Evaluation of healthcare students' knowledge on antibiotic use, antimicrobial resistance and antimicrobial stewardship programs and associated factors in a tertiary university in Ghana : findings and implications

Antimicrobial Resistance (AMR) is a major public health problem globally, and Ghana is no exception. Good knowledge regarding antibiotic use, AMR and the concept of antimicrobial stewardship (AMS) is critical among healthcare students to curb rising AMR rates in the future. Consequently, a need to ascertain this. A cross-sectional survey was undertaken among fifth-year pharmacy, medical students and fourth (final)-year nursing and physician assistantship students at the University of Health and Allied Sciences in Ghana to assess their knowledge on antibiotic use, AMR and AMS using a web-based self-administered structured questionnaire. Descriptive statistics, Fishers’ exact test and multiple logistic regression analyses were performed. 160 healthcare students were interviewed of which 56.3% (n=90) were male and 58.8% (n=94) were in their fourth year of study. Good knowledge of antibiotic use, AMR and AMS was associated with the study course (p=0.001) and the number of years of study (

Enhancing choices regarding the administration of insulin among patients with diabetes requiring insulin across countries and implications for future care

There are a number of ongoing developments to improve the care of patients with diabetes across countries given its growing burden. Recent developments include new oral medicines to reduce cardiovascular events and death. They also include new modes to improve insulin administration to enhance adherence and subsequent patient management thereby reducing hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-acting insulin analogues as well as continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump therapy and potentially hybrid closed-loops. The benefits of such systems have been endorsed by endocrine societies and governments in patients with Type 1 diabetes whose HbA1c levels are not currently being optimised. However, there are concerns with the low use of such systems across higher-income countries, exacerbated by their higher costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits. This is inconsistent in higher-income countries when compared with reimbursement and funding decisions for new high-priced medicines for cancer and orphan diseases, with often limited benefits, given the burden of multiple daily insulin injections coupled with the need for constant monitoring. This situation is different among patients and governments in low- and low-middle income countries struggling to fund standard insulins and the routine monitoring of HbA1c levels. The first priority in these countries is to address these priority issues before funding more expensive forms of insulin and associated devices. Greater patient involvement in treatment decisions, transparency in decision making, and evidence-based investment decisions should help to address such concerns in the future

A multicenter cross-sectional survey of knowledge, attitude and practices of healthcare professionals towards antimicrobial stewardship in Ghana : findings and implications

Antimicrobial stewardship (AMS) programs are part of the key activities that contribute to reducing antimicrobial resistance (AMR). Good knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) are essential to improving future antimicrobial use and reducing AMR, which is a priority in Ghana. A multicenter cross-sectional survey was conducted in six public hospitals in Ghana among key HCPs to assess their level of KAP towards AMS using a validated self-administered electronic questionnaire. Data analyses included descriptive and inferential statistics using STATA version 14. Overall, 339 out of 355 HCPs responded to the questionnaire, giving a response rate of 95.5%. Most responders were nurses (n = 256, 78.2%), followed by medical doctors (n = 45, 13.3%). The study recorded both poor knowledge (8.9%) and practice levels (35.4%), as well as a good attitude (78.8%) towards AMS. Ongoing exposure to AMS structured training, exposure to continuous professional development training on AMS in the previous year, and the number of years of working experience were predictors of the HCPs’ level of knowledge (aOR = 3.02 C.I = 1.12–8.11), attitude (aOR = 0.37 C.I = 0.20–0.69) and practice (aOR = 2.09 C.I =1.09–3.99), respectively. Consequently, concentrated efforts must be made to address current low levels of knowledge and poor practices regarding AMS among HCPs in Ghana as part of ongoing strategies in the National Action Plan to reduce AMR

Adherence to antimicrobial guidelines across sectors among African countries; findings and implications

Background and objectives: Adherence to standard treatment guidelines (STGs) is a pragmatic way to improve the quality and safety of antimicrobial prescribing. Previous studies showed adherence to guidelines as superior to assess quality compared to WHO/INRUD criteria and indicators, which include percentage INN prescribing and the number of antibiotics/prescription. Point prevalence surveys (PPS) are used to assess the quality of antimicrobial prescribing in hospitals, including guideline adherence. This study aimed to document STG adherence rates and associated rationale across sectors in Africa to highlight transferable learning and provide future direction. Method: Mixed approach, utilizing previous published studies coupled with unpublished studies, comprising one retrospective cross-sectional survey among ambulatory patients in one hospital in Ghana managing community-acquired pneumonia (CAP) and recently submitted PPS studies in Nigeria and South Africa. Results: Published studies in ambulatory care in Namibia showed 73% adherence, lower than the 80% target, with similar rates in a follow-up study among a range of public healthcare facilities. Key factors enhancing adherence were programmatic, including easy access to up-to-date and objective guidelines and ease of referencing. This compares to previous studies in Botswana where availability of guidelines in ambulatory care was a challenge, and in South Africa where adherence to guidelines for STIs was low. In Ghana, among 1929 CAP patients, adherence to national guidelines was only 32.5%. Factors affecting adherence included duration of antibiotic use, number of antibiotics prescribed, and certain patient clinical characteristics. This compared to a 50.0% to 66.7% rate of guideline adherence among two hospitals in Ghana, although for many indications, no guideline existed. In Namibia, adherence to national guidelines among referral hospitals was a 62%, lower than 95% target. Among hospitals in South Africa, there were concerns with adherence to guidelines for surgical prophylaxis in pediatric patients. This compares to 90.2% to 98% of prescribed antibiotics within South African STGs and Essential Medicine List in recent PPS studies. In Nigeria, there were no national or local guidelines to assess adherence in a recent PPS. The instigation of antimicrobial stewardship programmes (ASPs) among hospitals in Africa can enhance future adherence to guidelines through a variety of measures including education, prescribing toolkits and regular audit, reducing inappropriate antibiotic prescribing and costs. Conclusion: Adherence to agreed national and local guidance is variable across Africa due to a variety of reasons. Typically, multiple measures surrounding ASPs in hospitals and community settings are needed to enhance adherence to guidelines

