Evaluation of antibiotic prescribing for ambulatory patients seeking primary dental care services in a Public Hospital in Ghana

Background: 1 in 10 of all antibiotic prescriptions globally are for dental conditions with 80% of them being inappropriate making it a potential source of antimicrobial resistance. The study aims to evaluate antibiotic use among ambulatory patients seeking dental care services in a Public Hospital in Ghana. Methods: A retrospective clinical audit was conducted by extracting the medical records of all patients seeking dental primary care at the ambulatory care clinic of Keta Municipal Hospital (KMH) from January 2020 to December 2020 using the hospital’s electronic database. Descriptive statistics, bivariate and multivariate analysis were performed on the data collected. Results:1433 patient medical records were extracted from the hospital electronic data within the study period. The mean age of the patients identified was 39 years with almost two thirds being female. Over 90% of them were attended to by a dental nurse. 88.6% of the patients received antibiotics and 87.5% of antibiotics prescribed were non-compliant with Ghana Standard Treatment Guidelines. Again, three-quarters of the dental conditions were managed with dual antibiotics comprising of amoxicillin and metronidazole. Antibiotic prescription was associated with the age, gender, the type of prescriber and the type of dental condition diagnosed. Conclusion: There is a high usage of antibiotics for dental conditions managed at the outpatient section of the hospital. Development of local guidelines supported by education of dental clinician especially dental nurses on empiric selection of antibiotics for common dental conditions is a suitable target for AMS team to address in KMH

An assessment of the current level of implementation of the core elements of antimicrobial stewardship programmes in public hospitals in Ghana

Introduction. Antimicrobial resistance (AMR) is becoming a threat to global public health. Antimicrobial stewardship (AMS) programme (ASP) is one of the five strategic areas in the Ghana National Action Plan to fight this menace. Assessment of the core elements of ASP in a hospital setting has been identified as a pragmatic way of identifying the barriers and facilitators for its effective implementation. Method. The World Health Organization’s toolkit for assessment of the seven core elements of ASP in hospitals in low- and middle-income countries was used for this situational analysis of public hospitals in two regions of Ghana. The core elements included leadership commitment, accountability and responsibility, pharmacy expertise, AMS actions and interventions, education and training, and periodic monitoring and surveillance. Data collected using a checklist were imported into STATA version 14 for descriptive and bivariate analyses. Results. 15 public hospitals were assessed with the toolkit. Most of them were primary health care facilities (n=12, 80.0%), had bed capacities between 100 to 199 beds, less than fifty medical doctors (n=12, 80.0%), less than five pharmacists (n=10, 66.7%), and between 100 to 199 nurses. Performances in four out of the seven core elements were most deficient and they included leadership commitment, pharmacy expertise, AMS actions (interventions) implemented, monitoring and surveillance of antibiotic use and bacteria resistance rates. Pharmacist-led ASPs were also found to be associated with their formal training on AMS. Key barriers identified included lack of skilled human resources, lack of available time for AMS-related duties and poor laboratory infrastructure. Conclusion. There was sub-optimal performance for almost all the core elements of ASP in the public hospitals in Ghana hampered mostly by lack of skilled human and financial resources. Pharmacists must be empowered through formal training and certificate programs in infectious disease management and AMS principles and strategies to enhance their contribution towards ASPs in hospitals The results from this study should encourage nationwide assessment of ASPs across hospital settings in Ghana to better evaluate the level of their implementation and address potential barriers to guide AMS policies and ASP strategy development towards the fight against AMR

Activities in Namibia to limit the impact of COVID-19 versus Europe and Iran and the implications for the future

Introduction and aims: Considerable differences in prevalence and mortality rates from COVID-19, with higher rates among European countries and Iran versus African and Asian countries in part due to early and extensive prevention measures. There has been considerable controversy surrounding hydroxychloroquine, with resultant misinformation increasing prices and suicides. Growing concerns also with unintended consequences of lockdown and other measures. Consequently, a need to investigate changes in utilisation and prices of relevant medicines during the pandemic in Namibia with its proactive approach to guide future decision making. Community pharmacists play a key role in this respect. Methods: Questionnaire survey among 55 pharmacists from March to end June 2020. Results: Proactivity among some pharmacists to plan for the pandemic with increased stocks. Limited increases in utilisation of antimalarials and antibiotics in Namibia versus other countries enhanced by restrictions on self-purchasing in Namibia, reflected in limited price rises and shortages. Higher use of Vitamin C/ immune boosters in Ghana and Nigeria versus Namibia reflected in higher price rises, with increased utilisation and prices of PPE across all countries. Encouragingly lower increases in herbal medicines in Namibia versus Ghana. Concerns though with unintended consequences. Conclusion: Encouraging to see continued low prevalence and mortality rates from COVID-19 in Namibia and limited increase in utilisation of antimalarials and antibiotics with prescribing restrictions. Concerns with rising rates of malaria and other infectious diseases following lockdown need addressing. Pharmacists can help plan for the future, educate the public during pandemics, help with vaccinations and general medicines management

