A systematic Review and Meta-analysis of Antimicrobial Prescriptions in East Africa

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Addis Abeba University


Background: Antimicrobial resistance is one of the major global health problems that has been worsened due to poor antibiotic stewardship by health workers and improper use of antimicrobial by the patients among other factors. Quality data representative of the extent of poor antimicrobial stewardship in low- and middle-income countries is scanty, but high incidences of antimicrobial resistance are increasingly reported in many settings across the globe. The objective of the present study was, therefore, to evaluate prescriptions for antimicrobials in East Africa. Methods: A comprehensive literature search strategy that includes text words and medical subject headings was developed and applied to predefined electronic databases. Two researchers independently screened the titles and abstracts of the outputs of the literature search. Full texts were then independently reviewed by the two researchers. Extracted data from included studies were pooled using meta-analysis. Results: Majority of the included studies (30.8%) were retrieved from Ethiopia, followed by Sudan, Kenya and Tanzania each contributing 19.2%. The overall proportion of encounter with antimicrobials reported was 57% (95%CI 42%; 73%). Ethiopia had an overall patient encounter with antimicrobials of 63% [95%CI: 50%, 76%] followed by Sudan with an overall encounter with antimicrobials of 62% [95%CI: 34%, 85%]. Studies included from Kenya reported the overall encounter with antimicrobials of 54% [95%CI: 15%, 90%], whereas studies from Tanzania reported an overall patient encounter with antimicrobials of 40% [95%CI: 21%, 60%]. Conclusion: Prescription patterns demonstrated in this review significantly deviate from WHO recommendations suggesting inappropriate antimicrobial use in the East African countries. Considering the global threat posed by antimicrobial resistance, perhaps countries with few research being carried out on antimicrobial use patterns and resistance should focus more resources on this important research agenda as a matter of public health priority.



Antimicrobial Prescriptions