scholarly journals Survey of the pattern of antibiotic dispensing in private pharmacies in Nepal

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032422 ◽  
Author(s):  
Anant Nepal ◽  
Delia Hendrie ◽  
Suzanne Robinson ◽  
Linda A Selvey
Keyword(s):  
Respiratory Infections ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Study Data ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Middle Income ◽  
Frequency Distributions ◽  
Low Middle Income Countries

ObjectivesPrivate pharmacies are widely established in most low/middle-income countries (LMICs) including Nepal, and are often considered as a patient’s first point of contact for seeking healthcare. The aim of this study was to investigate the pattern of antibiotic dispensing in private pharmacies through exit interviews with patients to review their medication information.Design and settingCross-sectional study. Data collection was carried out in 60 days at 33 randomly selected private pharmacies in the Rupandehi district of Nepal.ParticipantsPatients attending private pharmacies (n=1537).Main outcome measureThe pattern of antibiotic prescribing and dispensing was investigated using WHO’s core prescribing indicator, ‘the percentage of patients prescribed an antibiotic’. Frequency distributions were presented based on patients’ characteristics, sources of antibiotic, registration status of pharmacies and education of the pharmacist or drug retailer, and disease or condition. χ2tests and regression analysis were applied to explore factors associated with the pattern of antibiotic dispensing.ResultsOf patients attending private pharmacies, the proportion receiving at least one antibiotic (38.4%) was above the WHO recommended value (20.0%–26.8%). The most commonly dispensed antibiotics were cefixime (16.9%) and the third-generation cephalosporins (38.0%) class. High dispensing rates of antibiotics for selected conditions (eg, respiratory infections, diarrhoeal cases) appeared contrary to international recommendations. The percentage of antibiotic dispensed was highest for patients who obtained their medicines from unlicensed pharmacies (59.1%). Young people were more likely to receive antibiotics than other age groups.ConclusionsThe antibiotic dispensing pattern from private pharmacies in Nepal was high compared with WHO guidelines, suggesting initiatives to reduce inappropriate use of antibiotics should be implemented. The findings of this study may be generalisable to other LMICs in order to assist in developing policies and guidelines to promote more appropriate dispensing and prescribing practices of antibiotics and limit the spread of antibiotic resistance.

scholarly journals Analysis of patterns of antibiotic prescribing in public health facilities in Nepal

2020 ◽  
Vol 14 (01) ◽  
pp. 18-27 ◽  
Author(s):  
Anant Nepal ◽  
Delia Hendrie ◽  
Suzanne Robinson ◽  
Linda A Selvey
Keyword(s):  
Public Health ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Antibiotic Prescribing ◽  
Who Guidelines ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Middle Income ◽  
Public Health Facilities ◽  
Inappropriate Use

Introduction: Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. Little is known about antibiotic prescribing practices at public health facilities in low- and middle-income countries. We examined patterns of antibiotic prescribing in public health facilities in Nepal and explored factors influencing these practices. Methodology: A cross-sectional study of antibiotic prescribing in public health facilities was conducted in the Rupandehi district of Nepal. Six public health facilities were selected based on WHO guidelines, and data were extracted from administrative records for 6,860 patient encounters. Patterns of antibiotic prescribing were investigated using descriptive statistics. Chi-squared tests and logistic regressions were applied to explore factors associated with antibiotic prescribing. Results: Of patients attending public health facilities, the proportion prescribed at least one antibiotic (44.7%) was approximately twice the WHO recommended value (20.0 to 26.8%). The antibiotic prescribing rate for hospital inpatients (64.6%) was higher than for other facilities, with the prescribing rate also high in primary health care centres (50.4%) and health posts (52.2%). The most frequently (29.9%) prescribed antibiotic classes were third-generation cephalosporins. Females (p = 0.005) and younger (p < 0.001) patients were more likely to be prescribed antibiotics. High prescribing rates of antibiotics for selected diseases appeared contrary to international recommendations. Conclusion: Antibiotic prescribing in public health facilities was high compared with WHO guidelines, suggesting the need for strategies to reduce misuse of antibiotics. This study provides useful information to assist in formulating policies and guidelines to promote more appropriate use of antibiotics in Nepal.

scholarly journals Prescribers’ Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 858
Author(s):  
Reema A. Karasneh ◽  
Sayer I. Al-Azzam ◽  
Mera Ababneh ◽  
Ola Al-Azzeh ◽  
Ola B. Al-Batayneh ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Attitudes And Behaviors ◽  
And Behaviors ◽  
Ease Of Access

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.

scholarly journals Prevalence and correlates of adherence to movement guidelines among urban and rural children in Mozambique: a cross-sectional study

