Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis

Abstract Background Bacterial infection has been estimated to become the leading cause of death by 2050, causing 10 million deaths across the globe due to the surge in antibiotic resistance. Despite western sub-Saharan Africa being identified as one of the major hotspots of antimicrobial resistance...

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Main Authors: Eric S. Donkor, Abdul-Halim Osman, Bill Clinton Aglomasa, Aaron Awere-Duodu, Alex Odoom, Bismark Opoku-Asare, Gilbert Lazarus
Format: Article
Language:English
Published: BMC 2025-02-01
Series:Antimicrobial Resistance and Infection Control
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Online Access:https://doi.org/10.1186/s13756-024-01504-3
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author Eric S. Donkor
Abdul-Halim Osman
Bill Clinton Aglomasa
Aaron Awere-Duodu
Alex Odoom
Bismark Opoku-Asare
Gilbert Lazarus
author_facet Eric S. Donkor
Abdul-Halim Osman
Bill Clinton Aglomasa
Aaron Awere-Duodu
Alex Odoom
Bismark Opoku-Asare
Gilbert Lazarus
author_sort Eric S. Donkor
collection DOAJ
description Abstract Background Bacterial infection has been estimated to become the leading cause of death by 2050, causing 10 million deaths across the globe due to the surge in antibiotic resistance. Despite western sub-Saharan Africa being identified as one of the major hotspots of antimicrobial resistance (AMR) with the highest mortality, a comprehensive regional analysis of the magnitude and key drivers of AMR due to human antibiotic use has not been conducted. Method We carried out a systematic review by conducting a comprehensive search in various databases including PubMed and Scopus for eligible articles published in the English Language between 1 January 2000 and 14 February 2024. Five key domains of antibiotic use were focused on: (1) antibiotic consumption; (2) appropriate antibiotic prescription; (3) indicators or key drivers of antibiotic use; (4) antimicrobial stewardship (AMS) interventions; (5) knowledge, attitudes and perceptions of antibiotic consumers and providers. Data were extracted from eligible papers for all the five domains under consideration and random-effects model meta-analysis was carried out for antibiotic consumption. Results Out of the 2613 records obtained, 64 articles which were unevenly distributed in the region were eligible for inclusion in our study. These articles reported on antibiotic consumption (5), appropriate antibiotic prescription (10), indicators or key drivers of antibiotic use (10), AMS interventions (10), and 31 studies reported on knowledge, attitudes and perceptions. Antibiotic consumption for inpatients has a pooled estimate of 620.03 defined daily dose (DDD) per 100 bed-days (confidence interval [CI] 0.00–1286.67; I2 = 100%) after accounting for outliers while prescribing appropriateness ranged from 2.5% to 93.0% with a pooled estimate of 50.09 ([CI: 22.21–77.92%], I2 = 99.4%). Amoxicillin, gentamicin, amoxicillin-clavulanate, metronidazole, and ceftriaxone were the commonly consumed antibiotics. Community-acquired infection, hospital-acquired infection, and prophylaxis were the major indicators of antibiotic use. AMS was effective to varying degrees with bundled interventions and gamified antimicrobial stewardship decision support application being the most effective. Healthcare workers demonstrated acceptable antibiotic knowledge but individuals from formal and informal settings self-medicate with antibiotics and had moderate to low knowledge of antibiotic use and resistance. Conclusion This review identified gaps in knowledge and highlighted areas where prompt actions are required, it further guides future research endeavors and policy development. The findings underscore the need for further implementation of AMS programs across the West African region to enhance understanding of antibiotic use patterns, prescribing practices, and the factors influencing them in the region.
