Factors associated with antibiotic prescription for patients diagnosed with acute upper respiratory tract infections in high volume private outpatient facilities in kampala, uganda

Abstract

Introduction: Most acute upper respiratory tract infections (ARIs) are caused by viruses which are self-limiting and do not require antibiotics as part of treatment. Prescribing antibiotics for patients with ARIs is common in Kampala. Unnecessary prescription of antibiotics contributes significantly to the emergency of anti-microbial resistant which is an emerging public health crisis.

Objective: To determine the factors associated with antibiotic prescription for acute upper respiratory tract infections in private out-patient health centers.

Methodology: This was a cross-sectional survey, with both quantitative and qualitative data collection methods. The study was conducted in purposively selected high volume private outpatient health centers in Kampala. One health facility with the highest number of monthly patient visits was selected from each of the five divisions of Kampala and the number of participants was distributed proportional to the number of patient visits per facility. The allocated number of participants per health facility was spread over the study period (one month) and the number of participants to be interviewed per facility per day was obtained. Research assistants were stationed at each of the facilities to collect information from patient interviews and clinical notes. The data was then analyzed using odds ratios and logistic regression.

Results: The proportion of patients diagnosed with ARIs to whom antibiotics were prescribed was 74%. Antibiotic prescription was significantly associated with presenting with symptoms for more than 10 days (OR = 2.43, CI (1.06 - 5.56), p = 0.035), presenting with fever (OR = 4, CI (2.04 - 10.21), p = <0.001), having laboratory tests done (OR = 3, CI (1.83 – 5.08), p = <0.001 ) and not having medical insurance (OR= 0.27, CI (0.15 – 0.48), p = <0.001). Other factors noted to be associated with antibiotic prescription from qualitative finding were patients’ expectation, low prescriber years of experience, and being diagnosed with pharyngitis/laryngitis/tonsillitis. The study identified several policy facilitators of antibiotic prescription including restrictive policy content to antibiotic prescription; the establishment of the National action plan for antimicrobial resistance, the regular evaluation and amendment of existing policies, and the existence of supervisory and monitoring program like the Supervisory performance assessment and recognition strategy and the Medicines therapeutic committees. There were also policy barriers noted including; the limited mandate of NDA, the lack of financial power, interest, and motivations by several policy actors to implement policies in private health facilities, the varying interpretation of some policies between policy actors, and lack of political will causing delays in passing/ratifying drafted or revised policies.

Conclusion: Antibiotic prescription for ARIs is high in outpatient health facilities in Kampala and there are patient, prescriber, and health facility factors that affect it. There are also policy gaps and barriers which if addressed will reduce antibiotic prescription and thus reduce the risk of AMR.