in the literature.methods The systematic review protocol for this study was registered in PROSPERO (CRD42020170504). We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies relating to antibiotic prescribing of health professionals in outpatient settings in low-income and lower-middle-income countries. Behavioural interventions were classified as persuasive, enabling, restrictive, structural or bundle (mix of different interventions). In total, 3,514 abstracts were screened and 42 studies were selected for full-text review, with 13 studies included in the final narrative synthesis. results Of the 13 included studies, five were conducted in Vietnam, two in Sudan, two in Tanzania, two in India and two in Kenya. All studies were conducted in the outpatient or ambulatory setting: eight took place in primary health centres, two in private clinics and three in pharmacies. Our review found that enabling or educational interventions alone may not be sufficient to overcome the ingrained incentives to link revenue generation to sales of antibiotics, and hence, their inappropriate prescription or misuse. Bundle interventions appear to be very effective at changing prescription behaviour among healthcare providers, including drug sellers and pharmacists.conclusions Multi-faceted bundle interventions that combine regulation enforcement with face-toface education and peer influence may be more effective than educational interventions alone at curbing inappropriate antibiotic use. keywords antibiotic resistance, systematic review, behavioural Sustainable Development Goals (SDGs): Good health and well-being, strengthen capacity to manage health risks

Antibiotic use from formal and informal healthcare providers in the Democratic Republic of Congo: a population-based study in two health zones

“…Antibiotic dispensing by private providers is not overseen by health authorities, nor are we aware of existing antibiotic stewardship interventions targeting private providers those in DRC or elsewhere in Central Africa. Intervention bundles to optimize antibiotic use, including training of medicine store staff and other community-level providers, have shown to improve clinical care and in some occasions to decrease antibiotic use [20,21] and should be considered on a wider scale, albeit adapted to the local health care landscape.…”

Instruments used to measure knowledge and attitudes of healthcare professionals towards antibiotic use for the treatment of urinary tract infections: A systematic review

“…Despite the abundance of interventions, the effectiveness of these interventions remains questionable as deviation from evidence-based guidelines among healthcare professionals continues [ 8 ]. Although not specific to UTIs, a systematic review by Nair et al [ 18 ] and Tonkin‐Crine et al [ 14 ] suggests that effective interventions are multifaceted in their approach and addressed all concerns of healthcare professionals. The World Health Organisation (WHO) agrees and has acknowledged that effective interventions must also fill existing gaps in healthcare professionals’ knowledge and attitudes [ 22 ].…”

“…The relationship between knowledge, attitudes, and practice can also be modified by exogenous factors affecting prescribing behaviour such as patient characteristics [ 18 ]. These characteristics include patients’ socioeconomic status, age, and ethnicity [ 19 ].…”

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“…Despite the abundance of interventions, the effectiveness of these interventions remains questionable as deviation from evidencebased guidelines among healthcare professionals continues [8]. Although not specific to UTIs, a systematic review by Nair et al [18] and Tonkin-Crine et al [14] suggests that effective interventions are multifaceted in their approach and addressed all concerns of healthcare professionals. The World Health Organisation (WHO) agrees and has acknowledged that effective interventions must also fill existing gaps in healthcare professionals' knowledge and attitudes [22].…”