923 Effect of Interventions on Misuse of Antibiotics/Antibacterial Drugs in Developing Countries: a Systematic Review

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923 Effect of Interventions on Misuse of
Antibiotics/Antibacterial Drugs in Developing
Countries a Systematic Review

• Bbosa, Godfrey Sande1,2 Wong, Geoff2 Kyegombe,
  David B3 Ogwal-Okeng, Jasper1
• 1 Makerere University College of Health
  Sciences, Uganda
• 2 University of London, United Kingdom
• 3 Kampala International University Medical
  School, Ishaka Campus, Uganda

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Introduction

• Misuse of antibiotics/antibacterial drugs is a
  global problem especially in developing countries
  with poor healthcare systems corruption
• Occurs at all levels in both public Private
  Healthcare facilities
• Reported up to 75 of antibiotics are prescribed
  inappropriately in teaching hospitals in
  developing countries (Nambiar, 2003)
• Are used in conditons where not needed like flu
  etc.
• Resulted in failure of eradicating infectious
  bacteria, emergence of resistance, waste of
  resources, increased cost of treatment, ADR
  death (Kardas et al., 2005)

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Many Factors Influence Use of Medicines
Policy, Legal and Regulatory framework
Prescriber, Dispenser their workplaces
Rational Drug Use
Patient community

• Drug Supply System

Interventions are directed at these components
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Objectives of the review

• Review determined effect of various intervention
  studies on AB misuse in developing countries
• Research question
• What are the various interventions measures used
  in controlling irrational use of
  antibiotics/antibacterial agents in developing /
  poorer nations?
• What is the impact of various intervention
  measures used in controlling the irrational use
  of antibiotics/antibacterial agents in developing
  / poorer nations?

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Methods

• Study design A systematic review
• Search strategy was developed to retrieve
  relevant articles from various databases
  including
• Medline/PubMed
• Embase
• INRUD/Management Sciences for Health (MSH)
• WHO
• Cochrane
• Google scholar search engine was used to retrieve
  more studies from Journal articles abstracts
• Gray literature by manual method

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Criteria for inclusion and exclusion of studies
in the review

• All the studies included in the review followed
  PICO-DTS where
• Patient, population, or problem (P)
• Intervention, independent variable, or exposure
  (I)
• Comparators (control) (C)
• Dependent variables or outcomes of interest (O)
• Study design (D)
• Timing (T)
• Study setting (S)
• (Moher Tricco, 2008 Stone, 2002)
• All studies were included or excluded basing on
  each of the above

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Data extraction storage of primary data

• Data was extracted using the designed data
  extraction sheet basing on aims of review
  criteria
• Geographical location of where study was
  conducted based (World Bank Country
  Classification, 2010).
• Categories subcategories of intervention
• - Education - Managerial/education
• - Managerial - Economic/financial
• - Regulatory - Education/regulation
• - Diagnostic - Multifaceted (Combination of
  almost all)
• Study settings
• Hospitals - Out-patients Departments
• Public Healthcare facilities - Private
  Pharmacies/ drug stores
• Community
• Outcome measure basing on effect effect size on
  AB

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Quality of evidence

• Quality was judged by Appraisal of individual
  primary research studies for inclusion in reviews
  (Gough, 2007)
• A Trustworthiness of results (Methodological
  quality)
• B Appropriateness of use of that study design
  for review's research question (Methodological
  relevance)
• C Appropriateness of focus of research for
  answering the review question (Topic relevance)
• D Judgment of overall weight of evidence (WoE)
  based on assessments made for each of criteria
  A-C
• Each of the studies were assessed as follows
• 1-Strongly Agree 5- Agree 10 Disagree or using
  Yes (Y) or No (N) or Not applicable (NA)

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Results
Articles retrieved and screened
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Discussion

• A total of 722 articles were retrieved and 55
  were reviewed
• 10.9 were from Africa, 63.6 from Asia, 9.1
  from Latin America 16.4 from South-eastern
  Europe
• A total of 52.7 were hospital settings, 5.5
  outpatient departments, 21.8 public health care
  facilities, 12.7 private pharmacies/drug stores,
  and 7.3 communities
• Education intervention was 27.3
• With group discussion having 19.2 mean reduction
  in AB use, 27.6 in AB prescription 41 belief
  of no AB use
• Community training had 30.5 reduction in AB use
  (highest), 23.8 mean reduction in AB
  prescription 36 belief of no AB use

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• Managerial was 20 with 8 improvement in AB dose
• 8100 AB use adherence 31.8 mean reduction of
  AB receipt
• 29.1 change of AB in resistance cases and
  9.8-100 reduction in prophylactic AB use.
•  Managerial/education was 3.6 with 4.7
  reduction in AB prescription
• Regulatory was 9.1 with 60.5 improvement in AB
  use in restriction unlike 16.4 in
  non-restriction
•  Education/regulation were 9.1
• with 8 reduction in non-indicated AB, 24
  improved AB use rate, 14 mean appropriate AB use
  improvement
• 11.1 reduction of incidence of bacterial
  resistance
• 75.1 reduction in AB use in diarrhea, 42.4
  reduction in scabies, 13.833.6 reduction in AB
  use in ARI
• Overall 60 reduction in AB use

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• Diagnostic was 3.6, with 68 reduction in AB
  use after diagnostic test as compared to100 in
  control
• Was 73 likelihood of AB use in test vs 87 in
  ve test
• Multifaceted interventions were 27.3
• 63 improvement in appropriate AB doses
  prescribed (best), 2.6 mean no. of AB encounter
  reduction, 23 AB prescription reduction
• 18.3 generic AB prescribing improvement, 32.1
  reduction in AB use, 89 reduction in AB use in
  ARI, 82 in surgery, 62.7 mean reduction in
  deliveries, 39 in STDs, 36.3 mean reduction in
  diarrhea, 14.6 mean reduction in malaria
• 611 reduction cost of treating
  bacteria-resistant organisms
•  Some studies, was 6.3 reductions in mean AB
  encounters after 1 month of intervention, then
  increased to 7.7 after 3 months hence lack of
  sustainability of intervention programme as
  observed in some studies
• No study on economic/financial intervention found

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Conclusion

• Misuse of antibacterial/antibacterial drugs is on
  increase especially in developing countries
• Variety of interventions are used for irrational
  use of AB drugs had some impact
• Most of interventions were done in Asia
• Multifaceted interventions are effective in
  reducing misuse inappropriate use of AB drugs
  reduce emergence of resistance to commonest
  bacteria in developing countries
• Some studies showed a tendency of reverting once
  intervention programme stops

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Acknowledgments Source of funding

• Acknowledge staff of Common Wealth Scholarship
  programme staffs of University of London,
  Department of Primary Care Population Health
  (PCPH) for their support especially Prof. Petra
  Boyton, Prof. Ceri Butler, Prof. Trish Greenhalgh
  others
• Funding Source
• Common Wealth Scholarship Programme and
  University College London, Department of Primary
  Care and Population Health (PCPH)

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End