Knowledge, attitude and antibiotic prescribing patterns of medical doctors providing free healthcare in the outpatient departments of public hospitals in Sierra Leone: a national cross-sectional study

Abstract

Background Antibiotic resistance is a global health crisis and irrational prescribing behaviour has been identified as a contributing factor. The current study aimed to assess the knowledge of, attitudes towards and practices regarding antibiotic prescribing of medical doctors providing free healthcare services in the outpatient departments of public hospitals in Sierra Leone. In addition, we evaluated prescribing patterns of antibiotics. Methods The study has two parts. First, we conducted a cross-sectional survey using a self-administered questionnaire to assess doctor’s knowledge of, attitudes towards and practices regarding prescribing antibiotics. Second, using patient medical records, we used the World Health Organization methodology on how to assess drug use in health facilities to evaluate prescribing patterns of antibiotics in four selected public hospitals in Sierra Leone. Results Of 130 administered questionnaires, 119 were returned, for a response rate of 91.5%. The majority of doctors (n=83 [69.7%]) agreed that amoxicillin is safe in the first 3 weeks of pregnancy and considered antibiotic resistance a global (n=108 [90.7%]) and national (n=97 [81.5%]) public health crisis. Less than a quarter of medical doctors agreed that antibiotics may speed up the recovery when added to malaria (n=25 [21%]) or cold and cough (n=81 [68%]) therapies. Prescribing pattern results show that children <5 y of age (adjusted odds ratio 5.199 [confidence interval 2.743 to 9.855], p<0.0001) were more likely to be prescribed an antibiotic than pregnant women/lactating mothers. Penicillins were the most commonly prescribed pharmacological class of antibiotics, with amoxicillin being the most commonly prescribed penicillin. Conclusions Doctors demonstrated a sound knowledge of antibiotics and antibiotics resistance, with a positive attitude towards prescribing antibiotics. However, the prescribing pattern of antibiotics was irrational, necessitating the need for the establishment of audit and feedback programmes such as antimicrobial stewardship programmes.

Knowledge, attitude, and practice on antibiotics use among healthcare workers: A cross-sectional study in Niger state, Nigeria

“…Several studies have shown that the degree of antibiotic awareness among healthcare workers has increased over the past few years (Chukwu et al, 2021). Most respondents agreed that antibiotic resistance is a problem in Nigeria and around the world, which is in line with national studies conducted in Nigeria (Ogoina et al, 2021), Sierra Leone (Kabba et al, 2020), Ethiopia (Abera et al, 2014), Ghana (Labi et al, 2018) and Gabon (Adegbite et al, 2022). However, only one-third of respondents agreed that AMR is a serious issue in their hospitals, in contrast to the same national surveys (Kabba et al, 2020; Ogoina et al, 2021).…”

“…A hospital-based cross-sectional study was conducted from March to June 2022 among healthcare workers in Niger State, Nigeria. A structured self-administered, pretested questionnaire was designed using previous studies (Kabba et al, 2020; Chukwu et al, 2021; Ogoina et al, 2021). The questionnaire was categorised into eight sections in which Section A contained the sociodemographic parameters of respondents; Section B included 20 positive and negative questions covering their knowledge of antibiotics and antibiotic resistance; Section C had 15 positive and negative questions evaluating the attitude towards the prescription of antibiotics; Section D comprised 17 positive and negative questions assessing the practice of prescribing antibiotics, Section E evaluated the frequency of self-reported antibiotic prescriptions in the past 6 months using six-point Likert scale.…”

Pilot drug and therapeutic committee program in Sierra Leone: a descriptive mixed method study

“…In a study involving the analysis of prescriptions form the outpatients' department (OPD), Cole et al concluded that medicines were not rationally prescribed for children underfive as per WHO prescribing indicators 11 . Similar findings from a study focusing on antibiotic prescribing at a national level 12 and antibiotics use for none bacterial infection, and prophylaxis 13 have also been reported, which might explain the high prevalence of multidrug resistance bacteria in Sierra Leone 14,15 . The key reason for this trend, according to the WHO and empirical evidence, is the shortage of skilled health workers, fragility in the health system; 16,17 limited diagnostics capacity in most hospitals and inadequate regulatory framework on the import and sales of pharmaceuticals 13,17 .…”

Pilot drug and therapeutic committee programme in Sierra Leone: A descriptive mixed method study

“…In a study involving the analysis of prescriptions from the outpatient department, Cole et al concluded that medicines were not rationally prescribed for children under 5 years as per WHO prescribing indicators. 11 Similar findings from studies focusing on antibiotic prescribing at a national level, 12 and antibiotic use for nonbacterial infection, and prophylaxis 13 have also been reported, which might explain the high prevalence of multidrug-resistant bacteria in Sierra Leone. 14,15 According to the WHO and empirical evidence, the key reason for this trend is the shortage of skilled health workers, fragility in the health care system, 16,17 limited diagnostics capacity in most hospitals and inadequate regulatory framework on the import and sales of pharmaceuticals.…”