Abstract

Research Article

General practitioners’ knowledge, attitudes and practices on antibiotic prescribing for acute respiratory infections in children in Lubumbashi, Democratic Republic of Congo

Aubin Ndjadi Wembonyama Kasongo, Olivier Mukuku*, Gray A-Wakamb Kanteng, Mick Ya-Pongombo Shongo, André Kabamba Mutombo, Albert Mwembo-A-Nkoy Tambwe, Dieudonné Tshikwej Ngwej, Stanis Okitotsho Wembonyama and Oscar Numbi Luboya

Published: 16 September, 2020 | Volume 4 - Issue 1 | Pages: 011-017

Objective: To assess the knowledge, attitudes and practices declared among general practitioners (GPs) concerning the use of antibiotics for the treatment of ARI in children under 5 years in Lubumbashi.

Methods: A cross-sectional survey was conducted to assess the level of knowledge, attitude and practices concerning antibiotic prescribing among 67 GPs working in the pediatric setting in various health structures in Lubumbashi city, in the Democratic Republic of Congo. Data were collected from April 1st to June 30th, 2020.

Results: GPs had limited knowledge about antibiotic prescriptions (mean of 46% correct answers to 8 questions). Although they are generally concerned about antibiotic resistance (mean ± SD = 0.50 ± 0.68), and are unwilling to submit to pressure to prescribe antibiotics to meet patient demands and expectations (mean ± SD = –1.78 ± 0.31) and the requirements to prescribe antibiotics for fear of losing patients (mean ± SD = –1.67 ± 0.47), there was a lack of motivation to change prescribing practices (mean ± SD = −0.37 ± 0.94) and strong agreement that they themselves should take responsibility for tackling antibiotic resistance (mean ± SD = 1.24 ± 0.74). Multiple linear regression results showed that higher knowledge scores were associated with less avoidance of responsibility when prescribing antibiotics (β = 0.919; p = 0.000).

Conclusion: To curb the over-prescription of antibiotics, it is not enough to improve knowledge in itself. The lack of motivation of physicians to change must be addressed through a systematic approach. These data show the need for interventions that support the rational prescribing of antibiotics.

Read Full Article HTML DOI: 10.29328/journal.jprr.1001015 Cite this Article Read Full Article PDF

Keywords:

Respiratory tract infections; Child; Anti-bacterial agents; Evidence-based practice

