DIAGNOSTIC AND PRESCRIBING PRACTICES IN PERIPHERAL HEALTH FACILITIES IN RURAL WESTERN KENYA

Abstract Background Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana. Methods Secondary data obtained from the medical records of 2519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2015 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7–72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR = 0.40, 95% CI: 0.32, 0.51; p < 0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11817 ◽

2020 ◽

Vol 14 (01) ◽

pp. 18-27 ◽

Cited By ~ 3

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.

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Religious Collaboration Enhances Patient Satisfaction among Faith-Based Groups and Health Facilities in Western Kenya

Christianity and Social Change in Contemporary Africa: Volume One ◽

10.2307/j.ctv12pnnq5.6 ◽

2020 ◽

pp. 57-80

Author(s):

Mary N. Getui ◽

Nema C. Aluku ◽

William T. Story

Keyword(s):

Patient Satisfaction ◽

Health Facilities ◽

Western Kenya ◽

Faith Based

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Mortality of sick children after outpatient treatment at first-level health facilities in rural western Kenya

Tropical Medicine & International Health ◽

10.1111/j.1365-3156.2007.01898.x ◽

2007 ◽

Vol 12 (10) ◽

pp. 1258-1268 ◽

Cited By ~ 6

Author(s):

Kim A. Lindblade ◽

Mary J. Hamel ◽

Daniel R. Feikin ◽

Frank Odhiambo ◽

Kubaje Adazu ◽

...

Keyword(s):

Outpatient Treatment ◽

Health Facilities ◽

Western Kenya ◽

Sick Children

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Uptake and outcomes of early infant male circumcision services in four counties in Western Kenya

African Health Sciences ◽

10.4314/ahs.v21i.10s ◽

2021 ◽

Vol 21 ◽

pp. 59-63

Author(s):

Thomas Okwaro Andale ◽

Onesmus Gachuno ◽

Theresa Odero Mary Awuor

Keyword(s):

Adverse Event ◽

Adverse Events ◽

Male Circumcision ◽

Male Infant ◽

Health Facilities ◽

Western Kenya ◽

Early Infant ◽

Hiv Prevention Strategies ◽

Early Infant Male Circumcision ◽

Infant Male

Background: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%. Objectives: To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised. Methods: A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program. Results: A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of facilities offering EIMC while Migori had the lowest proportion. Uptake of EIMC was low at 17.4% for all male infants born, far less than the anticipated target of 40%. Average adverse event rates were 0.3%. Conclusion: EIMC uptake remains low in this region of Kenya due to small number of health facilities offering the service. The proportion of circumcised early male infants born at the target health facilities is below the national target of 40% even though the rate of adverse events among those circumcised is acceptable. Keywords: Adverse event; circumcision; early male infant; uptake; western Kenya.

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Antibiotics prescription for febrile patients: associated factors in a health facility-based survey in the Greater Accra region of Ghana

10.21203/rs.2.10739/v2 ◽

2019 ◽

Author(s):

Michael Mireku Opoku ◽

Harriet Affran Bonful ◽

Kwadwo Ansah Koram

Keyword(s):

Integrated Management ◽

Blood Film ◽

Health Facilities ◽

Full Blood Count ◽

Baseline Survey ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Factors Associated ◽

