Multicentre point prevalence survey regarding antimicrobial use among community healthcare centres across South Africa

Background: A considerable proportion of antibiotics globally are consumed in ambulatory care especially among low- and middle-income countries; however, there are appreciable knowledge gaps regarding the extent and rationale for their use especially among African countries. Objective: Undertake a point prevalent survey (PPS) among community health centres (CHCs) in South Africa (SA) to address this. Methods: A PPS was undertaken among patients attending 18 randomly selected CHCs in South Africa (2 from each Province). A newly developed web-based application was used to record antibiotic utilisation data given the time taken with paper-based systems, with utilisation assessed against South African and WHO (AWaRe list) guidelines. Results: The prevalence of antimicrobial use was 21.5% (420 of 1958 patients), which included one or more antimicrobials per patient. Amoxicillin (32.9%), isoniazide (11.3%) and a combination of rifampicin, isoniazid, pyrazinamide and ethambutol (Rifafour®) (10.5%) were the most frequently prescribed antibiotics. Encouragingly, most antimicrobials were from the WHO Access list (62.1%) with only 15.0% from the Watch List and none from the Reserve list; however, 22.8% were unclassified. There was high adherence to the SA standard treatment guidelines (93.4%). Ear, nose and throat infections were the most common (22.8%), with no culture results recorded in patients’ files. Conclusions: Encouraging to see high adherence to SA guidelines, with the majority from the WHO Access list. However, concerns with appreciable prescribing of antimicrobials for upper respiratory tract infections and lack of sensitivity testing. Antimicrobial stewardship programmes can help address identified concerns and we will be following this up

Antimicrobial management of skin and soft tissue infections among surgical wards in South Africa : findings and the implications

Skin and soft tissue infections (SSTIs) are one of the most common infectious diseases requiring antibiotics. However, complications of SSTIs may lead to overprescribing of antibiotics and sub-sequent antibiotic resistance. Consequently, monitoring prescribing alignment with current recommendations from the South African Standard Treatment Guidelines (STG) is necessary to improve care. This study involved reviewing pertinent patients with SSTIs who were prescribed antimicrobials on the surgical ward of a leading South African tertiary public hospital from April to June 2021 using an adapted data collection tool. Sixty seven patient files were reviewed. Among patients with SSTIs, hypertension and chronic osteomyelitis were the most frequent co-morbidities at 22.4% and 13.4%, respectively. The most diagnosed SSTIs were surgical site in-fections (35.1%), wound site infections (23%) and major abscesses (16.2%). Blood cultures were performed on 40.3% of patients, with Staphylococcus aureus (32.7%) and Enterococcus spp (21.2%) the most cultured pathogens. Cefazolin was prescribed empirically among 46.3% patients for their SSTIs. In addition, SSTIs were treated with gentamycin, ciprofloxacin and rifampicin at 17.5%, 11.3% and 8.8%, respectively, with treatment fully complying with STG recommendations in 55.2% of cases. Overall, the most common cause of SSTIs was Staphylococcus aureus and empiric treatment is recommended as initial management. Subsequently, culture sensitivities should be performed to enhance adherence to STGs and improve future care

Antimicrobial stewardship for outpatients with chronic bone and joint infections in the orthopaedic clinic of an academic tertiary hospital, South Africa

Bone and joint infections are associated with prolonged hospitalizations, high morbidity and complexity of care. They are difficult to treat and successful therapy requires organism specific antimicrobial therapy at high doses for a prolonged duration as recommended in standard treatment guidelines (STG). Adherence to the treatment plan is equally important, which is enhanced with knowledge of the condition as well as appropriate antibiotics. Consequently, the aim of this study was to provide antimicrobial stewardship (AMS) services to outpatients with chronic bone and joint infections presenting to the orthopaedic clinic at a public South African tertiary hospital . A total of 44 patients participated in this study. Chronic osteomyelitis was diagnosed in 39 (89%) patients and septic arthritis in 5 (11%). The majority (43%) of infections were caused by Staphylococcus aureus followed by Pseudomonas aeruginosa (14%). 71 antibiotics were prescribed at baseline with rifampicin prescribed the most (39%) followed by ciprofloxacin (23%). The majority (96%) of the antibiotics were not prescribed according to the South African STG; however, interventions were only needed in 31% of prescribed antibiotics (n=71) since the STG only recommends empiric therapy directed against Staphylococcus aureus. 77% of the patients obtained a high self-reported adherence score at baseline. Consequently, there is a need to improve AMS in bone and joint infections to improve future care

A narrative review of antibiotic prescribing practices in primary care settings in South Africa and potential ways forward to reduce antimicrobial resistance

DATA AVAILABILITY STATEMENT : We have already referenced all sourced papers and publications.SUPPLEMENTARY MATERIALS : TABLE S1. Suggested activities in the short to medium term to reduce inappropriate prescribing of antibiotics in primary care settings in South Africa; TABLE S2: ASPs introduced across LMICs to improve antimicrobial prescribing in ambulatory settings and their impact. References [155–170] are cited in the supplementary materials.There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the ‘Access’ group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than ‘Watch’ antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.https://www.mdpi.com/journal/antibioticsam2024PharmacologySDG-03:Good heatlh and well-bein

