High prevalence of inappropriate antibiotic prescriptions in selected health care facilities in Uganda

Abstract

Background Antibiotic resistance is a major public health challenge affecting low- and middle-income countries such as Uganda. The link between inappropriate use of antibiotics and the development of antibiotic resistance is well known. We characterized antibiotic prescriptions and determined factors associated with inappropriate antibiotic prescriptions among outpatient cases in selected health facilities in Central Uganda. Methods This was a cross-sectional study conducted in twelve selected health facilities in the Luwero and Mukono districts of Uganda from February to March 2022. Data were extracted from the records of patients of all ages who presented to outpatient departments with i) acute fever, ii) acute watery diarrhea with no blood, iii) cough or iv) fever. Data on socio-demographics, presenting health conditions and antibiotics prescribed were collected. Multivariate analysis was performed using modified Poisson regression modelling to determine factors associated with inappropriate antibiotic prescriptions among outpatient cases. Prevalence risk ratios with their 95% confidence intervals were determined. Findings A total of 350 records of outpatient cases were extracted. Almost half (42.0%, 147/350) of the patient cases were aged 0–5 years, and more than half (55.7%, 195/350) were females. Majority, 79.7% (279/350) of the patient cases received an antibiotic. On average, each patient received 1.25 antibiotics. Three-quarters (75.7%, 265/350) of the participants had an inappropriate antibiotic prescription. A prescriber being a clinical officer was 1.18 times more likely to inappropriately prescribe an antibiotic compared to a medical officer (adjusted PR = 1.18, 95% CI: 1.02–1.38). Compared to public health facilities, private-not-for-profit (PNFP) health facilities were more likely to have inappropriate antibiotic prescriptions (adjusted PR = 1.18, 95% CI: 1.02–1.35). Conclusion Our study found a high proportion of inappropriate antibiotic prescription with patients visiting private (PNFP) health facilities more likely to have inappropriate antibiotic prescription. Our findings call for the urgent implementation of antimicrobial stewardship interventions in health facilities in Uganda.