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Taru Manyanga ◽  
Joel D. Barnes ◽  
Jean-Philippe Chaput ◽  
Peter T. Katzmarzyk ◽  
Antonio Prista ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sleep Duration ◽  
Screen Time ◽  
Cross Sectional Study ◽  
Rural Children ◽  
Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

Abstract Background Insufficient physical activity, short sleep duration, and excessive recreational screen time are increasing globally. Currently, there are little to no data describing prevalences and correlates of movement behaviours among children in low-middle-income countries. The few available reports do not include both urban and rural respondents, despite the large proportion of rural populations in low-middle-income countries. We compared the prevalence of meeting 24-h movement guidelines and examined correlates of meeting the guidelines in a sample of urban and rural Mozambican schoolchildren. Methods This is cross-sectional study of 9–11 year-old children (n = 683) recruited from 10 urban and 7 rural schools in Mozambique. Moderate- to vigorous-intensity physical activity (MVPA) and sleep duration were measured by waist-worn Actigraph GT3X+ accelerometers. Accelerometers were worn 24 h/day for up to 8 days. Recreational screen time was self-reported. Potential correlates of meeting 24-h movement guidelines were directly measured or obtained from validated items of context-adapted questionnaires. Multilevel multivariable logit models were used to determine the correlates of movement behaviours. Meeting 24-h movement guidelines was defined as ≥60 min/day of MVPA, ≤2 h/day of recreational screen time, and between 9 and 11 h/night of sleep. Results More rural (17.7%) than urban (3.6%) children met all three 24-h movement guidelines. Mean MVPA was lower (82.9 ± 29.5 min/day) among urban than rural children (96.7 ± 31.8 min/day). Rural children had longer sleep duration (8.9 ± 0.7 h/night) and shorter recreational screen time (2.7 ± 1.9 h/day) than their urban counterparts (8.7 ± 0.9 h/night and 5.0 ± 2.3 h/day respectively). Parental education (OR: 0.37; CI: 0.16–0.87), school location (OR: 0.21; CI: 0.09–0.52), and outdoor time (OR: 0.67; CI: 0.53–0.85) were significant correlates of meeting all three 24-h movement guidelines. Conclusions Prevalence and correlates of meeting movement guidelines differed between urban and rural schoolchildren in Mozambique. On average, both groups had higher daily MVPA minutes, shorter sleep duration, and higher recreational screen time than the 24-h movement guidelines recommend. These findings (e.g., higher than recommended mean daily MVPA minutes) differ from those from high-income countries and highlight the need to sample from both urban and rural areas.

scholarly journals Prescribing practices using WHO prescribing indicators and factors associated with antibiotic prescribing in six community pharmacies in Asmara, Eritrea: a cross-sectional study

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Nebyu Daniel Amaha ◽  
Dawit G. Weldemariam ◽  
Nuru Abdu ◽  
Eyasu H. Tesfamariam
Keyword(s):  
Sampling Technique ◽  
Cross Sectional Study ◽  
Essential Medicines ◽  
Community Pharmacies ◽  
Antibiotic Prescribing ◽  
Sectional Study ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Prescribing Indicators ◽  
Factors Affecting

Abstract Background Antibiotics require more prudent prescribing, dispensing and administration than other medicines because these medicines are at a greater risk of antimicrobial resistance (AMR). Studying the current medicine use practices and factors affecting the prescribing of an antibiotic would help decision makers to draft policies that would enable a more rational use of medicines. Methods A prospective, descriptive, and cross-sectional study was conducted to assess the current prescribing practices including antibiotics use in six community pharmacies in Asmara. A total of 600 encounters were reviewed using the WHO core prescribing indicators between May 5 and May 12, 2019 using stratified random sampling technique. Descriptive statistics and logistic regression were employed using IBM SPSS® (version 22). Results The average number of medicines per prescription was 1.76 and 83.14% of the medicines were prescribed using generic names while 98.39% of the medicines were from the National Essential Medicines List (NEML). The percentage of prescriptions containing antibiotics was 53%. The number of encounters containing injections was 7.8%. Patient age, gender and number of medicines prescribed were significantly associated with antibiotic prescribing at bivariate and multivariable models. Subjects under the age of 15 were approximately three times more likely to be prescribed antibiotic compared to subjects whose age is 65 and above (Adjusted Odds Ratio (AOR): 2.93, 95%CI: 1.71–5). Similarly, males were more likely to be prescribed antibiotic than females (AOR: 1.57, 95%CI: 1.10–2.24). Subjects to whom three to four medicines prescribed were two times more likely to be prescribed an antibiotic compared to those who were to be prescribed one to two medicines per encounter (AOR: 2.17, 95%CI: 1.35–3.5). A one-unit increase in the number of medicines increased the odds of antibiotic prescribing increased by 2.02 units (COR: 2.02; 95%CI: 1.62–2.52). Conclusions This study found that the percentage of antibiotics being prescribed at the community pharmacies in Asmara was 53% which deviated significantly from the WHO recommended values (20–26.8%). Furthermore, the percentage of encounters with an injection was 7.8% lower than the WHO value of 13.4–24.0%. Patients’ age, gender and number of medicines were significantly associated with antibiotic prescribing.