Availability of medicines in community pharmacy to manage patients with COVID-19 in Kenya; pilot study and implications

Multiple measures have been instigated across countries to prevent the spread and treat patients COVID-19 with personal protective equipment (PPE), sanitation measures and medicines. However, there has been considerable controversy surrounding initially endorsed treatments such as hydroxychloroquine with misinformation increasing prices and suicides. Prices of PPE and medicines have increased in countries following shortages, potentially catastrophic among lower- and middle-income countries (LMICs) with high co-payment levels. Consequently, there is a need to investigate changes in availability, utilisation, prices and shortages of relevant medicines during the pandemic in Kenya. To address this, a questionnaire was emailed to ten randomly selected community pharmacists from 21 purposely selected pharmacists attached to the University of Nairobi, with the survey covering the period from the start of the pandemic to the end of May 2020. This included suggestions from community pharmacists on potential ways forward with future pandemics. Six pharmacists eventually took in this pilot study. Two thirds noted increased requests for antimalarials and antibiotics; however, these were not dispensed with pharmacists recommending alternatives for symptomatic relief. There was increased use of analgesics as well as vitamins. Price rises were seen for hydroxychloroquine as well as vitamins and zinc (50-100% increase in price); however, no shortages were seen. The pharmacists believed their future role in pandemics include education, improved stock control and patient counselling. Overall, it was encouraging to see increases in the utilisation of vitamins/ immune boosters alongside no antimalarials or antibiotics dispensed without a prescription despite the hype and requests. Community pharmacists have a key role in any pandemic with prevention and guidance, and we will be monitoring this. Countries such as Kenya can also act as exemplar countries where there continues to be high rates of self-purchasing of antibiotics

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 (

Antimicrobial point prevalence surveys in two Ghanaian hospitals : opportunities for antimicrobial stewardship

Background: Improved knowledge regarding antimicrobial use in Ghana is urgently needed to reduce antimicrobial resistance (AMR). This includes point prevalence studies (PPS) in hospitals. Objectives were: (i) provide baseline data in two hospitals (Keta Municipal Hospital – KMH and Ghana Police Hospital – GPH) and identify priorities for improvement; (ii) assess the feasibility of conducting PPS; (iii) compare results with others. Methods: Standard PPS design using the Global PPS paper forms, subsequently transferred to their template. Training undertaken by the Scottish team. Quality indicators included rationale for use; stop and review dates, and guideline compliance. Results: Prevalence of antibiotic use was 65.0% in GPH and 82.0% in KMH. Penicillins and other beta-lactam antibiotics were the most prescribed in both hospitals, with third generation cephalosporins mainly used in GPH. Antibiotic treatment was mainly empirical and commonly administered intravenously (IV), duration was generally short with timely oral switching, and infections were mainly community acquired. Encouragingly, good documentation of the indications for antibiotic use in both hospitals and 50.0-66.0% guideline compliance (although for many indications no guideline existed). In addition, almost all prescribed antibiotics had stop dates and there appeared no missed doses. The duration of use for surgical prophylaxis was generally more than one day (69.0% in GPH and 77.0% in KMH). Conclusions: These two hospitals were the first in Ghana to use the Global PPS system. We found the PPS was feasible and relatively rapid, achieved with limited training. Targets for improvement identified included broad-spectrum antibiotics, duration of treatment and high empiric use

Prevalence and determinants of serious spontaneously reported adverse drug events among three outpatient care settings in Ghana : findings and implication

Objective Most evidence of adverse drug events (ADEs) come from hospitals as the risks associated with hospital care are higher. However, under-reporting of ADEs is a critical problem in all health care settings. This is important in Sub-Saharan African countries like Ghana with limited resources and high prevalence of both infectious and non-infectious diseases. Consequently, this study sought to determine the annual prevalence of spontaneously reported ADEs using six years reports and factors associated with the occurrence of serious ADE among outpatient care settings in Ghana to provide future guidance. Method A cross-sectional study was conducted using duplicates of Ghana Food and Drugs Authority adverse event forms retrieved from 3 outpatient care setting who had submitted their reports to the National Pharmacovigilance Centre in Ghana between 2013 and 2018. The raw data were entered into Microsoft excel and analyzed using stata version 14. Bivariate analyses were performed using Pearson chi square and all variables that were statistically significant were used for a multivariate analysis. Results Overall, 93 spontaneously reported cases of ADEs were identified during the study period. The mean age of the patients with a reported ADE was 42 ± 17 years, the annual prevalence rate was 192 reports per 1,000,000 population among our study population and the rate of serious ADE was 35.48% (95% CI: 25.83%-46.09%). Serious ADEs were associated with the type of indication for which the drug was prescribed (p=0.048), the duration of ADEs (p=0.047) and the decision to administer treatment at the reporting facility (p=0.017) and was independently predicted by duration of ADEs (aOR =7.63, 1.37-42.65) and decision to administer treatment for ADEs (aOR=20.28, 2.38-172.57). Conclusion Early reporting of ADEs at outpatient settings is essential. Patient education and awareness of potential ADE must be intensified for early identification and we will be following this u

Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana : findings and implications

Background: Surgical site infections (SSIs) are among the most common infections seen in hospitalized patients in low- and middle-income countries (LMICs), accounting for up to 60% of hospital-acquired infections. Surgical antimicrobial prophylaxis (SAP) has shown to be an effective intervention for reducing SSIs and their impact. There are concerns of inappropriate use of SAP in Ghana and therefore our audit in this teaching hospital. Method: A retrospective cross sectional clinical audit of medical records of patients undergoing surgery over a 5-month duration from January to May 2021 in Ho Teaching Hospital. Data collection form was designed to collect key information including the age and gender of patient, type and duration of surgery, choice and duration of SAP. Data collected were assessed for the proportion of SAP compliance with Ghana standard treatment guidelines (STG) and its association with various patient, surgical wound and drug characteristics. Results: Of the 597 medical records assessed, the mean age of patients was 35.6± 12.2 years with 86.8% (n=518) female. Overall SAP compliance with the STG was 2.5% (n=15). SAP compliance due to appropriate choice of antimicrobials was 67.0% (n=400) and duration at 8.7% (n=52). SAP compliance was predicted by duration of SAP (pConclusion: SAP compliance rate was suboptimal, principally due to a longer duration of prescription. Quality improvement measures such as education and training of front-line staff on guideline compliance, coupled with clinical audit and regular updates, are urgently needed to combat inappropriate prescribing and rising resistance rates

Developing a Sustainable Antimicrobial Stewardship (AMS) Programme in Ghana: Replicating the Scottish Triad Model of Information, Education and Quality Improvement

(1) Background: Our aim was to develop robust and reliable systems for antimicrobial stewardship (AMS) in Keta Municipal Hospital and Ghana Police Hospital. Objectives were to build capacity through training staff in each hospital, establish AMS teams, collect data on antibiotic use and support local quality improvement initiatives. (2) (2) Methods: The Scottish team visited Ghana hospitals on three occasions and the Ghanaian partners paid one visit to Scotland. Regular virtual meetings and email communication were used between visits to review progress and agree on actions. (3) Results: Multi-professional AMS teams established and met monthly with formal minutes and action plans; point prevalence surveys (PPS) carried out and data collected informed a training session; 60 staff participated in training delivered by the Scottish team and Ghanaian team cascaded training to over 100 staff; evaluation of training impact demonstrated significant positive change in knowledge of antimicrobial resistance (AMR) and appropriate antibiotic use as well as improved participant attitudes and behaviours towards AMR, their role in AMS, and confidence in using the Ghana Standard Treatment Guidelines and antimicrobial app. (4) Conclusions: Key objectives were achieved and a sustainable model for AMS established in both hospitals

Activities in Namibia to limit the prevalence and mortality from COVID-19 including community pharmacy activities and the implications

Considerable differences exist in prevalence and mortality rates from COVID-19 across countries due to the extent of prevention measures instigated and their timeliness. There has been considerable controversy surrounding hydroxychloroquine, with resultant misinformation increasing prices and suicides. Prices have also increased for Personal Protective Equipment (PPE). There are also growing concerns regarding the unintended consequences from COVID-19 including patients with non-communicable diseases. Consequently, a need to investigate key areas and the preparedness of community pharmacists, who play a key role in Namibia and wider to provide future direction. In view of this, we sought to assess changes in utilisation, prices and shortages of relevant medicines early in the pandemic in Namibia combined with the preparedness of community pharmacists to deal with key issues to guide future activities. This was achieved via a questionnaire survey among 55 pharmacists from March to end June 2020 including suggestions on potential ways forward and comparisons with other African and Asian countries. We found limited increases in the utilisation of antimalarials and antibiotics in Namibia versus Bangladesh, Ghana, and Nigeria, enhanced by restrictions on self-purchasing in Namibia reflected by limited price rises and shortages. This is encouraging. Higher use of vitamin C/ immune boosters in Ghana and Nigeria versus Namibia reflected in higher price rises, with increased utilisation and prices of PPE across a range of African and Asian countries. Encouragingly limited increases in herbal medicine use in Namibia. Future roles of community pharmacists in pandemics include education, good stock control, and screening. More research is needed assessing the unintended consequences of COVID-19