Assessment of antimicrobial stewardship programmes and antibiotic use among children admitted to two hospitals in Sierra Leone: a cross-sectional study

Antimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the...

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Published in:	Antimicrobial resistance & infection control Vol. 13; no. 1; pp. 80 - 11
Main Authors:	Kamara, Ibrahim Franklyn, Fofanah, Bobson Derrick, Nuwagira, Innocent, Kamara, Kadijatu Nabie, Tengbe, Sia Morenike, Abiri, Onome, Kamara, Rugiatu Z, Lakoh, Sulaiman, Farma, Lynda, Kamara, Abibatu Kollia, Hailu, Binyam, Dove, Djossaya, Squire, James Sylvester, D'Almeida, Selassi A, Sheriff, Bockarie, Mustapha, Ayeshatu, Bawa, Najima, Lagesse, Hailemariam, Koroma, Aminata Tigiedankay, Kanu, Joseph Sam
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 22-07-2024 BioMed Central BMC
Subjects:	Adolescent Anti-Bacterial Agents - therapeutic use Antibiotics Antibiotics use Antimicrobial Stewardship Antimicrobial stewardship programmes Child Child, Preschool Children Cross-Sectional Studies Dispensing Dosage and administration Drug resistance in microorganisms Drugs Female Health aspects Humans Infant Male Point prevalence survey Prevention Sierra Leone Surveys and Questionnaires Tertiary Care Centers Sierra Leone Sierra Leone Antibiotics use Antimicrobial stewardship programmes Children Point prevalence survey
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Summary:	Antimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone. This was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children's Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22. Both ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% - 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription. The non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2047-2994 2047-2994
DOI:	10.1186/s13756-024-01425-1