Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals

Sulaiman Lakoh; Valerie John-Cole; Ronita D C Luke; Nellie Bell; James B W Russell; Ayeshatu Mustapha; Umu Barrie; Onome T Abiri; Joshua M Coker; Matilda N Kamara; Freddie J Coker; Olukemi Adekanmbi; Ibrahim Franklyn Kamara; Bobson Derrick Fofanah; Darlinda F Jiba; Adetunji O Adeniji; Sartie Kenneh; Gibrilla F Deen; Troy D Moon; George A Yendewa; Emmanuel Firima

doi:10.1016/j.ijregi.2023.02.004

Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals

IJID Reg. 2023 Feb 20:7:43-51. doi: 10.1016/j.ijregi.2023.02.004. eCollection 2023 Jun.

Authors

Sulaiman Lakoh^{1

2

3

4}, Valerie John-Cole^{1

2}, Ronita D C Luke^{1

2}, Nellie Bell^{1

2}, James B W Russell^{1

2}, Ayeshatu Mustapha², Umu Barrie⁴, Onome T Abiri^{1

2}, Joshua M Coker^{1

2}, Matilda N Kamara¹, Freddie J Coker^{1

2}, Olukemi Adekanmbi^{5

6}, Ibrahim Franklyn Kamara⁷, Bobson Derrick Fofanah⁷, Darlinda F Jiba², Adetunji O Adeniji^{1

2

8}, Sartie Kenneh², Gibrilla F Deen^{1

2}, Troy D Moon⁹, George A Yendewa^{10

11

12}, Emmanuel Firima^{13

14

15

16}

Affiliations

¹ College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
² Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
³ Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
⁴ Infectious Disease Research Network, Freetown, Sierra Leone.
⁵ Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
⁶ Department of Medicine, University College Hospital, Ibadan, Nigeria.
⁷ World Health Organization Country Office, Freetown, Sierra Leone.
⁸ Department of Obstetrics & Gynaecology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
⁹ Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.
¹⁰ Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
¹¹ Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
¹² Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
¹³ Division Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
¹⁴ University of Basel, Basel, Switzerland.
¹⁵ SolidarMed, Maseru, Lesotho.
¹⁶ Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria.

Abstract

Objective: As there are no country-representative data on bacterial sensitivities to guide antimicrobial stewardship (AMS) interventions, an AMS programme was established in the outpatient clinics of three tertiary hospitals in Freetown, Sierra Leone.

Methods: The study employed a cross-sectional design to collect antibiotic prescribing data from 370 pregnant women and lactating mothers, 314 children and 229 regular patients in the outpatient clinics of the Princess Christian Maternity Hospital (PCMH), Ola During Children's Hospital and Connaught Hospital (CH), respectively, in April 2022. All data were analysed using Stata Version 16.

Results: Of 913 patients, most were female (n=635, 69.5%), treated at PCMH (n=370, 40.5%) and had a bacterial infection (n=661, 72.4%). The indication for prescribing antibiotics was inappropriate in 252 (27.6%) patients. Of the 1236 prescriptions, 393 (31.8%) were made at CH. The duration of antibiotic use was not stated in 230 (18.6%) prescriptions. Overall antibiotic consumption was 55.3 defined daily doses per 1000 outpatient-days.

Conclusion: Gaps in antibiotic prescriptions were identified in the outpatient clinics of three national referral hospitals in Sierra Leone. In order to combat antimicrobial resistance, AMS interventions are needed to reduce the prescription of antibiotics for inappropriate indications or without specified duration.

Keywords: AWaRe; Antibiotic consumption; Antibiotic use; Antimicrobial resistance; Defined daily dose; Freetown, Sierra Leone.

Grants and funding

001/WHO_/World Health Organization/International