scholarly journals Antibiotic Prescription Patterns for Acute Diarrhea in a Hospital in Shanghai in 2016: A Cross-sectional Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S326-S326
Author(s):  
Yanhong Hu ◽  
Shanjuan Wang ◽  
Sunying Hua ◽  
Merlin Willcox ◽  
Michael Moore ◽  
...  
Keyword(s):  
Acute Diarrhea ◽  
Respiratory Infections ◽  
Final Analysis ◽  
Antibiotic Use ◽  
Negative Resistance ◽  
Cross Sectional Study ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Oral Rehydration ◽  
Stewardship Program

Abstract Background Unnecessary antibiotic use increases the risk for antibiotic resistance. The rates of antibiotic use for upper respiratory infections are high in hospitals in China. Although most guidelines advise against the use of antibiotics for acute diarrhea, little is known about antibiotic use practices for acute diarrhea in China. Methods A retrospective prescription review from a Shanghai hospital outpatient electronic health records system was conducted from 1 January 2016 to 30 December 2016. Records were included for adult patients. The microbial resistance seasonal data in 2016 were extracted. Chi-squared and multivariable logistic regression and adjusted odd ratio (aOR) were used to assess the relationships between demographic characteristics and antibiotic prescribing. Results In total, there were 16,565 prescriptions, 16,060 prescriptions were included in the final analysis after excluding the follow up visits. There were 12,131 (76%) prescriptions with antibiotics prescribed. 5505 (45%) of the antibiotics prescribed were injectable. Of the antibiotics prescribed, levofloxacin was the most frequent (85%), followed by various cephalosporins (14%). Of the cephalosporin prescriptions, third-generation products were the most common (97%). Treatment with oral rehydration salts (ORS) was prescribed 34 (0.2%) times, probiotics were prescribed 3414 (21%) times and smectite was prescribed 2209 (14%) times. Multivariable regression analysis showed that those more likely to receive antibiotics were age 31–50 aOR 1.3 (1.1–1.4), P &lt; 0.001, evaluated in the late evening (11pm to 7am) aOR 2.6 (2.2–2.9) P &lt; 0.001, in the early evening (6pm-11pm) aOR 2.0 (1.8–2.2) P &lt; 0.001, in the summer (June-August) aOR 1.7 (1.5–1.9) P &lt; 0.001. At the same time, the Gram-positive and Gram-negative resistance rates to levofloxacin exceeded 40%, including 50% of E. coliisolates. Conclusion High rates of antibiotic use were observed for acute diarrhea in this hospital. Given the inappropriateness of antibiotics for acute diarrhea and the nonsensical high rates of of intravenous levofloxacin use and the concurrent high rates of the levofloxacin resistance, a more effective antibiotic stewardship program is needed to improve patient outcomes, reduce costs, reinforce policy and address the underlying causes of antibiotic abuse. Disclosures All authors: No reported disclosures.

scholarly journals Composite index of anthropometric failure among under 5 children attending the Immunoprophylaxis clinic in a tertiary care hospital in Nagpur, Maharashtra, India

2018 ◽  
Vol 5 (3) ◽  
pp. 888
Author(s):  
Abhijit Kherde ◽  
Chaitanya R. Patil ◽  
Jyotsna Deshmukh ◽  
Prithvi B. Petkar
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Age Groups ◽  
Composite Index ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Study Data ◽  
Care Hospital ◽  
Global Public Health ◽  
Cross Sectional

Background: Under nutrition is a global public health problem. There are numerous methods of assessment of malnutrition among which CIAF is the most recent, relatively robust since it envisages all the parameters for estimation of nutritional status of the children. So, this study was conducted to find the rates of composite index of anthropometric failure in the children attending the Immunoprophylaxis clinic in a tertiary care hospital of Nagpur and to find associations with the socio demographic variables.Methods: This descriptive cross-sectional study was conducted at the Immunoprophylaxis clinic of a tertiary care institute in Nagpur from September 2016 to January 2017. The study subjects were the children attending the OPD of Immunoprophylaxis clinic of a tertiary care hospital. Necessary permissions were taken before the start of the study. Data was collected using pretested and pre-designed questionnaire. Height and weight were measured using standard guidelines and categorized into groups of CIAF as described by Nandy et al.Results: A total of 460 study subjects were enrolled in the study. The mean age group of the study subjects was 2.47±1.56 years. According to the grades of CIAF, 48.51% were having no failure. Age and gender were factors which were associated with failure status by CIAF.Conclusions: We found high rates of anthropometric failure in our study. The age groups less than 3 years had higher odds of being in failure when compared to more than 3 years age. Further, males had higher odds of being into failure when compared to females. Community based studies are recommended.

