The knowledge, attitudes and practices of doctors, pharmacists and nurses on antimicrobials, antimicrobial resistance and antimicrobial stewardship in South Africa

Abstract

Background: Sustained injudicious and indiscriminate use of antimicrobials has exerted selection pressure for developing antimicrobial resistance (AMR), requiring behaviour change from healthcare professionals (HCPs) based on their knowledge, attitudes and practices (KAP) on antimicrobials, AMR and antimicrobial stewardship (AMS). Methods:A cross-sectional online questionnaire-based survey was conducted nationally amongst doctors, pharmacists and nurses from November 2017 to January 2018. The questionnaire comprised demographic information and KAP questions.Results: Respondents comprised of 1120 doctors, 744 pharmacists and 659 nurses. Antimicrobial resistance was considered a severe problem globally and nationally by majority of HCPs. Self-assessment of knowledge revealed gaps in understanding of antimicrobials, AMR and AMS. Confidence scores in prescribing by doctors, pharmacists and nurses were 57.82%, 32.88% and 45.28%, respectively. Doctors, 441 (45.2%) indicated no confidence in using combination therapy. Prescribing correctly showed a confidence level of 33.99% from 436 doctors, 41.88% from nine pharmacists and 35.23% from 107 nurses. Healthcare professionals ( 1600[91.22%]) stated educational campaigns would combat AMR. Only 842 (40.13%) HCPs attended training on these topics and 1712 (81.60%) requesting more education and training. Conclusion:This is the first comparative survey on KAP of practising doctors, pharmacists and nurses in South Africa. Doctors had the highest knowledge score followed by nurses and pharmacists. Practice scores did not corroborate knowledge and the higher attitude scores. Gaps in KAP were evident. Healthcare professionals indicated the need for more education and training, thus requiring a review of pre-service and in-service education and training in addition to continued professional development programmes for practising HCPs.

Knowledge, attitudes and practices on antimicrobial resistance among pharmacy personnel and nurses at a tertiary hospital in Ndola, Zambia: implications for antimicrobial stewardship programmes

“… 28 Similar findings were reported in South Africa, in which gaps in knowledge, attitudes and practices regarding AMR were identified among pharmacists and nurses. 36 The current findings and those reported from other studies suggest the need for increasing training and educational activities concerning AMR. Alongside this, AMS programmes should be strengthened in all areas of clinical practice.…”

“…The survey on antibiotic use and resistance conducted among health workers in South Africa also had similar findings; the study revealed that health workers thought antibiotic resistance was a global and national problem, with a lower proportion of nurses compared with pharmacists who were aware of this. 36 This could mean that nurses thought antibiotic resistance was an issue but not significant or serious enough to be considered a public health problem. One way to address this negative attitude would be to include this message in future WAAW campaigns.…”

“…In the said study, significantly more nurses than pharmacists did not know that the use of antibiotics in animals contributes to resistance and thus did not think that reducing AMU in animals could reduce AMR. 36 Previous efforts by the Zambian government have educated agriculture and veterinarian personnel about the contribution of antibiotic use in plants and livestock to AMR. 33 However, this message must be delivered to HCWs so they can be fully equipped to deal with issues related to AMR.…”

“…This is similar to the study conducted in South Africa, where most pharmacists and nurses had not attended workshops or training in AMS. 36 There is a need to improve the knowledge, attitudes and practices of HCWs on AMR by promoting the establishment of AMS programmes in healthcare facilities and encouraging pharmacists and nurses to enrol for CPD education on AMU and AMR. 43 , 44 …”

Determinants of the Empiric Use of Antibiotics by General Practitioners in South Africa: Observational, Analytic, Cross-Sectional Study

“…We are aware that there have been a number of studies undertaken in South Africa to monitor prescribing and resistance patterns in ambulatory care; however, these have shown variable findings alongside requests for additional data to guide future strategies [ 14 , 24 , 35 , 36 , 37 ]. In addition, there have been concerns among physicians in South Africa regarding their knowledge of antibiotics and AMR as well as confidence with prescribing antibiotics [ 38 ]. Between 2003 and 2005, two pilot projects undertaken in KwaZulu-Natal (KZN) Province and Brits (North West Province) assessed antibiotic use and resistance.…”