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. 2023 Feb 20:7:43-51.
doi: 10.1016/j.ijregi.2023.02.004. eCollection 2023 Jun.

Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals

Sulaiman Lakoh  1   2   3   4 , Valerie John-Cole  1   2 , Ronita D C Luke  1   2 , Nellie Bell  1   2 , James B W Russell  1   2 , Ayeshatu Mustapha  2 , Umu Barrie  4 , Onome T Abiri  1   2 , Joshua M Coker  1   2 , Matilda N Kamara  1 , Freddie J Coker  1   2 , Olukemi Adekanmbi  5   6 , Ibrahim Franklyn Kamara  7 , Bobson Derrick Fofanah  7 , Darlinda F Jiba  2 , Adetunji O Adeniji  1   2   8 , Sartie Kenneh  2 , Gibrilla F Deen  1   2 , Troy D Moon  9 , George A Yendewa  10   11   12 , Emmanuel Firima  13   14   15   16
Affiliations

Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals

Sulaiman Lakoh et al. IJID Reg. .

Abstract

Objective: As there are no country-representative data on bacterial sensitivities to guide antimicrobial stewardship (AMS) interventions, an AMS programme was established in the outpatient clinics of three tertiary hospitals in Freetown, Sierra Leone.

Methods: The study employed a cross-sectional design to collect antibiotic prescribing data from 370 pregnant women and lactating mothers, 314 children and 229 regular patients in the outpatient clinics of the Princess Christian Maternity Hospital (PCMH), Ola During Children's Hospital and Connaught Hospital (CH), respectively, in April 2022. All data were analysed using Stata Version 16.

Results: Of 913 patients, most were female (n=635, 69.5%), treated at PCMH (n=370, 40.5%) and had a bacterial infection (n=661, 72.4%). The indication for prescribing antibiotics was inappropriate in 252 (27.6%) patients. Of the 1236 prescriptions, 393 (31.8%) were made at CH. The duration of antibiotic use was not stated in 230 (18.6%) prescriptions. Overall antibiotic consumption was 55.3 defined daily doses per 1000 outpatient-days.

Conclusion: Gaps in antibiotic prescriptions were identified in the outpatient clinics of three national referral hospitals in Sierra Leone. In order to combat antimicrobial resistance, AMS interventions are needed to reduce the prescription of antibiotics for inappropriate indications or without specified duration.

Keywords: AWaRe; Antibiotic consumption; Antibiotic use; Antimicrobial resistance; Defined daily dose; Freetown, Sierra Leone.

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Conflict of interest statement

E.F. receives salary from the European Union's Horizon 2020 research and innovation programme under Marie Skłodowska-Curie grant agreement (No 801076), through SSPH+ Global PhD Fellowship Programme in Public Health Sciences (GlobalP3HS). G.A.Y. reports salary support from the National Institutes of Health/AIDS Clinical Trials Group under Award Numbers 5UM1AI068636-15, 5UM1AI069501-09 and AI068636 (150GYD212), and consultancy fees from Pfizer. The other authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Multi-variable logistic regression analysis of variables associated with inappropriate administration of antibiotics among outpatients in three hospitals in Freetown. ANC, antenatal care; AdjRR, adjusted risk ratio; CI, confidence interval.
Figure 2
Figure 2
Poisson regression analysis of variables associated with number of antibiotics administered to outpatients in three hospitals in Freetown. ANC, antenatal care; AdjOR, adjusted odds ratio; CI, confidence interval.
Figure 3
Figure 3
(a) Total antibiotic consumption presented as defined daily doses (DDDs) per 1000 outpatient-days by World Health Organization (WHO) AWaRe category in three hospitals in Freetown. (b) Proportion of total antibiotic DDDs per 1000 outpatient-days by WHO AWaRe category in the hospitals. (c) Total antibiotic consumption presented as DDDs per 1000 outpatient-days by WHO AWaRe category according to sex. (d) Proportion of total antibiotic DDDs per 1000 outpatient-days by WHO AWaRe category according to sex. CH, Connaught Hospital; PCMH, Princess Christian Maternity Hospital; ODCH, Ola During Children's Hospital.
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