Assessment of the quality of antimicrobial prescribing among hospitalized patients in a teaching hospital in Ghana: findings and implications

OBJECTIVE

There is a need to assess the quality of antimicrobial prescribing in hospitals as a first step toward improving future prescribing to reduce antimicrobial resistance (AMR). This is in line with Ghana's National Action Plan.

METHODS

A point prevalence survey of antimicrobial use was undertaken at the adult medical, surgical, and pediatric wards of Tamale Teaching Hospital using the standardized Global Point Prevalence Survey (GPPS) tool. Key target areas include adherence to current guidelines, limiting the prescribing of 'Watch' antibiotics with their greater resistance potential, and limiting the prescribing of antibiotics post-operatively to prevent surgical site infections (SSIs).

RESULTS

Out of 217 patients' medical records assessed, 155 (71.4%) patients were prescribed antimicrobials. The rates were similar among children (73.9%) and adults (70.3%). Most of the antibiotics prescribed were in the WHO 'Watch' group (71.0%) followed by those in the 'Access' group (29%). Out of the 23 cases indicated for surgical antimicrobial prophylaxis to prevent SSIs, the majority (69.6%) were given doses for more than 1 day, with none receiving a single dose. This needs addressing to reduce AMR and costs. Guideline compliance with the current Ghanaian Standard Treatment Guidelines (GSTG) for managing infections was also low (28.7%). The type of indication was the only independent predictor of guideline compliance (aOR = 0.013 CI 0.001-0.127, p-value = 0.001).

CONCLUSION

Given current concerns with antimicrobial prescribing in this hospital, deliberate efforts must be made to improve the appropriateness of prescribing to reduce AMR via targeted antimicrobial stewardship programs.

Prevalence of Hypertensive Disorders, Antihypertensive Therapy and Pregnancy Outcomes among Pregnant Women: A Retrospective Review of Cases at Tamale Teaching Hospital, Ghana

Hypertensive disorders associated with pregnancy are a major health concern and a leading cause of maternal indisposition and transience. The main objective of this study was to assess the prevalence of hypertension in pregnancy as well as antihypertensive therapy and pregnancy outcomes among pregnant women at Tamale Teaching Hospital (TTH) in Ghana. This was a retrospective study conducted using data from the folders of pregnant hypertensive patients. The study was conducted at the maternity ward of TTH from 1 June 2018 to 31 May 2019. Participants were all pregnant women with a diagnosis of hypertensive disorders. The prevalence of hypertensive disorders in pregnancy was 12.5%. The most common antihypertensive medication prescribed was sustained-release oral nifedipine, which was prescribed for 548 (81.4%) participants either alone or with methyldopa, followed by oral methyldopa: 506 (75.2%), intravenous hydralazine: 94 (14.0%), intravenous labetalol: 28 (4.2%) and diuretics: 10 (1.5%). Thirty-eight (5.7%) babies died before delivery, whereas 635 (94.3%) babies were born alive. Twenty-six out of the 38 dead babies (68.4%) were babies of pregnant women with elevated BP, whereas 12 (31.6%) were babies of those with normal BP. There was a statistically significant association between BP control and delivery outcomes. The study observed adherence to antihypertensive medicines recommended by the standard treatment guidelines of Ghana for the management of hypertensive disorders in pregnancy. The BPs of about two-thirds of the study participants were well controlled with the antihypertensive therapy. The majority of the study participants with well-controlled BP had positive delivery outcomes.

Assessing the prevalence and effect of adverse drug reactions among patients receiving first line anti-tubercular medicines in the Tamale Teaching Hospital, Ghana

Introduction

tuberculosis (TB) remains a global major health problem, especially in developing countries. Although treatment regimen for TB has been highly effective, treatment-related adverse effects account for significant morbidity leading to reduced effectiveness of therapy and high default rate. This study evaluated the nature and occurrence of Adverse Drug Reactions (ADRs) in patients receiving first line antitubercular therapy (ATT) in Tamale Teaching Hospital (TTH) and its effects on adherence.

Methods

the study was a cross-sectional study for a period of six months. A total of 66 participants who were on first line antituberculotic therapy consented for the study. Data was collected using a questionnaire and analysed using SPSS version 22.0.

Results

about 77% (n=51) of the participants had experienced ADRs. Gastrointestinal symptoms were the most commonly reported symptoms of ADR (80%, n=41). Regarding adherence, over half (51.0%, n=26) said the occurrence of the Adverse Drug Reaction had affected the manner in which they take their medications. Of these, 84.6% (n=22) of the participants indicated that they skipped/missed their medications and 15.4% stopped the medication entirely. About 39.2% (n=20) reported ADRs to a healthcare practitioner and 60.8% did not. All the reported cases were managed by a health practitioner using another medication.

Conclusion

the study showed that ADRs are common among patients receiving first line ATT. Gastrointestinal tract (GIT) related ADRs were the most common. Adherence to first line antitubercular therapy is poor as a result of adverse drugs reaction.