Skip to main content
Top
Published in: BMC Infectious Diseases 1/2021

Open Access 01-12-2021 | Antibiotic | Research article

Antimicrobial resistance awareness and antibiotic prescribing behavior among healthcare workers in Nigeria: a national survey

Authors: Emelda E. Chukwu, David A. Oladele, Christian A. Enwuru, Peter L. Gogwan, Dennis Abuh, Rosemary A. Audu, Folasade T. Ogunsola

Published in: BMC Infectious Diseases | Issue 1/2021

Login to get access

Abstract

Background

Antimicrobial resistance (AMR) is a global problem compromising the effective treatment of infectious diseases. The World Health Organization (WHO) is encouraging and promoting awareness creation among health workers as one of its strategies to reduce the rate of emergence and transmission of AMR. Available data on the prescribing behavior of healthcare workers (HCWs) in Nigeria remains incomplete. This study was designed to provide an up-to-date estimate of the knowledge, attitude and antibiotic prescribing behavior of HCWs in Nigeria.

Methods

This is a cross-sectional study. Self-administered questionnaires were distributed to healthcare workers selected from six states, one each from the 6 geopolitical zones in Nigeria. A multi-stage sampling technique was used to reflect the three tiers of healthcare: primary, secondary and tertiary levels. Quantitative data was summarized using descriptive statistics. All data analysis was done using the Statistical package for social sciences version 26.0.

Results

Of the 420 questionnaires distributed, 358 (85.2%) responded. The mean year of practice of the respondents was 9.32 ± 7.8 years. About a half (50.3%) agreed that their prescribing behavior could promote antimicrobial resistance. 49.2% had a good knowledge of AMR and physicians had significantly better knowledge than other HCWs (X2 = 69.59, P < 0.001). Several participants prescribed antibiotics for common viral infections such as sore throats (75.7%), measles (37.7%), common cold and flu (21.2%). Over 60.3% admitted prescribing antibiotics just to be on the safe side. In general, 70.9% of the respondents frequently or moderately use practice guidelines while 25.7% often apply the delayed antibiotic prescription (DAP) strategy to reduce antimicrobial prescription.

