Public hospital pharmacists’ knowledge, attitudes, and practices for antibiotic stewardship implementation in Limpopo Province, South Africa

Abstract

Background Hospital pharmacists are important in antibiotic stewardship programs (ASP), a global strategy to combat antibiotic resistance (ABR). South African public hospitals have limited ASP implementation. This study describes Limpopo Provincial Hospital pharmacists’ knowledge, attitudes, and practice toward ASP implementation. Method A questionnaire to explore pharmacists’ knowledge, attitudes and practices regarding ASP implementation comprised 43 questions hosted online. A link was sent by invitation e-mail to eligible respondents in November 2021. Five questions on respondents’ demographics, 15 questions on ASP knowledge, 10 Likert scale questions on attitude, and 13 on ASP practices were included. Mean (standard deviation (SD)) knowledge and attitude scores and a median (interquartile range (IQR)) practice score was calculated. Associations between categorical variables were assessed using chi-square/Fisher’s exact analysis (p < 0.05), with Cramér’s V as effect size. Results The survey yielded 35 responses (13.1%). Twenty (57.1%) respondents were female. Seventeen (48.6%) respondents were between the ages of 31 and 40 years. The mean knowledge score of respondents was 9.8 (2.6) (N = 34), with knowledge gaps on One Health and socioeconomic determinates of ABR. Ten (29.6%) respondents thought One Health discouraged multi-sector collaboration, and nineteen (55.9%) respondents thought ASP was the only strategic response to ABR. Sixteen (47.1%) respondents did not know that poor access to clean water accelerates ABR and seventeen (50.0%) did not know that poverty could be a determinant for antibiotic use. The mean respondent attitude score was 8.0 (1.7) (N = 28). Twenty-seven (96.4%) respondents agreed that ASP was necessary and agreed to participate in ASP respectively. All 28 (100.0%) respondents agreed to lead an ASP. The median (IQR) respondents’ practice score was − 2.0 (IQR: -6.0–5.8) (N = 16). Respondents were inconsistently (never, sometimes, every time) participating in multi-disciplinary forums (6/16, 37.5%) and expressed a desire for training (11/13, 84.6%) on ASP through in-service (7/27, 25.9%). Respondents thought ASP training should include medical officers (12/29, 41.4%) and nurses (9/29, 31.8%). Knowledge score was associated with gender (p = 0.048; V = 0.416) and attitude score (p = 0.013; V = 0.556). Conclusion Our study found pharmacists had good knowledge and a positive attitude toward ASP implementation but poor ASP practices. A multi-disciplinary in-service training could address identified knowledge and practice gaps.

Assessment of challenges and opportunities in antibiotic stewardship program implementation in Northwest Ethiopia

“…In the current study, 163 (90.1 %), 161 (89.0 %) and 128 (70.7 %) of the health professionals believed that AMR was a significant problem both in Ethiopia, worldwide, and in their hospitals respectively. Although there was a slight difference on magnitude, the report was almost similar to a report on health professionals' beliefs at Black Lion Hospital, which showed that antibiotic resistance is a significant problem worldwide (94.6 %), in Ethiopia (91.7 %) and in their hospital (84.5 %) [ 44 ], 93 % of physicians in Cameron perceive that AMR is a nationwide problem [ 72 ], physicians in Nigeria recognize AMR as a global (95.4 %) and local problem (81.1 %) [ 73 ], and in another study in Nigeria among health professionals, 96.0 % of whom believed that antibiotic resistance was a problem in Nigeria, 84.0 % agreed that AMR was a problem for their practice [ 46 ] but in Ghana very few physicians perceived antibiotic resistance as global problem (30.1 %), national problem (18.5 %), and problem in their hospital (8.1 %) [ 74 ]. In South Africa, 78.5 % of pharmacists perceived that AMR was a problem in their hospitals [ 75 ], and in Zambia, 95 % of health professionals perceived AMR as a current problem in their practice [ 76 ].…”

“…In the current study, health professionals believed that easy access to antibiotics without a prescription 155 (85.6 %), inappropriate consumption of antibiotics 137 (75.7 %), lack of adequate surveillance for drug-resistant organisms 127 (70.2 %) and adequate staff education regarding antibiotic consumption and resistance 124 (68.5 %), and overuse of antibiotics due to a lack of diagnostic tests 119(65.7 %) were perceived as key contributors to AMR in hospitals. This was similar to the study in Black Lion Hospital, which reported 84.3 % agreement with easy access to antibiotics, 82.0 % inappropriate consumption, and 64.4 % lack of adequate diagnostic tests as the main perceived causes of AMR [ 44 ] and in Ghana overuse of antibiotics in hospitals (67.5 %), uncompleted antibiotic therapy were common causes for AMR (50.31 %) and poor quality of antibiotics (37.7 %) [ 74 ]. In Uganda, antimicrobial overuse at hospitals (91 %), poor infection control practices by health professionals (79 %), and prescribing broad-spectrum antimicrobials when equally effective narrower-spectrum antimicrobials are available (73 %), were perceived causes for AMR [ 70 ], and in Cameron, physicians perceived that inappropriate use of antibiotics (94 %), overuse of antibiotics (87 %), and indiscriminate use of broad-spectrum antibiotics (71 %), were possible causes for AMR [ 72 ].…”