An Evaluation of Antibiotic Prescribing Practices Among Patients at Marondera Provincial Hospital, in Marondera District Using WHO-INRUD Core Drug Indicators

Abstract

Irrational prescribing of antibiotics in hospital settings, is one of the key drivers of the antimicrobial resistance (AMR) crisis globally. Studies conducted on the extent of antimicrobial use in Zimbabwe have shown considerable degree of resistance to commonly used first-line antibiotics. The objective of the study was to assess antibiotic prescribing practices at Marondera Provincial Hospital, in Marondera District, using the WHO-INRUD core drug indicators. The study also sought to evaluate the level of knowledge, attitude and practices (KAP) of health care workers towards antibiotic prescribing. A descriptive, cross-sectional study design was used. To investigate prescribing practices using prescribing indicators, 627 patient records were sampled out of 965 total patients’ records using the random systematic technique from January to November 2023. To investigate prescribing practices using patient care indicators and facility-specific indicators, a total of 102 randomly selected outpatients and one pharmacy personnel were observed and interviewed respectively. Sixty-five (65) health care workers were randomly selected to participate in the KAP survey. The study revealed a mixed profile of compliance to WHO-INRUD recommended good prescribing practices. For the prescribing indicators, the average number of antibiotics per encounter was 1.90 (optimal range = 1.6–1.8), the drugs prescribed by the generic name were 81.2% (optimal value = 100.0%), the encounters with an antibiotic prescribed were 65.0% (optimal range = 20.0–26.8%), the encounters with an injection prescribed were 64.5% (optimal range = 13.4–24.1%) and the drugs prescribed from the Essential Drugs List (EDL) were 100.0% (optimal value = 100.0%). For patient-care indicators, the average consultation time was 8.31minutes (optimal value = ≥10 minutes) and average dispensing time was 81.1seconds (optimal value = ≥90 seconds). The hospital had a copy of the essential drug list and availability of key antibiotics was 63.0% (optimal value =100.0%). Forty-seven (72.3%) health care workers had good knowledge, fifty-one (78.5%) good attitudes, and thirty -seven (56.9%) reported good practice towards antibiotic prescribing. There was a statistically significant association between gender and level of practice with knowledge with p-values of 0.03 and 0.01 respectively. Irrational prescribing of antibiotics and non-compliance across most of the core drug indicators was observed at the hospital which was consistent with the appreciable level of practices observed. This invites further concerted efforts towards implementing relevant interventions to address the identified irrational prescribing practices. Collectively, these can help mitigate against unnecessary economic burden of cost of healthcare and drug-related adverse effects through, for example, drug-drug interactions The implementation of ASPs at all health facilities is crucial.