Laboratory Investigations ◽

Greater Accra Region

Abstract Introduction: Frequent and/or misguided prescription of antibiotics are important facilitators of the emergence and spread of antibiotic resistance. In the absence of the implementation of effective interventions to control antibiotic use, its consumption may increase out of proportion to requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the proper use of antibiotics. The objective of this study was to determine the factors associated with of antibiotics prescription to febrile patients who seek care in health facilities within the Greater Accra region of Ghana. Methods: Secondary data obtained from a review of medical records of 2,519 febrile patients at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016 were used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotics prescription. Results: The prevalence of antibiotics prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with more years of practice (>5years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) times higher odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to be prescribed antibiotics compared with those under 5 years (AOR=0.40, 95% CI: 0.32, 0.51; p<0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed with antibiotics than those not referred. Presenting to the outpatient clinic with cough was associated with a 3.5 (95% CI: 2.54, 4.92) times higher odds of antibiotics prescribing. Conclusion: Prescription of antibiotics to febrile patients was high. Promoting laboratory testing can potentially reduce irrational antibiotics prescribing. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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A Cross-Sectional Survey of the Knowledge, Attitudes & Practices of Antimicrobial Users and Providers in an Area of High-Density Livestock-Human Population in Western Kenya

10.1101/2021.06.23.21259378 ◽

2021 ◽

Author(s):

Steven A Kemp ◽

Gina L Pinchbeck ◽

Eric M Fevre ◽

Nicola J Williams

Keyword(s):

General Education ◽

Treatment Failure ◽

East Africa ◽

High Density ◽

Prescribing Patterns ◽

Prescribing Practices ◽

Cross Sectional Survey ◽

Western Kenya ◽

Attitudes And Practices ◽

Veterinary Antimicrobials

Background Antimicrobial resistance (AMR) is one of the most important global health crises in recent times and is driven primarily by antimicrobial consumption. In East Africa, there is a paucity of data regarding the knowledge, attitudes and practices related to antimicrobial use (AMU). Here we investigate the ways in which antimicrobial users in the veterinary sector accessed veterinary antimicrobials, and common behaviours of veterinary antimicrobial users and prescribers associated with AMU and AMR. Methods In total, 70 farmers, staff at 49 agricultural-veterinary antimicrobial shops (agrovet staff) and 28 veterinary animal healthcare workers or veterinary surgeons (veterinary professionals) were interviewed in Busia county, western Kenya in 2016 using a standard questionnaire as a framework for structured interviews. Data recorded included participant demographics, level of education, access to and sources of veterinary antimicrobials, prescribing patterns and knowledge of AMR and antimicrobial withdrawal periods. Results The majority of antimicrobials were accessed through informal means, purchased from agroveterinary shops; more than half of staff did not hold nationally mandated qualifications to advise on or sell veterinary antimicrobials. Approximately 40% of veterinary antimicrobials were sold without a prescription and it was noted that both price and customer preference were important factors when selling antimicrobials in almost all agrovet shops. Knowledge of the dangers associated with AMR and AMU were mostly superficial. Treatment failure occurred often, and there was a lack of differentiation between AMR and simply treatment failure. Conclusion In this study area in East Africa with high-density human and livestock populations, AMU was primarily for maintenance of livestock health. These findings have highlighted several aspects surrounding inappropriate access to antimicrobials, and as such require attention from policy makers concerned with AMR in both livestock and human medicine sectors. Improving prescribing practices and ensuring a minimum level of general education and awareness of prescribers, as well as expanding the role of agrovet staff in antimicrobial stewardship programmes, may help begin to mitigate the maintenance and transmission of AMR, particularly amongst livestock.

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Malaria micro-stratification using routine surveillance data in Western Kenya

10.21203/rs.3.rs-53969/v3 ◽

2020 ◽

Author(s):

Victor A Alegana ◽

Laurissa Suiyanka ◽

Peter M Macharia ◽

Grace Ikahu-Muchangi ◽

Robert W Snow

Keyword(s):

