Tanzanian primary healthcare workers’ experiences of antibiotic prescription and understanding of antibiotic resistance in common childhood infections: a qualitative phenomenographic study

Abstract

Background Antibiotic resistance is a threat to global child health. Primary healthcare workers play a key role in antibiotic stewardship in the community, but few studies in low-income countries have described their experiences of initiating antibiotic treatment in children. Thus, the present study aimed to describe primary healthcare workers’ experiences of antibiotic prescription for children under 5 years of age and their conceptions of antibiotic resistance in Northern Tanzania. Methods A qualitative study involving individual in-depth interviews with 20 prescribing primary healthcare workers in Moshi urban and rural districts, Northern Tanzania, was performed in 2019. Interviews were transcribed verbatim, translated from Kiswahili into English and analysed according to the phenomenographic approach. Findings Four conceptual themes emerged during the analysis; conceptions in relation to the prescriber, the mother and child, other healthcare actors and in relation to outcome. The healthcare workers relied mainly on clinical examination and medical history provided by the mother to determine the need for antibiotics. Confidence in giving advice concerning non-antibiotic treatment varied among the participants and expectations of antibiotic treatment were perceived to be common among the mothers. Antibiotic resistance was mainly perceived as a problem for the individual patient who was misusing the antibiotics. Conclusions To increase rational antibiotic prescription, an awareness needs to be raised among Tanzanian primary healthcare workers of the threat of antibiotic resistance, not only to a few individuals, but to public health. Guidelines on childhood illnesses should be updated with advice concerning symptomatic treatment when antibiotics are not necessary, to support rational prescribing practices and promote trust in the clinician and mother relationship.

“I don’t hesitate to use the left-over antibiotics for my child” practices and experiences with antibiotic use among caregivers of paediatric patients at Zomba central hospital in Malawi

“…An earlier study done in Malawi has highlighted that the average consultation and dispensing time is too short to inform a patient about their medication adequately, possibly contributing to the confusion our participants had in distinguishing antibiotics from other categories of medicines [38]. In in Tanzania, a similar study argued that little/low knowledge on antibiotics may be attributed to the reason that during counseling, doctors use the general term 'germs' for indication of antibiotics, rather than specifically mentioning bacteria [10] thus people cannot differentiate between bacteria and viruses and hence concluding that antibiotics are effective against both [39]. Our findings revealed that most caregivers were aware of the time to give antibiotics and are consistent with a study in China where the participants demonstrated ambivalent attitudes towards compliance and completion of antimicrobial therapy and this discrepancy suggests that individuals would follow instructions on dosing regimens but not treatment duration [27].…”

Prevalence and Predictors of Antibiotic Prescriptions at Primary Healthcare Facilities in the Dodoma Region, Central Tanzania: A Retrospective, Cross-Sectional Study

“…Antibiotic-prescribing practices in primary healthcare facilities in Tanzania largely rely on clinical examination and patients’ medical history rather than microbiological evaluation [ 10 ]; this increases the potential for their misuse and/or overuse. A study involving patients in primary healthcare facilities conducted in Dar es salaam, Kilimanjaro, Mwanza and Mbeya Tanzania reported over 65% of antibiotic prescriptions [ 11 ].…”

Antibiotic use in children under five years of age in Northern Tanzania; the experiences of the caring mothers

“…These were also the two most common beliefs among the public found in a systematic review of studies mainly performed in high-income countries. (29) Antibiotic resistance was described by the mothers as a concern for, or within the individual not as a public health problem, similarly as expressed by the HCWs in our previous study (12) and by patients and prescribers in South Africa. (28)…”

“…The research team (CM, EM, GN, ME and RM) was appointed and trained as previously described. (12) An interview guide (in English) was developed by ME, ML and RM and translated into Kiswahili by CM, EM, GN and RM. In Kiswahili, the English term, 'antibiotics' (i.e., anti-bacterial substances) has been adopted into the language; therefore, 'antibiotics' were also used in the translated interview guide (Additional le 1).…”