Predictors of antibiotics prescription for febrile patients: A health facility-based survey in the Greater Accra region of Ghana
Introduction Frequent or/and misguided prescription of antibiotics are important facilitators of the emergence and spread of antibiotic resistance. In the absence of the implementation of effective interventions to control antibiotic use, its consumption may quadruple. Antibiotic stewardship interventions must be appropriately targeted to enhance the proper use of antibiotics. The objective of this study was to determine the predictors of prescribing antibiotics to febrile patients who seek
... in health facilities within the Greater Accra region of Ghana. Methods Secondary data obtained from a review of medical records of 2,519 febrile patients at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016, were used. In addition, sociodemographic data on the prescribers who saw the patients were obtained. The primary outcome was prescription of any antibiotic. Predictor variables included patients' demographics, symptoms, laboratory investigations, diagnoses and prescribed medicines. Binary and multivariable logistic regression analyses were used to determine the predictors of antibiotics prescription. Clustering was adjusted for in all the analyses. Results The prevalence of antibiotics prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with 6 to 9 years and 10 or more years of practice experience were 3 (95% CI: 1.99, 4.44) and 1.6 (95% CI: 1.12, 2.27) times more likely to prescribe antibiotics, respectively (p < 0.001). IMCI training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) times higher odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to be prescribed antibiotics compared with those under 5 years (AOR=0.40, 95% CI: 0.32, 0.51; p<0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed with antibiotics than those not referred. Presenting to the outpatient clinic with cough was associated with a 3.5 (95% CI: 2.54, 4.92) times higher odds of antibiotics prescribing. Conclusion Prescription of antibiotics to febrile patients was high. Promoting laboratory testing can potentially 3 reduce irrational antibiotics prescribing. Prescribing antibiotics for children under five and the prescribing practices of experienced prescribers should be targeted with interventions.