Antibiotic Prescribing Practices of Clinical Officers for Patients with Upper Respiratory Tract Infection at Kiambu County, Kenya
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Date
2024-11
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Publisher
Kenyatta University
Abstract
According to the World Health Organization (WHO), over 50% of all medicines are
prescribed, dispensed or sold inadvertently, and more than half of all patients take them
incorrectly. Antibiotics are the most routinely prescribed medications. Antibiotics are
incorrectly prescribed for viral illnesses and broad-spectrum antibiotics are being used in
place of narrow-spectrum antibiotics. Antibiotic resistance has emerged because of
incorrect antimicrobial treatment and misuse of antibiotics. Findings from studies have
shown an association between prescriber factors, patient factors, institutional factors and
antibiotic prescribing. There is scarce data in Kenya about antibiotic prescribing
practices, factors affecting antibiotic prescribing, how it varies between different
healthcare workers and the mechanism by which interventions are effective. The goal of
this study was to figure out antibiotic use among patients with upper respiratory tract
infections in Kiambu County. The study design was a cross-sectional hospital-based
study. The study area was one public level 5 hospital, five public level 4 hospitals and 14
public health centers within Kiambu County. Data was collected in the form of a modified
WHO prescribing indicators checklist and using questionnaires. The WHO prescribing
indicators checklist on rational use of medicine was used to collect data from 600 patient
encounters. The questionnaire was used to collect data from 36 clinicians working in the
outpatients. The data from the checklist included the total number of medications
prescribed per encounter, the number of encounters with antibiotics, the proportion of
generic antibiotics prescribed, the proportion of antibiotics prescribed from the Kenya
Essential Medicines List (KEML), the antibiotic prescribed, its dose, frequency, duration
and indication. The data from the questionnaire included prescriber age, gender, level of
education, work experience, laboratory availability, availability of antibiotics and
availability of guidelines. An Open Data Kit (ODK) was used to collect the WHO data
collection checklist. Data was imported into a Microsoft Excel sheet from the ODK server
then exported to a Statistical Package for Social Science (SPSS) version 22.0 for further
cleaning and analysis. Descriptive statistics of frequencies and percentages were used to
summarize categorical variables, and median (interquartile range) was used in case of
continuous variables. Logistic regression was employed to find the association between
antibiotic prescribing and the prescribing factors. Odds ratio with 95% confidence
interval was reported in the logistic regression analysis. All analysis were considered
significant when p < 0.05. Antibiotics were prescribed in 78% of patient encounters,
96.8% of encounters with an antibiotic had a generic antibiotic, and 96.6% of antibiotics
prescribed were from the KEML. Over 91% of antibiotics prescribed were the right dose,
98.3% were the right frequency, 75.2% were the right duration, only 23.8% was the right
indication. Availability of antibiotics p=0.026 and availability of hospital guidelines
p=0.012 were significantly associated with rational antibiotic prescribing. Patient fever
significantly affected rational antibiotic prescribing (OR 4.7, 95% CI 2.49, 8.89,
p=<0.001), patient age and gender did not significantly affect antibiotic prescribing.
Prescriber gender, p=0.63, age, p=0.92, education level, p=0.99 and work experience,
p=0.22 did not significantly affect antibiotic prescribing.
Description
A Thesis Submitted in Partial Fulfilment of the Requirements for the Award of the Degree of Masters in Medicine (Family Medicine) in the School of Health Sciences of Kenyatta University November, 2024