WHO/INRUD core prescribing indicators and antibiotic utilization patterns among primary health care facilities in Ilala district, Tanzania

Amosi Kilipamwambu; George M Bwire; David T Myemba; Belinda J Njiro; Mtebe V Majigo

doi:10.1093/jacamr/dlab049

WHO/INRUD core prescribing indicators and antibiotic utilization patterns among primary health care facilities in Ilala district, Tanzania

JAC Antimicrob Resist. 2021 May 20;3(2):dlab049. doi: 10.1093/jacamr/dlab049. eCollection 2021 Jun.

Authors

Amosi Kilipamwambu¹, George M Bwire², David T Myemba², Belinda J Njiro¹, Mtebe V Majigo¹

Affiliations

¹ School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
² School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.

Abstract

Background: Antibiotic use requires regular monitoring to prevent emergence of antibiotic resistance.

Objectives: To assess antibiotic prescribing patterns at health care facilities (HCF) in Ilala district, Tanzania.

Methods: A 1 year retrospective study was conducted in four HCFs using WHO/International Network of Rational Use of Drugs (INRUD) core prescribing indicators. Factors associated with antibiotic prescription were analysed using logistic regression model.

Results: A total of 604 prescriptions were reviewed. Patients had median age (IQR) of 15 (4-31) years with majority having upper respiratory tract infection 33.3% (n = 201), urinary tract infection 31.1% (n = 188) or diarrhoea 21.2% (n = 128). Out of 624 prescribed antibiotics, amoxicillin was the most common (22.7%), followed by ciprofloxacin (13.6%) and metronidazole (11.6%). The studied HCFs had an average of 1.99 medicines prescribed per consultation (reference: 1.6-1.8). Of 1203 medicines prescribed, 51.9% (n = 624) were antibiotics (reference: 20.0%-26.8%). Additionally, 97.6% (n = 609) of the antibiotics appeared on the national essential medicines list, whereby 84.4% (n = 510) were prescribed by generic names (reference: 100%). Patients with peptic ulcers had a 4.4-fold higher chance of receiving antibiotics [adjusted odds ratio (aOR) = 4.4, 95% CI = 1.918-10.13, P = 0.0001] while patients with diarrhoea had a 2.6-fold higher chance of receiving at least one antibiotic (aOR = 2.6, 95% CI = 1.206-5.491, P = 0.015).

Conclusions: We found inappropriate use of antibiotics in the studied primary HCFs. Antibiotic stewardship programmes should be extended to primary HCFs found in Ilala district.