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Optimizing antibiotic prescribing in Nigerian hospitals

Kpokiri, Eneyi Edith; (2019) Optimizing antibiotic prescribing in Nigerian hospitals. Doctoral thesis (Ph.D), UCL (University College London).

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Background: Antimicrobial resistance (AMR) is a major concern facing global health today. It is severe in developing countries where the burdens of infectious diseases are much higher. Studies from developed countries suggest that antibiotic stewardship can improve antibiotic prescribing; however, these interventions are not directly applicable to developing countries. The aim of this study is to identify potentially feasible and effective strategies that will lead to improvements in antibiotic prescribing practices in hospitals in low and middle- income countries. Methods: A mixed methods approach was employed. First, a quantitative retrospective survey of antibiotic prescribing using patient’s case notes was conducted and then a qualitative prospective survey of prescribers and stakeholder’s perceptions of antibiotic prescribing. The qualitative survey employed semi-structured interviews to explore determinants of current antibiotic prescribing practices, suggestions to improve practice and the likely barriers. This study was carried out in four hospitals including two secondary and two tertiary care hospitals in Nigeria. Results: The results show that 72% of antibiotics were prescribed empirically. Only 28% of antibiotic prescriptions studied had complete compliance with the guidelines and relevant diagnostic tests were carried out in 15% of antibiotics prescriptions retrieved. Main determinants of current antibiotic prescribing practices include drug costs and availability, limited diagnostic resources and services, the excessive workload for healthcare providers, lack of policies/guidelines, and physicians’ attitudes. Recommendations prioritised by stakeholders for improvements to practice include provision of resources to support training and education, documentation and monitoring, improved diagnostic services and availability of antibiotics. Conclusion: This research extends our knowledge on antibiotic prescribing practices and strategies for implementing antibiotic stewardship programmes in resource poor settings. Establishing effective locally developed approaches can possibly improve antibiotic prescribing patterns. Achieving appropriate use and prescribing of antibiotics in Nigeria is a potentially achievable goal, provided the necessary resources are provided and funds allocated.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Optimizing antibiotic prescribing in Nigerian hospitals
Event: UCL (University College London)
Language: English
Additional information: Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/ 4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
Keywords: Antibiotic, Antibiotic prescribing, Nigeria, Hospitals, Antimicrobial resistance, LMIC
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
URI: https://discovery.ucl.ac.uk/id/eprint/10068672
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