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Title: Optimizing antibiotic prescribing in Nigerian hospitals
Author: Kpokiri, Eneyi Edith
ISNI:       0000 0004 7661 0569
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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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.
Supervisor: Smith, F. ; Taylor, D. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available