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Ensuring access to effective antibiotics and rational prescribing of antibiotics are critical in reducing antibiotic resistance. In this study, we evaluated antibiotic prescribing practices in a rural district in Uganda. It was a cross-sectional study that involved a retrospective review of 500 outpatient prescriptions from five health facilities. The prescriptions were systematically sampled. World Health Organization core medicine use prescribing and facility indicators were used. Percentage of encounters with one or more antibiotics prescribed was 23% (10,402/45,160). The mean number of antibiotics per prescription was 1.3 (669/500). About 27% (133/500) of the diagnoses and 42% (155/367) of the prescriptions were noncompliant with the national treatment guidelines. Prescribing antibiotics for nonbacterial infections such as malaria 32% (50/156) and noninfectious conditions such as dysmenorrhea and lumbago 15% (23/156) and nonspecific diagnosis such as respiratory tract infection 40% (59/133) were considered noncompliant with the guidelines. On average, 68% (51/75) of the antibiotics were available on the day of the visit. Inappropriate prescribing practices included excessive use of antibiotics and failure to diagnose and prescribe in compliance with treatment guidelines. There is a need to strengthen antibiotic use in the health facilities through setting up stewardship programs and interventions to promote adherence to national treatment guidelines.
This study was conducted in Yumbe district located in the northwestern part of Uganda, located approximately 590 km from Kampala, Uganda’s capital city. The district total population is 485,582, of which 48% are males and 52% are females. The district hosts refugees mainly from South Sudan and the Democratic Republic of Congo. There are 27 health facilities in the district. These include a general hospital (Yumbe hospital), which is the district referral hospital, two HC IVs, seven (7) health center grade IIIs (HC IIIs), and 17 health center grade IIs (HC IIs). These health facilities provide both curative and preventive services including Outpatient, in patient, Maternal and child health services, and community outreaches, plus other specialized services depending on the level of the facility. The study was conducted in five Health facilities: Yumbe Hospital/Yumbe HC IV, Midigo HC IV, Ariwa, Barakala, and Kulikulinga HC IIIs. These Health facilities were purposely selected. They attend to refugees and have admission facilities and laboratories. Yumbe Hospital was under major renovation and its services were transferred to Yumbe HC IV during the data collection period. This was a cross-sectional study. Outpatient records for a period of three months from March–May 2019 were reviewed. WHO core medicine use indicators for assessing outpatient medicine use were used. The study population included outpatients who were prescribed antibiotics from the five health facilities and tracer antibiotics. Prescriptions containing systemic antibiotics for both adults and children were considered for inclusion, while prescriptions containing topical antibiotics such as lotions, ointments, vaginal pessaries, and eye preparations like eye drops were excluded. Also, prescriptions from outreach and special doctors’ clinics were excluded. Only the selected 15 tracer antibiotics were used to assess for availability. Antibiotics in this study refer to medicines for treatment of bacterial infections only. Based on WHO/DAP/93 recommendation for sample size determination and sampling technique for prescribing indicators, 100 prescriptions were taken from each corresponding Health facility [30], meaning a total of 500 prescription forms meeting the inclusion criteria were reviewed in this study. A systematic sampling technique was employed to select the 100 prescriptions from each Health facility. The total numbers of prescriptions in the review period with an antibiotic prescribed were determined and the sampling interval was determined by dividing the total number by 100. A simple random sampling was used to select the first prescription. For Health facility indicators, 15 key tracer antibiotics were selected from each facility as per WHO recommendation of a minimum of 15 essential tracer medicines in each health facility. These were purposely selected by only including antibiotics that are expected to be available at the lowest level of care of the study facilities, i.e., HC III, according to the national EMHSL. The study indicators included: Data were collected using a structured check list for prescribing and health facility indicators. Data regarding prescribing indicators were taken from sampled prescription records retrospectively and were filled or recorded in the structured check list accordingly. Additionally, the availability of tracer antibiotics, which were assessed from the store, and the presence of EML and STG in the Outpatient Department (OPD) were also assessed in the facility indicator form accordingly. Data were collected from OPD registers, Dispensing logs, and stock cards or stock book. Additional information (e.g., prices) was obtained from recent invoices. Data collection was supervised by the researchers. Microsoft Excel 2010 version was used for the analysis. The scores of the indicators were compared with national and WHO standards/targets. Makerere University School of Health Sciences Research Ethics committee (MU-SHS-REC) granted ethical approval for the study.