A narrative review of antibiotic prescribing practices in primary care settings in South Africa and potential ways forward to reduce antimicrobial resistance

There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the ‘Access’ group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than ‘Watch’ antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators

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

Knowledge, attitude, and acceptance of COVID-19 vaccines among secondary school pupils in Zambia : implications for future educational and sensitisation programmes

The coronavirus disease 2019 (COVID-19) pandemic resulted in the closure of schools to slow the spread of the virus across populations, and vaccines administered to protect people from severe disease, including school children and adolescents. In Zambia, there is currently little information on the acceptance of COVID-19 vaccines among school-going children and adolescents despite their inclusion in the vaccination programme. This study assessed the knowledge, attitude, and acceptance of COVID-19 vaccines among secondary school pupils in Lusaka, Zambia. A cross-sectional study was conducted from August 2022 to October 2022. Of the 998 participants, 646 (64.7%) were female, and 127 (12.7%) would accept to be vaccinated. Those who were willing to be vaccinated had better knowledge (68.5% vs 56.3%) and a positive attitude (79.1% vs 33.7%) compared to those who were hesitant. Overall, the odds of vaccine acceptance were higher among pupils who had higher knowledge scores (AOR=11.75, 95% CI: 6.51-21.2), positive attitude scores (AOR=9.85, 95% CI: 4.35-22.2), and those who knew a friend or relative who had died from COVID-19 (AOR=3.27, 95% CI: 2.14-5.09). The low vaccine acceptance among pupils is of public health concern, emphasizing the need for heightened sensitisation programmes that promote vaccine acceptance among pupils in Zambia

COVID-19 vaccine acceptance and hesitancy among healthcare workers in Lusaka, Zambia; findings and implications for the future

The uptake of COVID-19 vaccines is critical to address the severe consequences of the disease. Previous studies have suggested that many healthcare workers (HCWs) are hesitant to re-ceive the COVID-19 vaccine, further enhancing hesitancy rates within countries. COVID-19 vaccine acceptance and hesitancy levels are currently unknown among HCWs in Zambia, which is a concern given the burden of infectious diseases in the country. Consequently, this study assessed COVID-19 vaccine acceptance and hesitancy among HCWs in Lusaka, Zambia. A cross-sectional study was conducted among 240 HCWs between August and September 2022 using a semi-structured ques-tionnaire. Multivariable analysis was used to determine key factors associated with vaccine hesi-tancy among HCWs. Of the 240 HCWs who participated, 54.2% were females. 72.1% of HCWs would accept to be vaccinated while 27.9% were hesitant. 93.3% of HCWs had positive attitudes towards COVID-19 vaccines, with medical doctors having the highest mean attitude score (82%). Encourag-ingly, HCWs with positive attitudes towards COVID-19 vaccines had reduced odds of being hesitant (AOR=0.02, 95% CI: 0.01-0.11,

Antibiotic utilization patterns for different wound types among surgical patients : findings and implications

Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post operatively. However, there are concerns with the extent of extend prophylaxis post-operatively especially among low- and middle-income countries (LMICs). This increases antimicrobial re-sistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study among 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. Identi-fied varables included post-op prophylactic antimicrobials given to all patients in all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures and among these, the use of third generation cephalosporins was common. The duration of post-operative prophylaxis was 3-4 days, appreciably longer than guideline suggestions, with most patients prescribed antimicrobials up to discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration post-operatively need to be addressed. This includes appropriate interventions, including antimicrobial stewardship pro-grams, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and reduce AM

Student’s perspectives, satisfaction and experiences with online and classroom learning during the COVID-19 pandemic : findings and implications on blended learning

Objectives: The coronavirus disease 2019 (COVID-19) pandemic disrupted classroom-based learning, necessitating the adoption of online learning in most universities. However, there has been a lack of information on university students' perspectives regarding online learning during the COVID-19 pandemic. This study assessed the perspectives, satisfaction, and experiences with online and classroom learning among human health students at the University of Zambia. Methods: This cross-sectional study was conducted among 737 students at the University of Zambia from October 2022 to April 2023. Data were analysed using Stata version 16.1. Results: Of the 737 participants, 51.6% were female and 56.5% agreed that blended learning should continue even after the COVID-19 pandemic. However, 78.4% of the students believed that group discussions were more suitable in the classroom than online learning. Most students (67.1%) disagreed that they preferred online learning to classroom learning. Further, 77.6% of the students disagreed that online learning gave more satisfaction than classroom learning. Conclusions: This study found that most students recommended the continuation of blended learning after the pandemic. However, they believed that follow-up tutorials and assessments were better undertaken in physical classrooms than online learning. These findings are important in sensitising stakeholders in the education sector and governments to consider blended learning as a teaching strategy in the future. There is a need to develop and implement curricula that offer blended learning to students as well as ensure the students have the necessary facilities and equipment to support such learning