Pattern of antimicrobial prescription in Africa: a systematic review of point prevalence surveys
Bibliographic record
Abstract
INTRODUCTION: Inappropriate use of antimicrobials is a cause for concern and contributes to the global antimicrobial resistance crises especially in Africa. This review aims to summarize the available evidence on the point prevalence and pattern of antimicrobial and/or antibiotic prescription in Africa. METHODS: This review was carried out between April and September 2021 and identified published studies up until March 2021 on the point prevalence of antibiotic and/or antimicrobial use in Africa. Sources searched were OVID, Pubmed, EMBASE, CINAHL, Web of Science, Google scholar, Google, and African journal online (AJOL). Observational studies that reported prevalence published in English language were included. Covidence systematic review software was used for this review. A form for data extraction using domains culled from the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) was developed on Covidence. Screening of studies for eligibility was done independently by two reviewers. Critical Appraisal tool for use in JBI Systematic Reviews for prevalence studies was used for quality appraisal. RESULTS: A total of 17 studies that met the inclusion criteria were included in the review. The overall prevalence of antimicrobial/antibiotic use among inpatients in these studies ranged from 40.7% to 97.6%. The median antimicrobial/antibiotic use was 61.3 [IQR= 45.5- 72.1]. The highest use of antimicrobials was reported among studies from Nigeria with a prevalence of 97.6%. The most prescribed antibiotics were the beta-lactam penicillin (Amoxicillin, clavulanic acid) (86.9%), and third generation cephalosporins (55.0%). There was general preference for parenteral route of administration of the antimicrobial agents (40-70%). Use for community acquired infections (28.0-79.5%) was the main reason for use. Majority of the prophylactic use of antimicrobial agents were for surgical prophylaxis. CONCLUSION: The high prevalence of antimicrobial use in Africa reinforces the need for continued surveillance and concerted efforts to institutionalize and support antimicrobial stewardship for prescribers in health institutions in the African region.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.097 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.008 | 0.009 |
| Bibliometrics | 0.020 | 0.022 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".