Abstract:

Background: A predictive statistical model projected that in 2019, an estimated 4.95 million deaths were associated with antibiotic resistance with 1.27 million of these attributed to antibiotic resistance (ABR). In Sub-Saharan Africa (SSA), one of the most affected regions globally, an estimated 27.3 per 100,000 deaths from antibiotic resistance were reported in the western SSA in 2019 as the highest mortality worldwide.

Objectives: To determine antibiotic use patterns among inpatients and explore healthcare providers' perceptions of access, usability, and availability of standard treatment guidelines, antibiotic stewardship, and antibiotic resistance information or programs within primary health care (PHC) facilities in Mwanza, Tanzania.

Methods: This was a point prevalence survey with a qualitative part conducted in four PHC health facilities in Mwanza, Tanzania. The health facilities were randomly selected after the stratification of public PHC facilities in the Mwanza region. In the quantitative component, the study used a World Health Organization methodology for a point prevalence survey on antibiotic use in hospitals version 1.1 (WHO-PPS). While in the qualitative part of the study, in-depth interviews were held with the healthcare providers, using a pre-tested Kiswahili interview guide. The in-depth interviews were conducted with the participants’ consent, recorded then transcribed verbatim to facilitate subsequent processing and analysis. NVivo 20 Software was used for inductive thematic data coding and analysis.

Results: The study highlighted the high use of antibiotics (97%) with only 49% of the antibiotics used complying with the Standard treatment guidelines (STG). Most healthcare providers commented that the STG is readily available but faces several challenges including the lack of laboratory capacity in culture and sensitivity and not being individualized as per case presentation or catering for their level of health services.

Recommendation: The Ministry of Health and Presidential Office-Regional and Local government should facilitate training and programs for PHC facilities in the Mwanza region to ensure that the healthcare providers are up to date with the current standard treatment guidelines, antimicrobial stewardship, and antibiotic resistance. In addition, the laboratory capacity for these district hospitals should be equipped with equipment and staff that can aid investigations such as bacteria culture and sensitivity that will ensure targeted therapy. Also, a point prevalence survey can be rolled out nationwide at the level of district hospitals to assess the use of antibiotics and allow targeted interventions for antibiotic stewardship. Further qualitative research such as ethnography must be undertaken among healthcare providers for deeper insight into rationale and behavior on antibiotic use.

Keywords: Antibiotics, Antibiotics stewardship, Antibiotic resistance.