title: A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana.
abstract: Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and 'no malaria drug' on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support of rational drug use.
authors.affiliation: Disease Control and Prevention Department, Ghana Health Service, Ministry of Health, P. O. Box KB 493, Accra, Ghana, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark, woedem@yahoo.co.uk.
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Ahiabu
authors.affiliation: Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark.
authors.forename: Britt P
authors.initials: BP
authors.lastname: Tersbøl
authors.affiliation: Department of Community Health, College of Health Sciences, University of Ghana P. O. Box KB 4236, Accra, Ghana and.
authors.forename: Richard
authors.initials: R
authors.lastname: Biritwum
authors.affiliation: Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark.
authors.forename: Ib C
authors.initials: IC
authors.lastname: Bygbjerg
authors.affiliation: Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark, Centre for Medical Parasitology, University of Copenhagen, CSS Building 22/23, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen K, Denmark.
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004352:Drug Resistance, Microbial; D017723:Drug Utilization Review; D018954:Drugs, Essential / Q000627:therapeutic use*; D005260:Female; D005869:Ghana; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards; D055553:Prescription Drugs / Q000600:supply & distribution*; D011320:Primary Health Care; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D018954:Drugs, Essential; D055553:Prescription Drugs
keywords: Antibiotic use; developing country; prescribing; primary health care; rational drug use