Spatial Resolution ◽

Population Distribution ◽

Indoor Residual Spraying ◽

Routine Data ◽

Malaria Risk ◽

Health Facilities ◽

Exceedance Probability ◽

Future Research ◽

Small Scale ◽

Western Kenya

Abstract Background There is an increasing need for finer spatial resolution data on malaria risk to provide micro-stratification to guide sub-national strategic plans. Here, spatial-statistical techniques are used to exploit routine data to depict sub-national heterogeneities in test positivity rate (TPR) for malaria among patients attending health facilities in Kenya. Methods Routine data from health facilities (n=1,804) representing all ages over 24 months (2018-2019) were assembled across 8 counties (62 sub-counties) in Western Kenya. Statistical model-based approaches were used to quantify heterogeneities in TPR and uncertainty at fine spatial resolution adjusting for missingness, population distribution, spatial data structure, month, and type of health facility. Results The overall monthly reporting rate was 78.7% (IQR 75.0-100.0) and public-based health facilities were more likely than private facilities to report ≥12 months (OR 5.7, 95% CI 4.3-7.5). There was marked heterogeneity in population-weighted TPR with sub-counties in the north of the lake-endemic region exhibiting the highest rates (exceedance probability >70% with 90% certainty) where approximately 2.7 million (28.5%) people reside. At micro-level the lowest rates were in 14 sub-counties (exceedance probability <30% with 90% certainty) where approximately 2.2 million (23.1%) people lived and indoor residual spraying had been conducted since 2017.Conclusion The value of routine health data on TPR can be enhanced when adjusting for underlying population and spatial structures of the data, highlighting small-scale heterogeneities in malaria risk often masked in broad national stratifications. Future research should aim at relating these heterogeneities in TPR with traditional community-level prevalence to improve tailoring malaria control activities at sub-national levels.

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Intermittent screening and treatment with dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy: implementation feasibility in a routine healthcare system setting in western Kenya

Malaria Journal ◽

10.1186/s12936-020-03505-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Jenny Hill ◽

Peter Ouma ◽

Seth Oluoch ◽

Jane Bruce ◽

Simon Kariuki ◽

...

Keyword(s):

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Standard Of Care ◽

Health Facilities ◽

Malaria In Pregnancy ◽

Sub Saharan Africa ◽

Directly Observed Therapy ◽

Western Kenya ◽

Sub Saharan ◽

In Pregnancy

Abstract Background Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for preventing malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. However, due to increasing parasite resistance to SP, research on alternative strategies is a priority. The study assessed the implementation feasibility of intermittent screening and treatment (ISTp) in the second and third trimester at antenatal care (ANC) with malaria rapid diagnostic tests (RDTs) and treatment of positive cases with dihydroartemisinin-piperaquine (DP) compared to IPTp-SP in western Kenya. Methods A 10-month implementation study was conducted in 12 government health facilities in four sub-counties. Six health facilities were assigned to either ISTp-DP or IPTp-SP. Evaluation comprised of facility audits, ANC observations, and exit interviews. Intermediate and cumulative effectiveness analyses were performed on all processes involved in delivery of ISTp-DP including RDT proficiency and IPTp-SP ± directly observed therapy (DOT, standard of care). Logistic regression was used to identify predictors of receiving each intervention. Results A total of 388 and 389 women were recruited in the ISTp-DP and IPTp-SP arms, respectively. For ISTp-DP, 90% (289/320) of eligible women received an RDT. Of 11% (32/289) who tested positive, 71% received the correct dose of DP and 31% the first dose by DOT, and only 6% were counselled on subsequent doses. Women making a sick visit and being tested in a facility with a resident microscopist were more likely to receive ISTp-DP (AOR 1.78, 95% CI 1.31, 2.41; and AOR 3.75, 95% CI 1.31, 2.40, respectively). For IPTp-SP, only 57% received a dose of SP by DOT. Payment for a laboratory test was independently associated with receipt of SP by DOT (AOR 6.43, 95% CI 2.07, 19.98). Conclusions The findings indicate that the systems effectiveness of ANC clinics to deliver ISTp-DP under routine conditions was poor in comparison to IPTp-SP. Several challenges to integration of ISTp with ANC were identified that may need to be considered by countries that have introduced screening at first ANC visit and, potentially, for future adoption of ISTp with more sensitive RDTs. Understanding the effectiveness of ISTp-DP will require additional research on pregnant women’s adherence to ACT.

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