Antibiotic prescription practices and associated factors among health workers in managing Pneumonia among children (<5 years) at Mengo and Lubaga Hospitals

Abstract

Introduction: Pneumonia is a major cause of morbidity and mortality in children under five years in low-and middle-income countries like Uganda. Inappropriate antibiotic prescription contributes to antimicrobial resistance and poor treatment outcomes. Objectives: To evaluate the antibiotic prescription practices and associated factors among children under five years admitted with pneumonia in the pediatric wards of Mengo and Lubaga hospitals in Kampala, Uganda. Methods: This was a cross-sectional study that collected data retrospectively from inpatient registers of children under five years with pneumonia admitted at Mengo and Lubaga hospitals. All inpatient records at the pediatric wards in the year 2022 that met the eligibility criteria were reviewed. Data was collected using a data abstraction tool. A data entry screen was developed in EpiData using checks, and data was entered in duplicate. The data was then transferred to STATA version 14 and cleaned prior to the analysis. Data analysis involved univariate, bivariate, and multivariate analyses using modified Poisson regression methods at 95% confidence level. Results: From the 678 files assessed for inappropriate antibiotic prescription, 375 (55.3%) were male, with a median age of 15 months and a median weight of 9.8 kg. Most files (99.7%) had a confirmed pneumonia diagnosis. The majority (82.0%) had two antibiotics prescribed, predominantly ceftriaxone and gentamicin (28.6%). Inappropriate antibiotic prescription prevalence was 39.7%, with 95.3% based on UCG, 48.7% on Lubaga's protocol, and 40.5% on Mengo's protocol. Bivariate analysis indicated age, weight, and hospital stay duration as significant factors. Multivariate analysis revealed that weight (aPR: 0.979, p=0.027) and hospital stay duration (aPR: 0.959, p=0.049) were significantly associated with inappropriate antibiotic prescriptions. Conclusion: This study highlights a significant reliance on dual antibiotic therapy for children under five with pneumonia in Mengo and Lubaga hospitals, with ceftriaxone and gentamicin being the most prescribed combination. High inappropriate antibiotic prescription rates based on UCG guidelines suggest deviations from recommended practices. Notably, child weight and hospital stay duration were linked to inappropriate prescription, emphasizing the need for enforcement of guideline adherence by health workers and continuous healthcare provider training to optimize antibiotic use and combat antimicrobial resistance.