Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology
Objective Inappropriate 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 Leo...
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BMJ Publishing Group
2023-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/12/e078367.full |
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| author | Innocent Nuwagira Sulaiman Lakoh Zikan Koroma James Baligeh Walter Russell Sia Morenike Tengbe Ibrahim Franklyn Kamara Joseph Kanu Anna Maruta Bobson Derrick Fofanah Kadijatu Nabie Kamara Bockarie Sheriff Victoria Katawera Selassi A D'Almeida Robert Musoke Rugiatu Z Kamara Abdul Razak Mansaray Fawzi Thomas Onome T Abiri Aminata Tigiedankay Koroma James Squire Mohamed Alex Vandi |
| author_facet | Innocent Nuwagira Sulaiman Lakoh Zikan Koroma James Baligeh Walter Russell Sia Morenike Tengbe Ibrahim Franklyn Kamara Joseph Kanu Anna Maruta Bobson Derrick Fofanah Kadijatu Nabie Kamara Bockarie Sheriff Victoria Katawera Selassi A D'Almeida Robert Musoke Rugiatu Z Kamara Abdul Razak Mansaray Fawzi Thomas Onome T Abiri Aminata Tigiedankay Koroma James Squire Mohamed Alex Vandi |
| author_sort | Innocent Nuwagira |
| collection | DOAJ |
| description | Objective Inappropriate 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.Design We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology.Setting The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services.Participants All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled.Outcome measures Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done.Results Of 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%).Conclusion There 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. |
| format | Article |
| id | doaj-art-8e7fafe26f2d4a94922afbbe48ef4bea |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-8e7fafe26f2d4a94922afbbe48ef4bea2025-08-20T02:11:24ZengBMJ Publishing GroupBMJ Open2044-60552023-12-01131210.1136/bmjopen-2023-078367Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodologyInnocent Nuwagira0Sulaiman Lakoh1Zikan Koroma2James Baligeh Walter Russell3Sia Morenike Tengbe4Ibrahim Franklyn Kamara5Joseph Kanu6Anna Maruta7Bobson Derrick Fofanah8Kadijatu Nabie Kamara9Bockarie Sheriff10Victoria Katawera11Selassi A D'Almeida12Robert Musoke13Rugiatu Z Kamara14Abdul Razak Mansaray15Fawzi Thomas16Onome T Abiri17Aminata Tigiedankay Koroma18James Squire19Mohamed Alex Vandi20World Health Organisation Country Office Sierra Leone, Freetown, Sierra LeoneCollege of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra LeoneSierra Leone Ministry of Health and Sanitation, Freetown, Sierra LeoneDepartment of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra LeoneSierra Leone Ministry of Health and Sanitation, Freetown, Sierra LeoneReproductive Maternal Newborn Child and Adolescent Health Unit, Universal Health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra LeoneNational Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra LeoneWorld Health Organisation Country Office Sierra Leone, Freetown, Sierra LeoneIPC/AMR, World Health Organisation Country Office Sierra Leone, Freetown, Sierra LeoneNational Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health, Freetown, Sierra LeoneUniversal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra LeoneUniversal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra LeoneUniversal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra LeoneEmergency Preparedness and Response, World Health Organization Country Office, Sierra Leone, Freetown, Sierra LeoneUS Center for Disease Control and Prevention Country Office, Sierra Leone, Freetown, Sierra LeoneLaboratory, Diagnostic and Blood Services, Ministry of Health and Sanitation, Freetown, Sierra LeonePharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra LeonePharmacovigilance and Clinical Trials Department, Pharmacy Board of Sierra Leone, Freetown, Sierra LeoneNational Surveillance Program, Directorate of Health Security and Emergency, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra LeoneGovernment of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra LeoneGovernment of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra LeoneObjective Inappropriate 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.Design We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology.Setting The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services.Participants All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled.Outcome measures Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done.Results Of 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%).Conclusion There 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.https://bmjopen.bmj.com/content/13/12/e078367.full |
| spellingShingle | Innocent Nuwagira Sulaiman Lakoh Zikan Koroma James Baligeh Walter Russell Sia Morenike Tengbe Ibrahim Franklyn Kamara Joseph Kanu Anna Maruta Bobson Derrick Fofanah Kadijatu Nabie Kamara Bockarie Sheriff Victoria Katawera Selassi A D'Almeida Robert Musoke Rugiatu Z Kamara Abdul Razak Mansaray Fawzi Thomas Onome T Abiri Aminata Tigiedankay Koroma James Squire Mohamed Alex Vandi Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology BMJ Open |
| title | Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology |
| title_full | Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology |
| title_fullStr | Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology |
| title_full_unstemmed | Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology |
| title_short | Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology |
| title_sort | antibiotic use among hospitalised patients in sierra leone a national point prevalence survey using the who survey methodology |
| url | https://bmjopen.bmj.com/content/13/12/e078367.full |
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