Antibiotic use on paediatric inpatients in a teaching hospital in the Gambia, a retrospective study

Background: Antibiotics are useful but increasing resistance is a major problem. Our objectives were to assess antibiotic use and microbiology testing in hospitalized children in the Gambia. Methods: We conducted a retrospective analysis of paediatric inpatient data at The Edward Francis Small Teaching Hospital in Banjul, The Gambia. We extracted relevant data from the admission folders of all patients (aged >28 days to 15 years) admitted in 2015 (January-December), who received at least one antibiotic for 24 h. We also reviewed the microbiology laboratory record book to obtain separate data for the bacterial isolates and resistance test results of all the paediatric inpatients during the study period. Results: Over half of the admitted patients received at least one antibiotic during admission (496/917) with a total consumption of 670.7 Days of Antibiotic Therapy/1000 Patient-Days. The clinical diagnoses included an infectious disease for 398/496, 80.2% of the patients on antibiotics, pneumonia being the most common (184/496, 37.1%). There were 51 clinically relevant bacterial isolates, Klebsiella species being the most common (12/51, 23.5%), mainly from urine (11/12, 91.7%). Antibiotic resistance was mainly to ampicillin (38/51, 74.5%), mainly reported as Coliform species 11/51, 21.6%. Conclusions: More than half of the admitted patients received antibiotics. The reported antibiotic resistance was highest to the most commonly used antibiotics such as ampicillin. Efforts to maximize definitive antibiotic indication such as microbiological testing prior to start of antibiotics should be encouraged where possible for a more rational antibiotic use

Reasons for admission and neonatal outcome in the neonatal care unit of a tertiary care hospital in Addis Ababa: a prospective study

Atnafu Mekonnen Tekleab,1 Gesit Metaferia Amaru,1 Yemisrach Abeje Tefera21Department of Pediatrics and Child Health, 2Department of Public Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia Background: The neonatal mortality rate in Ethiopia remains greater than 35 per 1,000 live births. Hence, identifying the reasons for neonatal admission and mortality in a hospital setting is crucial to improve the quality of existing practices in the hospital. The objective of this study was to describe the reasons for admission and the magnitude of neonatal mortality in the neonatal care unit of St Paul's Hospital Millennium Medical College. Methods and subjects: A prospective cohort study was conducted. A total of 216 neonates who were admitted to the neonatal care unit of St Paul's Hospital Millennium Medical College from March 1, 2015, to May 31, 2015, were included in this study. Data fields, determined prospectively, were collected by monitoring the neonates until discharge or death. The independent variables were demographic, obstetric, and clinical characteristics, while the dependent variable was neonatal mortality. Data were analyzed using simple frequencies, odds ratio, and finally binary logistic regression analysis for mortality outcome. Results: The most common primary diagnoses at admission to the neonatal care unit were prematurity with respiratory problem (36.6%), neonatal sepsis (22.7%), and asphyxia (16.2%). Out of the 216 neonates studied, 50 (23.2%) died. High case fatality was observed among neonates with the diagnosis of prematurity with respiratory problem (40.5%) and asphyxia (40.0%). Under multivariate analysis, diagnosis of asphyxia was an independent predictor of mortality (adjusted odds ratio =5.817; 95% confidence interval: 1.611–20.977), while gestational age above the mean of the study population (36.6 weeks) was protective of mortality (adjusted odds ratio =0.683; 95% confidence interval: 0.588–0.795). Conclusion: Nearly a quarter of admitted neonates died. This study identified asphyxia and prematurity as major causes of admission and mortality. Emphasis has to be given to prevent asphyxia and to improve the survival of preterm babies. Keywords: neonate, admission, death, Ethiopia, neonatal outcome, hospital, Addis Abab

Isolated absence of right pulmonary artery in a 4-year old child: a case report

Abate Yeshidinber Weldetsadik, Yemisrach Mekonnen Asfaw, Atnafu Mekonnen Tekleab Department of Pediatrics and Child Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia Abstract: Isolated unilateral absence of the pulmonary artery is a rare anomaly with congenital absence of the left or right pulmonary artery in the absence of other cardiac malformation, and diagnosis is usually made during adolescence. We report a 4-year old male child with isolated absence of the right pulmonary artery, who presented with recurrent chest infection and wheezing since infancy. Keywords: pulmonary artery, child, wheeze, chest infection, Ethiopi

Antibiotic prescribing practice in the management of cough or diarrhea among children attending hospitals in Addis Ababa: a cross-sectional study

Atnafu Mekonnen Tekleab, Yemisrach Mekonnen Asfaw, Abate Yeshidinber Weldetsadik, Gesit Metaferia Amaru Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia Background: Irrational use of antibiotics is a global problem. Failure to follow clinical guidelines is one of the main reasons for irrational use of antibiotics. Cough and/or diarrhea are the main childhood illnesses in Ethiopia, and health care providers are expected to follow the national guideline while managing these illnesses. This study tried to assess the extent of adherence to the guideline while managing cases of childhood diarrhea and/or cough.Methods: The study was conducted in 23 hospitals in Addis Ababa. Data were collected prospectively from April to June 2016 using a structured questionnaire. A total of 1,073 children aged 2–59 months who visited the hospitals for cough or diarrhea during the study period were included in the study. Equal number of cases were allocated to each hospital and consecutive cases were included in the study until the calculated sample size was attained for each hospital. Data collectors approached cases after they were seen by the health care provider. SPSS version 20 was used to analyze the data.Result: Of the total number of cases, an antibiotic was prescribed for 794 (74.0%) of the children. Cotrimoxazol 209 (26.3%), amoxicillin 185 (23.3%), and cephalosporines 174 (21.9%) were the three most commonly prescribed antibiotics. Six hundred eighty-eight (86.6%) of the prescriptions were determined to be inappropriate. Of the inappropriate prescriptions, 631 (91.7%) were for prescribing antibiotics when not necessary and 57 (8.3%) were for prescribing the wrong spectrum of antibiotics. Using multivariate analysis, a child not having diarrhea was independently associated with appropriate antibiotic prescription (adjusted odds ratio =0.261, 95% confidence interval: 0.095–0.714). The prescriber being qualified as a pediatrician was an independent predictor of inappropriate antibiotic prescription (adjusted odds ratio =9.967, 95% confidence interval: 4.221–23.532).Conclusion: The magnitude of inappropriate antibiotic prescription while managing cough and/or diarrhea in our setting was high. It needs urgent action to prevent emergence of antibiotic-resistant microorganisms. Keywords: diarrhea, cough, inappropriate antibiotic prescription, hospital, Addis Abab