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Knowledge and practices of healthcare professionals regarding antibiotic use in a district hospital, Southern Mozambique: a cross-sectional study

Thu, 24 Apr 2025 00:00:00 GMT

Title: Knowledge and practices of healthcare professionals regarding antibiotic use in a district hospital, Southern Mozambique: a cross-sectional study Authors: Faiela, Candido; Cambaco, Olga; Boene, Helena; