First assessment of the knowledge, attitudes, and practices of health actors in Togo and Ivory Coast in regard to antibiotic resistance

Abstract

Background and Aim: Bacterial resistance to antibiotics has now become a threat to global public health. This study aimed to assess the knowledge, attitudes, and practices of health actors in relation to antibiotic resistance (ABR) in two African countries. Materials and Methods: A cross-sectional and descriptive questionnaire study was conducted in Ivory Coast and Togo from August 2020 to July 2021. Actors were interviewed both in person 63% (n = 141) and remotely due to COVID-19 restrictions. Qualitative variables were described by frequencies and quantitative variables by the mean and associated standard deviation. The bivariate analysis was conducted through the Chi-square test and exact Fisher test with an acceptable risk of 5%. Results: The results showed that 88% and 50% of the actors from Togo and Ivory Coast, respectively, had a good knowledge of ABR even if most of the stakeholders had limited knowledge of antibiotics that are banned or of critical importance in human and animal medicine. More than 75% of the actors had good perceptions in regard to ABR and these were significantly related to their profession. As for the factors leading to an increase in ABR, the interviewees perceived self-medication in humans as the main contributing factor. Approximately 70% of the actors admitted to following inadequate practices in terms of the use and/or distribution of antibiotics, and 58% and 46% of them used preventive antibiotic therapy in Togo and Ivory Coast, respectively. Similarly, in the two countries, 39% and 69% of the actors, respectively, claimed that they do not systematically use the antibiogram, and 69% and 61% of drug distributors, also respectively, admitted to occasionally selling antibiotics without a prescription. Finally, more than 80% thought that the authorities in their country did not communicate sufficiently about ABR. Among the actions that could help to combat ABR, actors considered the strengthening of controls on the distribution of antibiotics and the education of nonprofessionals on the importance of antibiotic preservation as priorities. Conclusion: Although this first study had some limitations, that is, the low number of surveyed actors and non-standardized questionnaire used, it revealed that health actors in Togo and Ivory Coast have a good knowledge and perception in regard to antibiotics and ABR, but also follow inadequate practices.