Abstract

Background: Public knowledge and use of antibiotics is considered great factor that determines the spread of antibiotic resistance. Our aim was to assess the use of antibiotics and knowledge of antibiotic resistance among patients and also to find out the factors associated with their use.

Methods: A quantitative cross-sectional survey was performed on a sample of 203 randomly selected patients who came for consultation at the Limbe Regional Hospital. Data collected was entered, into excel and exported for analysis in Epi Info version 7.3.2.

Results: Among the 203 participants recruited, 62% had been self-medicated with antibiotics within the past 3 months and about 42% did not complete their last dose of antibiotic prescription. 39.4% had never heard of the term ‘antibiotic resistance’ and 28.6% believed that antibiotics work for all infections. 60% were self-medicated with antibiotics to treat mainly common cold, fever and cough. Although 83.3% of the patients knew that antibiotics are indicated for the treatment of bacterial infections, 47.8% incorrectly thought that antibiotics are also used to treat viral infections. About 66.5% were aware that resistance is associated with unnecessarily using antibiotics. There was no statistically significant factor associated with the use of antibiotics and self-medication.

Conclusion: Knowledge of antibiotics and their use is low among patients in Limbe Health Area attending the Regional Hospital. There is a high rate of self-medication and practices with non-prescribed antibiotics in the community of Limbe. We suggest that action is taken to increase the knowledge level, and proper use and dispensing of antibiotic medication in the community.

CHAPTER ONE

INTRODUCTION

1.1 Background

Antibiotics are considered the most commonly sold drug classes in the developing countries (1). Development of resistance to antibiotics has increased for reasons related to the use and misuse of antibiotics in both humans and animal. According to the US Centers for Disease Control and Prevention (CDC), up to 50% of all antibiotic prescriptions are not necessary or are not optimally effective as prescribed (2). The increase in the risk of antibiotic resistance facing the world today has the potential to render public health and the provision of healthcare services more complicated, especially in resource-limited countries. (3).

A well-documented risk factor for infection or colonization with antibiotic-resistant pathogens is recent antibiotic use, particularly within 4 weeks or 1 month before exposure. As a result, one of the primary strategies to prevent and control the development and spread of resistant pathogens is to reduce the selective pressure from overuse and misuse of antibiotics in human medicine (4). Duong in 2015 identified 6 main societal factors that contribute in the emergence of antibiotic resistance. These include; over prescription of antibiotics, patients not finishing their entire antibiotic course, overuse of antibiotics in animal an agricultural industries, poor hygiene and sanitation in communities, absence of newly developed antibiotics, and poor infection prevention and control in health care settings (5).

Antibiotic resistance is one of the top infectious disease threats facing the world today. The CDC estimates that each year in the United States, at least 2 million people acquire severe bacterial infections which are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of antibiotic-resistant infections. Many more deaths arise from other conditions that were complicated by an antibiotic resistant infection. This is similar to an estimated 25 000 deaths per year in Europe from antibiotic-resistant infection and 2.5 million extra hospital days. (3).

The World Health Organization (WHO) estimated that in Africa, infections accounted for 45% of deaths in 2014 and that infectious diseases were responsible for 48% of premature deaths worldwide the same year, (6). In a study conducted in Cameroon, multidrug resistance was observed in 27.6% of patients with a previous history of treatment of staphylococcus aureus infections in the Yaoundé military hospital (7). In another study by Ayukekbong and colleagues in 2017, it was noticed that misuse of antimicrobial drugs in Cameroon is facilitated by their availability over the counter, without prescription and through the unregulated supply chains in the country(8). It is worth noting that the WHO has identified Africa as one of the world regions without an established antimicrobial resistance (AMR) surveillance system. This lack of data on regional drug resistance patterns is problematic and often leads to treatment guidelines that are not evidence based (9).

