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Review
. 2023 Nov 7;16(1):137.
doi: 10.1186/s40545-023-00634-0.

Adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in sub-Saharan Africa: a systematic review and meta-analysis

Minyahil Tadesse Boltena  1   2 , Mirkuzie Woldie  3   4 , Yibeltal Siraneh  3 , Veronica Steck  5 , Ziad El-Khatib  6   7 , Sudhakar Morankar  3
Affiliations
Review

Adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in sub-Saharan Africa: a systematic review and meta-analysis

Minyahil Tadesse Boltena et al. J Pharm Policy Pract. .

Abstract

Background: Adherence to evidence-based standard treatment guidelines (STGs) enable healthcare providers to deliver consistently appropriate diagnosis and treatment. Irrational use of antimicrobials significantly contributes to antimicrobial resistance in sub-Saharan Africa (SSA). The best available evidence is needed to guide healthcare providers on adherence to evidence-based implementation of STGs. This systematic review and meta-analysis aimed to determine the pooled prevalence of adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in SSA.

Methods: The review followed the JBI methodology for systematic reviews of prevalence data. CINAHL, Embase, PubMed, Scopus, and Web of Science databases were searched with no language and publication year limitations. STATA version 17 were used for meta-analysis. The publication bias and heterogeneity were assessed using Egger's test and the I2 statistics. Heterogeneity and publication bias were validated using Duval and Tweedie's nonparametric trim and fill analysis using the random-effect analysis. The summary prevalence and the corresponding 95% confidence interval (CI) of healthcare professionals' compliance with evidence-based implementation of STG were estimated using random effect model. The review protocol has been registered with PROSPERO code CRD42023389011. The PRISMA flow diagram and checklist were used to report studies included, excluded and their corresponding section in the manuscript.

Results: Twenty-two studies with a total of 17,017 study participants from 14 countries in sub-Saharan Africa were included. The pooled prevalence of adherence to evidence-based implementation of antimicrobial treatment guidelines in SSA were 45%. The pooled prevalence of the most common clinical indications were respiratory tract (35%) and gastrointestinal infections (18%). Overall prescriptions per wards were inpatients (14,413) and outpatients (12,845). Only 391 prescribers accessed standard treatment guidelines during prescription of antimicrobials.

Conclusions: Healthcare professionals' adherence to evidence-based implementation of STG for antimicrobial treatment were low in SSA. Healthcare systems in SSA must make concerted efforts to enhance prescribers access to STGs through optimization of mobile clinical decision support applications. Innovative, informative, and interactive strategies must be in place by the healthcare systems in SSA to empower healthcare providers to make evidence-based clinical decisions informed by the best available evidence and patient preferences, to ultimately improving patient outcomes and promoting appropriate antimicrobial use.

Keywords: Adherence; Antibiotics prescription; Evidence-based medicine and infection; Standard treatment guidelines; Sub-Saharan Africa.

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Conflict of interest statement

The authors declare that this study is free of any competing financial and non-financial interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of included studies: Page et al. [96]
Fig. 2
Fig. 2
Funnel plot showing symmetric distribution of studies on adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in sub-Saharan Africa, 2023
Fig. 3
Fig. 3
Pooled prevalence of adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in sub-Saharan Africa
Fig. 4
Fig. 4
Pooled prevalence of respiratory tract infection as most common clinical indication as prescriptions made in sub-Saharan Africa
Fig. 5
Fig. 5
Pooled prevalence of gastrointestinal tract infection as second most common clinical indication as prescriptions made in sub-Saharan Africa
See this image and copyright information in PMC

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