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Antibiotic use and resistance: Knowledge, attitudes and perceptions among primary care prescribers in South Africa

E Farley, A Stewart, M-A Davies, M Govind, D van den Bergh, T H Boyles

Abstract


Background. Antibiotic resistance (ABR) is a major threat to global health, driven in part by inappropriate prescription of antibiotics in primary care.

Objectives. To describe South African (SA) prescribers’ knowledge of, attitudes to and perceptions of ABR.

Methods. We conducted a cross-sectional survey of knowledge of, attitudes to and perceptions of ABR among a convenience sample of primary healthcare providers in SA, the majority from the private sector. We used logistic regression to examine associations between knowledge and prescribing behaviours.

Results. Of 264 prescriber respondents, 95.8% (230/240) believed that ABR is a significant problem in SA and 66.5% (157/236) felt pressure from patients to prescribe antibiotics. The median knowledge score was 5/7, and scores were highest in respondents aged <55 years (p=0.0001). Prescribers with higher knowledge scores were more likely than those with lower scores to believe that to decrease ABR, narrow-spectrum antibiotics should be used (adjusted odds ratio (aOR) 1.29, 95% confidence interval (CI) 1 - 1.65) and more likely to report that explaining disease features that should prompt follow-up was a useful alternative to prescribing (aOR 1.47, 95% CI 1.058 - 2.04), and were less likely to report that antibiotics cannot harm the patient if they are not needed, so they prescribe when not necessary (aOR 0.57, 95% CI 0.38 - 0.84).

Conclusions. Prescribers of antibiotics in the private sector in SA were aware of the problem of ABR, but felt pressure from patients to prescribe. Those with higher knowledge scores reported positive prescribing behaviours, suggesting that more education is needed to tackle the problem of ABR.

 


Authors' affiliations

E Farley, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

A Stewart, Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, South Africa

M-A Davies, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, South Africa

M Govind, Independent Practitioners Association Foundation, Johannesburg, South Africa

D van den Bergh, Department of Quality Systems and Innovation, Netcare Hospitals Ltd, Johannesburg, South Africa; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

T H Boyles, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

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Keywords

Antibiotic resistance; Antimicrobial resistance; South Africa; Knowledge, attitudes and perceptions; Primary care prescribers

Cite this article

South African Medical Journal 2018;108(9):763-771. DOI:10.7196/SAMJ.2018.v108i9.12933

Article History

Date submitted: 2018-08-28
Date published: 2018-08-28

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