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spelling doaj-art-17c7eb626df54c1ca1ce66e2c0a795302025-02-09T12:54:46ZengBMCAntimicrobial Resistance and Infection Control2047-29942025-02-0114112910.1186/s13756-024-01504-3Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesisEric S. Donkor0Abdul-Halim Osman1Bill Clinton Aglomasa2Aaron Awere-Duodu3Alex Odoom4Bismark Opoku-Asare5Gilbert Lazarus6Department of Medical Microbiology, University of Ghana Medical SchoolDepartment of Medical Microbiology, University of Ghana Medical SchoolDepartment of Medical Microbiology, University of Ghana Medical SchoolDepartment of Medical Microbiology, University of Ghana Medical SchoolDepartment of Medical Microbiology, University of Ghana Medical SchoolDepartment of Medicine and Therapeutics, University of Ghana Medical SchoolOxford University Clinical Research Unit (OUCRU) IndonesiaAbstract Background Bacterial infection has been estimated to become the leading cause of death by 2050, causing 10 million deaths across the globe due to the surge in antibiotic resistance. Despite western sub-Saharan Africa being identified as one of the major hotspots of antimicrobial resistance (AMR) with the highest mortality, a comprehensive regional analysis of the magnitude and key drivers of AMR due to human antibiotic use has not been conducted. Method We carried out a systematic review by conducting a comprehensive search in various databases including PubMed and Scopus for eligible articles published in the English Language between 1 January 2000 and 14 February 2024. Five key domains of antibiotic use were focused on: (1) antibiotic consumption; (2) appropriate antibiotic prescription; (3) indicators or key drivers of antibiotic use; (4) antimicrobial stewardship (AMS) interventions; (5) knowledge, attitudes and perceptions of antibiotic consumers and providers. Data were extracted from eligible papers for all the five domains under consideration and random-effects model meta-analysis was carried out for antibiotic consumption. Results Out of the 2613 records obtained, 64 articles which were unevenly distributed in the region were eligible for inclusion in our study. These articles reported on antibiotic consumption (5), appropriate antibiotic prescription (10), indicators or key drivers of antibiotic use (10), AMS interventions (10), and 31 studies reported on knowledge, attitudes and perceptions. Antibiotic consumption for inpatients has a pooled estimate of 620.03 defined daily dose (DDD) per 100 bed-days (confidence interval [CI] 0.00–1286.67; I2 = 100%) after accounting for outliers while prescribing appropriateness ranged from 2.5% to 93.0% with a pooled estimate of 50.09 ([CI: 22.21–77.92%], I2 = 99.4%). Amoxicillin, gentamicin, amoxicillin-clavulanate, metronidazole, and ceftriaxone were the commonly consumed antibiotics. Community-acquired infection, hospital-acquired infection, and prophylaxis were the major indicators of antibiotic use. AMS was effective to varying degrees with bundled interventions and gamified antimicrobial stewardship decision support application being the most effective. Healthcare workers demonstrated acceptable antibiotic knowledge but individuals from formal and informal settings self-medicate with antibiotics and had moderate to low knowledge of antibiotic use and resistance. Conclusion This review identified gaps in knowledge and highlighted areas where prompt actions are required, it further guides future research endeavors and policy development. The findings underscore the need for further implementation of AMS programs across the West African region to enhance understanding of antibiotic use patterns, prescribing practices, and the factors influencing them in the region.https://doi.org/10.1186/s13756-024-01504-3West AfricaAntibioticsConsumptionAppropriatenessStewardshipIndicators
spellingShingle Eric S. Donkor
Abdul-Halim Osman
Bill Clinton Aglomasa
Aaron Awere-Duodu
Alex Odoom
Bismark Opoku-Asare
Gilbert Lazarus
Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis
Antimicrobial Resistance and Infection Control
West Africa
Antibiotics
Consumption
Appropriateness
Stewardship
Indicators
title Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis
title_full Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis
title_fullStr Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis
title_full_unstemmed Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis
title_short Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis
title_sort improving antibiotic utilization in west africa enhancing interventions through systematic review and evidence synthesis
topic West Africa
Antibiotics
Consumption
Appropriateness
Stewardship
Indicators
url https://doi.org/10.1186/s13756-024-01504-3
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