References

  1. Liu L, Oza S, Hogan D, Perin J, Rudan I, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2014; 385: 430-440. PubMed: https://pubmed.ncbi.nlm.nih.gov/25280870/
  2. Biezen R, Pollack AJ, Harrison C, Brijnath B, Grando D, et al. Respiratory tract infections among children younger than 5 years: current management in Australian general practice. Med J Aust. 2015; 202 262-265. PubMed: https://pubmed.ncbi.nlm.nih.gov/25758698/
  3. Zhang Z, Zhan X, Zhou H, Sun F, Zhang H, et al. Antibiotic prescribing of village doctors for children under 15 years with upper respiratory tract infections in rural China: a qualitative study. Medicine. 2016; 95: e3803. PubMed: https://pubmed.ncbi.nlm.nih.gov/27281082/
  4. Fletcher-Lartey S, Yee M, Gaarslev C, Khan R. Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: a mixed methods study. BMJ Open. 206; 6. PubMed: https://pubmed.ncbi.nlm.nih.gov/27798010/
  5. Moro ML, Marchi M, Gagliotti C, et al. Why do paediatricians prescribe antibiotics? Results of an Italian regional project. BMC Pediatrics. 2009; 9: 69.
  6. Stearns CR, Gonzales R, Camargo CA Jr, et al. Antibiotic prescriptions are associated with increased patient satisfaction with emergency department visits for acute respiratory tract infections. Acad Emerg Med. 2009; 16: 934-941. PubMed: https://pubmed.ncbi.nlm.nih.gov/19799568/
  7. van de Sande-Bruinsma N, Grundmann H, Verloo D et al. Antimicrobial drug use and resistance in Europe. Emergency and Infectious Disease. 2008; 14: 1722–1730. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630720/
  8. Fuller JD, McGeer A, Low DE. Drug-resistant pneumococcal pneumonia: clinical relevance and approach to management. Eur J Clin Microbiol Infect Dis. 2005; 24: 780–788. PubMed: https://pubmed.ncbi.nlm.nih.gov/16344922/
  9. WHA Resolution. WHA68.7—Global Action Plan on Antimicrobial Resistance; Sixty-Eighth World Health Assembly; WHO: Geneva, Switzerland, 2015.
  10. Hoa NQ, Larson M, Chuc NTK, Eriksson B, Trung NV, et al. Antibiotics and paediatric acute respiratory infections in rural Vietnam: health-care providers’ knowledge, practical competence and reported practice. Trop Med Int Health. 2009; 14: 546-555. PubMed: https://pubmed.ncbi.nlm.nih.gov/19320870/
  11. Petersen I, Hayward AC. Antibacterial prescribing in primary care. J Antimicrobial Chemotherapy. 2007; 60: i43–47. https://pubmed.ncbi.nlm.nih.gov/17656380/
  12. Liu C, Liu C, Wang D, Zhang X. Knowledge, Attitudes and Intentions to Prescribe Antibiotics: A Structural Equation Modeling Study of Primary Care Institutions in Hubei, China. Int J Environ Res Public Health. 2019; 16: 2385. PubMed: https://pubmed.ncbi.nlm.nih.gov/31284381/
  13. McCullough AR, Rathbone J, Parekh S, Hoffmann TC, Del Mar CB. Not in my backyard: A systematic review of clinicians’ knowledge and beliefs about antibiotic resistance. J Antimicrob Chemother. 2015; 70: 2465-2473. PubMed: https://pubmed.ncbi.nlm.nih.gov/26093375/
  14. Prise en charge communautaire intégrée des maladies de l’enfant: Documentation des meilleures pratiques et des goulots d'étranglement à la mise en œuvre du programme en République Démocratique du Congo. Kinshasa: USAID; 2012.
  15. Organisation Mondiale de la Santé, UNICEF. Manuel sur la PCIME: La prise en charge intégrée des maladies de l’enfant. Genève: OMS; 2005.
  16. Advocacy, Communication and Social Mobilization for TB Control: A Guide to Developing Knowledge, Attitude and Practice Surveys; World Health Organization: Geneva, Switzerland, 2008.
  17. Teixeira Rodrigues A, Roque F, Falcão A, Figueiras A, Herdeiro M. Understanding physician antibiotic prescribing behaviour: A systematic review of qualitative studies. Int. J. Antimicrob. Agents. 2013; 41: 203–221. PubMed: https://pubmed.ncbi.nlm.nih.gov/23127482/
  18. Lopez-Vazquez P, Vazquez-Lago JM, Figueiras A. Misprescription of antibiotics in primary care: A critical systematic review of its determinants. J Eval Clin .Pract 2012; 18: 473–484. PubMed: https://pubmed.ncbi.nlm.nih.gov/21210896/
  19. Quet F, Vlieghe E, Leyer C, Buisson Y, Newton PN, et al. Antibiotic prescription behaviours in Lao People’s Democratic Republic: A knowledge, attitude and practice survey. Bull. World Health Organ. 2015; 93: 219–227. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431558/
  20. Thriemer K, Katuala Y, Batoko B, Alworonga JP, Devlieger H, et al. Antibiotic prescribing in DR Congo: A knowledge, attitude and practice survey among medical doctors and students. PLoS ONE. 2013; 8: e55495. PubMed: https://pubmed.ncbi.nlm.nih.gov/23441152/
  21. Garcia C, Llamocca LP, Garcia K, Jimenez A, Samalvides F, et al. Knowledge, attitudes and practice survey about antimicrobial resistance and prescribing among physicians in a hospital setting in Lima, Peru. BMC Clin Pharmacol. 2011; 11: 18. PubMed: https://pubmed.ncbi.nlm.nih.gov/22085536/
  22. Soon GS, Laxer RM. Approach to recurrent fever in childhood. Canadian Family Physician. 2017; 63: 756-762. PubMed: https://pubmed.ncbi.nlm.nih.gov/29025800/
  23. Perz JF, Craig AS, Coffey CS, et al. Changes in antibiotic prescribing for children after a community‐wide campaign. JAMA. 2002; 287: 3103–3109. PubMed: https://pubmed.ncbi.nlm.nih.gov/12069673/
  24. Finkelstein JA, Huang SS, Kleinman K, et al. Impact of a 16‐community trial to promote judicious antibiotic use in Massachusetts. Pediatrics. 2008; 121: e15– 23. PubMed: https://pubmed.ncbi.nlm.nih.gov/18166533/
  25. El Khoury G, Ramia E, Salameh P. Misconceptions and malpractices toward antibiotic use in childhood upper respiratory tract infections among a cohort of Lebanese parents. Evaluation & the health professions. 2018; 41: 493-511. PubMed: https://pubmed.ncbi.nlm.nih.gov/28692318/
  26. Akkerman AE, Kuyvenhoven MM, van der Wouden JC, Verheij TJ. Determinants of antibiotic overprescribing in respiratory tract infections in general practice. J. Antimicrob. Chemother. 2005; 56: 930–936. PubMed: https://pubmed.ncbi.nlm.nih.gov/16155062/
  27. Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: Questionnaire study. BMJ 1997; 315: 1211–1214. PubMed: https://pubmed.ncbi.nlm.nih.gov/9393228/
  28. Cockburn J, Pit S. Prescribing behaviour in clinical practice: Patients’ expectations and doctors’ perceptions of patients’ expectations—A questionnaire study. BMJ. 1997; 315: 520–523. PubMed: https://pubmed.ncbi.nlm.nih.gov/9329308/
  29. Mangione-Smith R, McGlynn EA, Elliott MN, Krogstad P, Brook RH. The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics. 1999; 103: 711–718. PubMed: https://pubmed.ncbi.nlm.nih.gov/10103291/
  30. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. BMJ. 2010; 340: 1120. PubMed: https://pubmed.ncbi.nlm.nih.gov/20483949/

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