Journal Article

Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology

Kamara, Kadijatu Nabie, Koroma, Zikan, Tengbe, Sia Morenike, Sheriff, Bockarie, Squire, James, Kamara, Ibrahim Franklyn, Musoke, Robert, Abiri, Onome T, Mansaray, Abdul Razak, Nuwagira, Innocent, Lakoh, Sulaiman, Thomas, Fawzi, D'Almeida, Selassi A, Maruta, Anna, Koroma, Aminata Tigiedankay, Russell, James Baligeh Walter, Katawera, Victoria, Fofanah, Bobson Derrick, Vandi, Mohamed Alex, Kanu, Joseph, Kamara, Rugiatu Z

2023

Overview

ObjectiveInappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone.DesignWe conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology.SettingThe study was conducted in 26 public and private hospitals that are providing inpatient healthcare services.ParticipantsAll patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled.Outcome measuresPrevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done.ResultsOf the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%).ConclusionThere was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Anti-Bacterial Agents - therapeutic use / Antibiotics / Antimicrobial agents / Bacterial infections / Child / Cross-Sectional Studies / Data collection / GDP / Gross Domestic Product / Health policy / Hospitals / Hospitals, Private / Hospitals, Public / Humans / Infections / Maternal & child health / Mortality / Penicillin / Prescription drugs / Prevalence / Public Health / Sample size / Sierra Leone - epidemiology / Surveys and Questionnaires / World Health Organization