000			03465nam a22003497a 4500
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005			20240305193727.0
008			221114b |||||||| |||| 00| 0 eng d
028			_b Phone: +255 28 298 3384
028			_b Fax: +255 28 298 3386
028			_b Email: vc@bugando.ac.tz
028			_b Website: www.bugando.ac.tz
040			_cDLC
041			_aEnglish
100			_aJeremiah Seni _919633
245			_aAntimicrobial use across six referral hospitals in Tanzania _b A point prevalence survey
260			_aMwanza, Tanzania: _bBritish Medical Journal Publishing Group & _b Catholic University of Health and Allied Sciences [CUHAS – Bugando] _c 2020/12/1
300			_aPages e042819
490			_vBMJ open Volume 10 Issue 12
520			_aAbstract Objective: To delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes. Design: Cross-sectional analytical study. Setting: Six referral hospitals in Tanzania. Participants: Patients irrespective of age and gender (n=948) admitted in the six referral hospital wards before 8:00 hours on each day of the survey were included in December 2019. Using the WHO PPS methodology, data on hospitals, wards, patients, antibiotics, and indications for antibiotics were collected. Outcome measures: We analysed the prevalence of antibiotic use by referral hospital, ward, indication and patient characteristics as the main outcomes. We also described adherence to the Tanzania Standard Treatment Guidelines (STG) and WHO’s AWaRe categorisation of antibiotics. Results: Approximately 62.3% of inpatients were prescribed antibiotics, predominantly from the Access group of antibiotics (ceftriaxone, metronidazole or ampicillin–cloxacillin). The overall adherence of antibiotic prescriptions to the Tanzania STG was high (84.0%), with the exception of Sekou Toure Regional Referral Hospital (68.0%) and Maweni Regional Referral Hospital (57.8%). The most common indication for antibiotic prescriptions was community-acquired infections (39.8%). Children less than 2 years of age (OR 1.73, 95% CI 1.02 to 2.92, p=0.039); admission to surgical wards (OR 4.90, 95% CI 2.87 to 8.36, p <0.001); and admission to paediatric wards (OR 3.93, 95% CI 2.16 to 7.15, p <0.001) were associated with increased odds of antibiotic use. Only 2 of 591 patients were prescribed antibiotics based on culture and antimicrobial susceptibility testing results. Conclusions: Empirical use of antibiotics is common, and the Access group of antibiotics is predominantly prescribed in children less than 2 years and patients admitted to surgical and paediatric wards. Lack of utilisation of antimicrobial susceptibility testing services in these hospitals requires urgent interventions. Routine monitoring of antibiotic use is recommended to be part of antibiotic stewardship programmes in Tanzania.
700			_aSiana G Mapunjo _923367
700			_a Rachel Wittenauer _923368
700			_aRichard Valimba _923369
700			_a Andy Stergachis _923370
700			_a Brian J Werth _923371
700			_aSamir Saitoti _923372
700			_aNoel H Mhadu _923373
700			_a Edgar Lusaya _923374
700			_aNiranjan Konduri _923375
856			_uhttp://dx.doi.org/10.1136/bmjopen-2020-042819
942			_2ddc _cVM
999			_c19417 _d19417