Situational analysis of antibiotic use and resistance in Ghana: policy and regulation

Abstract

BackgroundAntibiotics have played an essential role in decreasing morbidity and mortality from infectious diseases. However, indiscriminate use and unrestricted access is contributing to the emergence of bacterial resistance. This paper reports on a situational analysis of antimicrobial use and resistance in Ghana, with focus on policy and regulation.MethodsRelevant policy documents, reports, regulations and enactments were reviewed. PubMed and Google search engines were used to extract relevant published papers. Websites of stakeholders such as Ministry of Health (MOH) and its agencies were also reviewed. An interview guide was used to elicit responses from selected officials from these sectors.ResultsLaws and guidelines to control the use of antimicrobials in humans were available but not for animals. There was no National Antimicrobial Policy (NAP). A health practice regulatory law mandates Physicians, Physician Assistants, Midwives and trained Nurses to prescribe antimicrobials. However, antibiotics are widely prescribed and dispensed by unauthorised persons, suggesting weak enforcement of the laws. Antibiotics were also supplied to and from unapproved medicine outlets. The Standard Treatment Guidelines (STG), Essential Medicines List (EML) and the National Health Insurance Scheme Medicines List (NHISML) provide restrictions regarding levels of prescribing of antimicrobials. However, existing guidelines on antibiotic use are mostly not adhered to. The use of Automatic Stop Orders to avoid wastage in the hospitals is also not practiced. Data on use of antibiotics for individuals are not readily available in most facilities. Again, there are no standards or guidelines on veterinary use of antibiotics. Surveillance systems for consumption of antibiotics and resistance monitoring were not in place in most health facilities. However, there is an ongoing national action to create awareness on bacteria resistance, strengthening knowledge through research and surveillance and development of NAP in line with global action plan on antimicrobial resistance.ConclusionAbsence of national antimicrobial policy, weak regulatory environment and non-adherence to practice standards may have contributed to increased and unregulated access to antimicrobials in Ghana, a catalyst for development and spread of antimicrobial resistance.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-4910-7) contains supplementary material, which is available to authorized users.

Determinants of Inappropriate Antibiotics Use in Rural Central Ghana Using a Mixed Methods Approach

“…This was further substantiated by our findings where seeking healthcare from drug peddlers was marginally associated with inappropriate use. In Ghana, pharmacies are licensed to dispense antibiotics under recommendation and supervision of a practicing pharmacist likewise health centers which are managed by physician assistants (39,40). Pharmacies and health centers are therefore expected to provide adequate services including appropriate provision of some categories of antibiotics.…”

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…Successful initiatives typically target all key stakeholder groups, are usually country specific, take into account issues of culture as well as the availability, access and affordability to physicians and medicines, and are evidence based 29,52,243 . Given continuing concerns with AMR rates, activities and strategies to improve future prescribing and dispensing of antibiotics for URTIs will grow in all countries, including LMICs, as they develop and monitor their antibiotic prescribing as part of their national action plans (NAPs) 66,180,240,242,[249][250][251][252] , with 'essential medicine' policies typically associated with lower antibiotic prescribing in LMICs 119 .…”

“…Typical activities include documenting current antibiotic utilization and resistance rates alongside planning educational, monitoring and other activities among all key stakeholder groups. Such LMICs include Botswana, Ghana (Table 2), Kenya, Kosovo, Malaysia, Nigeria, Pakistan, Swaziland, Vietnam and Zimbabwe 72,180,251,252,[254][255][256][257] .…”

Outpatient prescription audit in a tertiary care hospital at Puducherry

“…This variable was devised by the WHO to avoid indiscriminate use of antimicrobials which in turn helps to reduce the risk of antimicrobial resistance. [18][19][20] Lesser incidence of resistance reduces the health care related expenditures, as the cost involved in managing antimicrobial resistance is quite exhaustive. 21 An appreciable score of 0.16% against the WHO standards of <10% pertaining to the prescriptions with injections was observed in our study.…”