Conclusion

This study reveals an overall moderate level of knowledge of AMR and attitude towards minimizing the emergence of antimicrobial resistance though this did not translate significantly to practice. Further efforts must be made in order to improve rational prescription of antimicrobials among HCWs in Nigeria.
Appendix
Available only for authorised users
Literature
2.
go back to reference Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;2:CD003543.PubMed Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;2:CD003543.PubMed
3.
go back to reference Price L, Gozdzielewska L, Young M, Smith F, MacDonald J, McParlandet J, et al. Effectiveness of interventions to improve the public‘s antimicrobial resistance awareness and behaviours associated with prudent use of antimicrobials: a systematic review. J Antimicrob Chemother. 2018;73:1464–78.CrossRef Price L, Gozdzielewska L, Young M, Smith F, MacDonald J, McParlandet J, et al. Effectiveness of interventions to improve the public‘s antimicrobial resistance awareness and behaviours associated with prudent use of antimicrobials: a systematic review. J Antimicrob Chemother. 2018;73:1464–78.CrossRef
4.
go back to reference Langdridge D, Davis M, Gozdzielewska L, McParland J, Williams L, Young M, et al. A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public. Br J Health Psychol. 2019;24:66–87.CrossRef Langdridge D, Davis M, Gozdzielewska L, McParland J, Williams L, Young M, et al. A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public. Br J Health Psychol. 2019;24:66–87.CrossRef
5.
go back to reference Shallcross LJ, Davies DSC. Antibiotic overuse: a key driver of antimicrobial resistance. Br J Gen Pract. 2014;64:604–5.CrossRef Shallcross LJ, Davies DSC. Antibiotic overuse: a key driver of antimicrobial resistance. Br J Gen Pract. 2014;64:604–5.CrossRef
7.
go back to reference Smith M, Higgs J, Ellis E. Factors influencing clinical decision making. In: Clinical reasoning in the health professions. 3rd ed. Sydney: Butterworth-Heinemann; 2008. p. 89–100. Smith M, Higgs J, Ellis E. Factors influencing clinical decision making. In: Clinical reasoning in the health professions. 3rd ed. Sydney: Butterworth-Heinemann; 2008. p. 89–100.
9.
go back to reference Apisarnthanarak A, Tunpornchai J, Tanawitt K, Mundy LM. Non-judicious dispensing of antibiotics by drugstores in Pratumthani, Thailand. Infect Control Hosp Epidemiol. 2008;29:572–5.CrossRef Apisarnthanarak A, Tunpornchai J, Tanawitt K, Mundy LM. Non-judicious dispensing of antibiotics by drugstores in Pratumthani, Thailand. Infect Control Hosp Epidemiol. 2008;29:572–5.CrossRef
10.
go back to reference Kamuhabwa AAR, Silumbe R. Knowledge among drug dispensers and antimalarial drug prescribing practices in public health facilities in Dar Es Salaam. Drug Healthc Patient Saf. 2013;5:181–9.CrossRef Kamuhabwa AAR, Silumbe R. Knowledge among drug dispensers and antimalarial drug prescribing practices in public health facilities in Dar Es Salaam. Drug Healthc Patient Saf. 2013;5:181–9.CrossRef
11.
go back to reference Thakolkaran N, Shetty AV, NDR D’S, Shetty AK. Antibiotic prescribing knowledge, attitudes, and practice among physicians in teaching hospitals in South India. J Fam Med Prim Care. 2017;6:526–32.CrossRef Thakolkaran N, Shetty AV, NDR D’S, Shetty AK. Antibiotic prescribing knowledge, attitudes, and practice among physicians in teaching hospitals in South India. J Fam Med Prim Care. 2017;6:526–32.CrossRef
14.
go back to reference Laxminarayan RA, Duse C, Wattal AK, Zaidi AKM, Wertheim HFL, Sumpradit N, et al. Antibiotic resistance - the need for global solutions. Lancet Infect Dis. 2013;13:1057–98.CrossRef Laxminarayan RA, Duse C, Wattal AK, Zaidi AKM, Wertheim HFL, Sumpradit N, et al. Antibiotic resistance - the need for global solutions. Lancet Infect Dis. 2013;13:1057–98.CrossRef
17.
go back to reference Nigeria Center for Disease Control (NCDC), Federal Ministries of Agriculture, Environment and Health. Antimicrobial Use and Resistance in Nigeria: situation analysis and recommendations. 2017. Available from https://ncdc.gov.ng › themes › common › docs › protocols. Nigeria Center for Disease Control (NCDC), Federal Ministries of Agriculture, Environment and Health. Antimicrobial Use and Resistance in Nigeria: situation analysis and recommendations. 2017. Available from https://​ncdc.​gov.​ng › themes › common › docs › protocols.
18.
go back to reference Chukwu EE, Oladele DA, Awoderu OB, Afocha EE, Lawal RG, Abdus-salam I, et al. A national survey of public awareness of antimicrobial resistance in Nigeria. Antimicrob Resist Infect Control 2020;9:72 https://doi.org/https://doi.org/10.1186/s13756-020-00739-0. Chukwu EE, Oladele DA, Awoderu OB, Afocha EE, Lawal RG, Abdus-salam I, et al. A national survey of public awareness of antimicrobial resistance in Nigeria. Antimicrob Resist Infect Control 2020;9:72 https://​doi.​org/​https://​doi.​org/​10.​1186/​s13756-020-00739-0.