scholarly journals Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

2021 ◽  
Vol 6 (12) ◽  
pp. e006788
Author(s):  
Edwin Charles Ernest ◽  
Augustino Hellar ◽  
John Varallo ◽  
Leopold Tibyehabwa ◽  
Margaret Mary Bertram ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Surgical Safety ◽  
Safe Surgery ◽  
Low Middle Income Countries ◽  
Utilisation Rate ◽  
Surgical Teams ◽  
The Impact

IntroductionDespite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).MethodsWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.ResultsThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.ConclusionOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.

scholarly journals Antibiotic Prescribing Practices of Endodontic Postgraduate Trainees in Karachi, Pakistan

2021 ◽  
Vol 30 (03) ◽  
pp. 183-188
Author(s):  
Azam Muhammad Aliuddin ◽  
◽  
Sarosh Sadruddin Morani ◽  
Abubakar Sheikh ◽  
Saqib Rashid ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Apical Periodontitis ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Post Graduate ◽  
Odontogenic Infections ◽  
First Choice ◽  
Graduate Trainees

OBJECTIVE: The aim of this study was to assess the knowledge of Endodontic Postgraduate trainees regarding clinically relevant situations where an antibiotic cover is needed and is focused on the prescription patterns of various antibiotics depending on the clinical evaluation of the patients. METHODOLOGY: A cross sectional study was performed in which data was collected from five different dental institutes offering post-graduate residency in endodontics all over Karachi, Pakistan. Preferred antibiotic for odontogenic infections and the duration for the antibiotic coverage were evaluated amongst postgraduate clinicians. A total of 100 questionnaires were distributed out of which only 82 questionnaires came back with responses. The study was conducted for a period of one month from August 2018- September 2018. The data collected was analyzed by SPSS version 21. RESULTS: A combination of amoxicillin with Clavulanic acid was the first choice of antibiotic in patients with no known allergies to penicillin (40.6%), whereas erythromycin was the first choice of antibiotic in patients having allergic reactions to penicillin (39.3%). The duration of treatment on average was 5 days. In clinical situations of irreversible pulpitis, with or without apical periodontitis, 74.3% and 67% of the respondents prescribed antibiotics. 78 % of respondents have prescribed antibiotics in cases of necrotic pulp with acute apical periodontitis. CONCLUSION: Our study concludes that antibiotic over prescription is very common amongst post graduate trainees and is contributing towards a larger issue of antibiotic resistance. Proper protocols of prescription should be followed by professionals and further refinement is required focusing on need, duration and choice of the antibiotic being used. KEYWORDS: Antibiotics, Odontogenic infections, Endodontics, Microbial resistance

scholarly journals Maternal Outcome in Ruptured Uterus: A Review of 72 Cases

2016 ◽  
Vol 5 (1) ◽  
pp. 20-26
Author(s):  
Nibedita Roy ◽  
Kamrun Nahar ◽  
Uttam Kumar Sarker ◽  
Fouzia Akter ◽  
Ayesha Beg ◽  
...  
Keyword(s):  
Age Groups ◽  
Cross Sectional Study ◽  
Study Data ◽  
Maternal Outcome ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Data Collection Sheet ◽  
Death Cases ◽  
Ruptured Uterus

This descriptive type of cross-sectional study of 72 cases of uterine rupture was conducted over 1 year (from September 2006 to August 2007) in the department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Bangladesh to evaluate the maternal outcome of different types of surgery, to assess the maternal mortality and maternal morbidity. All cases of ruptured uterus which were received & treated and did not die within 30 minutes of admission are included in the study. Data were collected by preformed data collection sheet. The results showed that the common age groups were between 20-30 years in 31(68.00%) cases. Among all ruptured cases, 6 cases (8.33%) were Primigravida, 52 cases (72.22%) were between gravida 2nd to 4th and 14 cases (19.44%) were gravida 5th or above. Among all cases, 66 cases (91.66%) required blood transfusion; Subtotal hysterectomy was done in 36 cases (50.00%), total hysterectomy in 4 cases (5.56%), and repair of the rent in 32 cases (44.44%). Associated operations were done along with repair or hysterectomy in 13 (18.05%) cases. Postoperative complications were found in 23 (31.94%) cases. The shortest stay was 8 days & the longest stay was 62 days. The hospital staying was about 2 weeks in 48(66.70%) cases. Among 10 death cases (13.90%) maximum patient died within first 5 hours. The causes of maternal death were due to septicemia, renal failure and shock in 20%, 30% and 50% respectfully. CBMJ 2016 January: Vol. 05 No. 01 P: 20-26

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