In 2014, the WHO published the first report on antibiotic resistance in nine bacteria of international concern; Escherichia coli-resistant to third generation cephalosporin, Klebsiellapneumonae- resistant to third generation cephalosporin, Staphylococcus aureus-resistant to beta-lactam, Streptococcus pneumonae-resistant or non-susceptible to penicillin, Nontyphoidal Salmonella-resistant to fluoroquinolones, Shigella species-resistant to fluoroquinolones, Neisseria gonorrhoeae-decreased susceptibility to third generation cephalosporin (10). This report revealed an amazingly high rate of resistance to commonly used antibiotics.

In 2015, the World Health Assembly adopted a global action plan to fight resistant pathogens. The five strategic objectives included; 1) to improve awareness and understanding of antimicrobial resistance through effective communication, education and training; 2)to strengthen the knowledge and evidence base through surveillance and research; 3)to reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures; 4)to optimize the use of antimicrobial medicines in human and animal health; and 5) to develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions (11). Interventions to prevent the development and spread of resistant pathogens are now one of the strategic goals of the African Centers for Disease Control and Prevention (12).

Nursing staff (midwives, qualified nurses, trainees and healthcare support workers) work across all healthcare settings and specialties. They are the main providers of direct physical care supporting patients, their caregivers and loved ones and constitute the largest part of the workforce (approximately 75%). It is crucial that the contribution and role of nurses is clearly articulated or the profession risks being seen as ‘lay contributors’ to this important issue. Many of the activities that nurses lead on or contribute to, are subtle, and the direct contribution to improving infection prevention and control and therefore AMR, is not always obvious (13).

Nurses work as individuals as well as in teams and are frequently involved in service planning/commissioning as well as implementation and delivery including performance management and provision of care. This enables nursing teams to share and communicate across organizational and national boundaries, creating unique opportunities to influence improvements in care pathways, nursing practice, education, public health and research to name but a few, all of which has the potential to contribute to AMR reduction strategies. (13).

To begin resolving the problem of antibiotic use and misuse particularly in Cameroon, a more thorough understanding of what influences the development and expression of patients’ expectations should be gained. Understanding patients’ knowledge, attitude, and practices may facilitate more effective communication between the clinical staff and patients, as well as aid in the development of effective ways to educate the population.

1.2 Problem Statement

According to the Centers for Disease Control and Prevention (CDC), antibiotic use is the single most important factor leading to antibiotic resistance. The CDC estimates that every year, 2 million Americans develop serious infections involving bacteria that resist one or more antibiotics, and these infections kill at least 23,000 each year (14). There is only one factor driving this problem of antibiotic resistance which is antibiotic use. Even when antibiotics are used appropriately, their use can select for resistant bacterial populations (15).

It was confirmed by a study carried out in cameroon, by Ekambi et al., that misuse, little practical knowledge and high self-medication confirms the unsatisfactory outcome of antibiotic use in the country (16). In another study conducted in Cameroon, multidrug resistance was observed in 27.6% of patients with a previous history of treatment of staphylococcus aureus infections in the Yaoundé military hospital (7).

Antibiotic misuse arises from the interaction between factors such as, knowledge and experiences of prescribers, diagnostic uncertainty, perceptions of patients in relation to the patient-prescriber interaction, and insufficient patient education by the health care team. In addition, other factors include patients’ knowledge, beliefs and attitudes towards antibiotic use, self-medication, patients’ expectations, and patients’ experience with antibiotics (17).

The misuse and overuse of antibiotics have led to multidrug-resistant species. Over the counter sales of antibiotics without prescription, indiscriminate addition of antibiotics to livestock feed and lack of a standard treatment protocol based on a drug resistance profile for clinical isolates have contributed towards the menace of drug resistance. This has also led to colonization by multidrug-resistant superbugs (18).

1.3 Research Objectives

1.3.1 General Objectives

The objective of this study is to assess the use of antibiotics and knowledge of antibiotic resistance among patients in the Limbe Health Area (LHA).

1.4.2 Specific Objectives

1. To assess knowledge of antibiotic use and resistance among patients.
2. To find out how patients in the LHA use antibiotics.
3. To find out the factors associated with patients’ use of antibiotics and knowledge of antibiotic resistance.

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