Key Considerations From a Health Authority Perspective When Proton Pump Inhibitors Are Used to Treat Gastroesophageal Reflux Disease (GERD) and Their Implications

The growing prevalence of gastroesophageal reflux disease (GERD) needs to be carefully managed to relieve the symptoms and prevent complications. Complications of GERD can include erosive esophagitis, Barrett’s esophagus and gastrointestinal (GI) bleeding. Proton pump inhibitors (PPIs) are typically first-line treatment for GERD alongside lifestyle changes in view of their effectiveness and cost-effectiveness. However, there are concerns with adherence to dosing regimens and recommended lifestyle changes reducing their effectiveness. There are also concerns about potential complications from chronic high-dose PPIs. These include an increased risk of chronic kidney disease, cardiovascular events and infections. Recommendations to physicians include prescribing or dispensing the lowest dose of PPI for the shortest time, with ongoing patient monitoring. Activities among community pharmacists and others have resulted in increased dispensing of PPIs without a prescription, which can be a challenge. PPIs are among the most prescribed and dispensed medicines in view of their effectiveness in managing GERD. However, there are concerns with the doses prescribed and dispensed as well as adherence to lifestyle advice. These issues and challenges need to be addressed by health authorities to maximize the role and value of PPIs

Antibiotic susceptibility surveillance in the Punjab Province of Pakistan : findings and implications

Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR

Ongoing efforts to improve antimicrobial utilisation in hospitals among African countries and implications for the future

There are serious concerns with rising antimicrobial resistance (AMR) across countries 67 increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives 68 globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no excep-69 tion especially with the highest rates of AMR globally. Key activities in NAPs include gaining a 70 greater understanding of current antimicrobial utilisation patterns through point prevalence sur-71 veys (PPS) and subsequently instigating antimicrobial stewardship programmes (ASPs). Conse-72 quently, there is a need to comprehensively document current utilisation patterns among hospitals 73 across Africa coupled with ASP studies. 33 PPS studies ranging from single up to 18 hospitals were 74 documented from a narrative review with typically over 50% of in-patients prescribed antimicrobi-75 als, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole were the most prescribed 76 antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively 77 was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated 78 across Africa in recent years to improve future prescribing utilising a range of prescribing indicators. 79 The various findings resulted in a range of suggested activities that key stakeholders, including 80 governments and healthcare professionals, should undertake in the short, medium and long term 81 to improve future antimicrobial prescribing and reduce AMR

Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

From MDPI via Jisc Publications RouterHistory: accepted 2021-06-02, pub-electronic 2021-06-07Publication status: PublishedAntimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up

Challenges and innovations brought about by the Covid-19 pandemic regarding medical and pharmacy education especially in Africa and implications for the future

Background: Multiple measures introduced early to restrict COVID-19 have dramatically impacted the teaching of medical and pharmacy students, exacerbated by the lack of infrastructure and experience with e-learning at the start of the pandemic. In addition, the costs and reliability of the Internet across Africa pose challenges alongside undertaking clinical teaching and practical programmes. Consequently, there is a need to understand the many challenges and how these were addressed, given increasingly complex patients, to provide future direction. Method: An exploratory study was conducted among senior-level medical and pharmacy educators across Africa, addressing four key questions, including the challenges resulting from the pandemic and how these were dealt with. Results: Staff and student members faced multiple challenges initially, including adapting to online learning. In addition, concerns with the lack of equipment (especially among disadvantaged students), the costs of Internet bundles, and how to conduct practicals and clinical teaching. Multiple activities were undertaken to address these challenges. These included training sessions, developing innovative approaches to teaching, and seeking ways to reduce Internet costs. Robust approaches to practicals, clinical teaching, and assessments have been developed. Conclusions: Appreciable difficulties to teaching arising from the pandemic are being addressed across Africa. Research is ongoing to improve education and assessments

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries