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. 2023 Dec 30;13(12):e078367.
doi: 10.1136/bmjopen-2023-078367.

Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology

Ibrahim Franklyn Kamara  1 , Joseph Kanu  2   3 , Anna Maruta  4 , Bobson Derrick Fofanah  5 , Kadijatu Nabie Kamara  6 , Bockarie Sheriff  7 , Victoria Katawera  7 , Selassi A D'Almeida  7 , Robert Musoke  8 , Innocent Nuwagira  4 , Sulaiman Lakoh  9 , Rugiatu Z Kamara  10 , Sia Morenike Tengbe  9 , Abdul Razak Mansaray  11   12 , Zikan Koroma  9 , Fawzi Thomas  13 , Onome T Abiri  14   15 , Aminata Tigiedankay Koroma  16 , James Baligeh Walter Russell  17 , James Squire  17 , Mohamed Alex Vandi  17
Affiliations

Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology

Ibrahim Franklyn Kamara et al. BMJ Open. .

Abstract

Objective: Inappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone.

Design: We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology.

Setting: The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services.

Participants: All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled.

Outcome measures: Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done.

Results: Of the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%).

Conclusion: There was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.

Keywords: Health policy; Hospitals, Public; PUBLIC HEALTH; Public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Graph showing the top 10 antibiotics prescribed to patients admitted across 26 hospitals during the national point prevalence survey in Sierra Leone, 2021.
Figure 2
Figure 2
Bar chart showing the classification of antibiotics prescribed to patients across the 26 hospitals in the national point prevalence survey on antibiotic use in Sierra Leone in 2022 according to the WHO AWaRe categorisation.
See this image and copyright information in PMC

References

    1. Shaikh Q, Sarfaraz S, Rahim A, et al. WHO point prevalence survey to describe the use of antimicrobials at a tertiary care center in Pakistan: a situation analysis for establishing an antimicrobial stewardship program. Antibiotics (Basel) 2022;11:1555. 10.3390/antibiotics11111555 - DOI - PMC - PubMed
    1. Ogyu A, Chan O, Littmann J, et al. National action to combat AMR: a one-health approach to assess policy priorities in action plans. BMJ Glob Health 2020;5:e002427. 10.1136/bmjgh-2020-002427 - DOI - PMC - PubMed
    1. Patel J, Harant A, Fernandes G, et al. Measuring the global response to antimicrobial resistance, 2020–21: a systematic governance analysis of 114 countries. Lancet Infect Dis 2023;23:706–18. 10.1016/S1473-3099(22)00796-4 - DOI - PubMed
    1. Raees I, Atif HM, Aslam S, et al. Understanding of final year medical, pharmacy and nursing students in Pakistan towards antibiotic use, antimicrobial resistance and stewardship: findings and implications. Antibiotics (Basel) 2023;12:135. 10.3390/antibiotics12010135 - DOI - PMC - PubMed
    1. Hansson K, Brenthel A. Imagining a post-antibiotic era: a cultural analysis of crisis and antibiotic resistance. Med Humanit 2022;48:381–8. 10.1136/medhum-2022-012409 - DOI - PMC - PubMed

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