19.
go back to reference Ogundele SO, Ogunleye OO, Mutiu B, Akodu SO. Audit of use of antimicrobial agents at a tertiary health Centre in Lagos, Nigeria. J Public Health Epidemiol. 2015;7(8):263–7.CrossRef Ogundele SO, Ogunleye OO, Mutiu B, Akodu SO. Audit of use of antimicrobial agents at a tertiary health Centre in Lagos, Nigeria. J Public Health Epidemiol. 2015;7(8):263–7.CrossRef
20.
go back to reference Oduyebo OO, Olayinka AT, Iregbu KC, Versporten A, Goossens H, Nwajiobi-Princewill PI, et al. A point prevalence survey of antimicrobial prescribing in four Nigerian tertiary hospitals. Ann Trop Pathol. 2017;8:42–6.CrossRef Oduyebo OO, Olayinka AT, Iregbu KC, Versporten A, Goossens H, Nwajiobi-Princewill PI, et al. A point prevalence survey of antimicrobial prescribing in four Nigerian tertiary hospitals. Ann Trop Pathol. 2017;8:42–6.CrossRef
21.
go back to reference Ahmad JL, Aminu B, Magaji BA. Knowledge, belief and practice of interventions to contain antimicrobial resistance among physicians in Sokoto, North-West Nigeria. Orient J Med. 2015;27(3–4):71–8. Ahmad JL, Aminu B, Magaji BA. Knowledge, belief and practice of interventions to contain antimicrobial resistance among physicians in Sokoto, North-West Nigeria. Orient J Med. 2015;27(3–4):71–8.
25.
go back to reference Salm F, Schneider S, Schmücker K, Petruschke I, Kramer TS, Hanke R, et al. Antibiotic prescribing behavior among general practitioners – a questionnaire-based study in Germany. BMC Infect Dis 2018; 18:208 https://doi.org/https://doi.org/10.1186/s12879-018-3120-y. Salm F, Schneider S, Schmücker K, Petruschke I, Kramer TS, Hanke R, et al. Antibiotic prescribing behavior among general practitioners – a questionnaire-based study in Germany. BMC Infect Dis 2018; 18:208 https://​doi.​org/​https://​doi.​org/​10.​1186/​s12879-018-3120-y.
28.
go back to reference Fadare JO, Ogunleye O, Iliyasu G, Adeoti A, Schellack N, Engler D, et al. Status of antimicrobial stewardship programmes in Nigerian tertiary healthcare facilities: findings and implications. J Glob Antimicrob Resist. 2019;17:132–6.CrossRef Fadare JO, Ogunleye O, Iliyasu G, Adeoti A, Schellack N, Engler D, et al. Status of antimicrobial stewardship programmes in Nigerian tertiary healthcare facilities: findings and implications. J Glob Antimicrob Resist. 2019;17:132–6.CrossRef
29.
go back to reference de la Poza AM, Dalmau GM, Bakedano MM, AIG G, Criado YC, Anadón SH, et al. Prescription strategies in acute uncomplicated respiratory infections: a randomized clinical trial. JAMA Intern Med. 2016;176:21–9.CrossRef de la Poza AM, Dalmau GM, Bakedano MM, AIG G, Criado YC, Anadón SH, et al. Prescription strategies in acute uncomplicated respiratory infections: a randomized clinical trial. JAMA Intern Med. 2016;176:21–9.CrossRef
30.
go back to reference Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations—a questionnaire study. BMJ. 1997;315:520–3.CrossRef Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations—a questionnaire study. BMJ. 1997;315:520–3.CrossRef
31.
go back to reference Watson RL, Dowell SF, Jayaraman M, Keyserling H, Kolczak M, Schwartz B. Antimicrobial use for pediatric upper respiratory infections: reported practice, actual practice, and parent beliefs. Pediatrics. 1999;104:1251–7.CrossRef Watson RL, Dowell SF, Jayaraman M, Keyserling H, Kolczak M, Schwartz B. Antimicrobial use for pediatric upper respiratory infections: reported practice, actual practice, and parent beliefs. Pediatrics. 1999;104:1251–7.CrossRef
32.
go back to reference Di Pentima MC, Chan S, Hossain J. Benefits of a pediatric antimicrobial stewardship program at a children’s hospital. Pediatrics. 2011;128:1062–70.CrossRef Di Pentima MC, Chan S, Hossain J. Benefits of a pediatric antimicrobial stewardship program at a children’s hospital. Pediatrics. 2011;128:1062–70.CrossRef
33.
go back to reference Gould IM. Benefits of antimicrobial stewardship in hospitals: evidence from a recent cochrane review. J Microbiol Immunol Infect. 2017;48:S24.CrossRef Gould IM. Benefits of antimicrobial stewardship in hospitals: evidence from a recent cochrane review. J Microbiol Immunol Infect. 2017;48:S24.CrossRef
34.
go back to reference Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017;6:47.CrossRef Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017;6:47.CrossRef
Metadata
Title
Antimicrobial resistance awareness and antibiotic prescribing behavior among healthcare workers in Nigeria: a national survey
Authors
Emelda E. Chukwu
David A. Oladele
Christian A. Enwuru
Peter L. Gogwan
Dennis Abuh
Rosemary A. Audu
Folasade T. Ogunsola
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Antibiotic
Published in
BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-020-05689-x

Other articles of this Issue 1/2021

BMC Infectious Diseases 1/2021 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.