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Table 7 Studies conducted to generate reliable data on antimicrobial consumption and use

From: Moving from assessments to implementation: promising practices for strengthening multisectoral antimicrobial resistance containment capacity

DRC: National consumption study covering 2018–2019 [55, 56]

Collaborators: Directorate of Pharmacy and Medicine and other national stakeholders, WHO, MTaPS program

Tool: WHO ATC/DDD methodology

Setting: Retrospective consumption study for January 2018 to December 2019 with Kinshasa, Haut Katanga, and Nord-Kivu as the data collection sites

Findings:

• 85% of the antimicrobials were used in the private sector, 13% were used with development partners’ support, and only 2% were used in the public sector

• Aggregate consumption increased from 12 to 16 DDD per 1,000 persons/day from 2018 to 2019

• Approximately 70% of antibiotics consumed were in the ‘access’ group of AWaRe categories

Tanzania: National Consumption of Antimicrobials in Tanzania: 2017–2019 [57]

Collaborators: Tanzanian Ministry of Health, Tanzania Medicine & Medical Devices Authority, St. John’s University of Tanzania, University of Washington, MTaPS program

Tool: WHO ATC/DDD methodology

Sample: Data on all antimicrobials imported into Tanzania (2017–2019), purchasing data from the Medical Stores Department, and data from local manufacturers

Findings:

• The DDD per 1,000 population per day declined from 136.41 in 2017 to 54.98 in 2018 and 51.02 in 2019

• Most antimicrobial consumption occurred in the private sector, with the proportion increasing annually from 2017 to 2019

• > 90% of antimicrobial consumption was ‘access’ medications, with ‘watch’ and ‘reserve’ medications accounting for < 10% and < 1%, respectively

Tanzania: Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey [58]

Collaborators: Tanzanian Ministry of Health, Catholic University of Health and Allied Sciences, University of Washington, MTaPS program

Tool: WHO point prevalence tool

Sample and setting: 948 patients from 6 referral hospitals

Findings:

• Approximately 62.3% of inpatients were prescribed antibiotics. Children less than 2 years of age, admission to surgical and pediatric wards, and being male were associated with increased odds of being prescribed antibiotics

• Prescriptions were predominantly from the AWaRe ‘access’ group of antibiotics with an average of 84.0% in compliance with the standard treatment guidelines

• Only 2 of 591 patients were prescribed antibiotics based on culture and antimicrobial susceptibility testing results

Uganda: Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda [59]

Collaborators: Ministry of Health, Makerere University School of Health Sciences, University of Washington, Overseas Strategic Consulting, Ltd., MTaPS program

Tool: WHO point prevalence tool

Sample and setting: 1,077 patients from 13 hospitals nationwide

Findings:

• 74% of patients were on at least one antibiotic. Males were more likely to be prescribed an antibiotic compared to females, and public hospitals were significantly more likely to be associated with antibiotic use than private hospitals

• Compliance with the Uganda Clinical Guidelines was low (30% of antibiotics prescribed)

• A high proportion of prescriptions (44%) included antibiotics from the WHO ‘watch’ classification, primarily due to the high use of ceftriaxone, which was prescribed most frequently

• Very high use of parenteral antibiotics (88%) compared to oral use (12%)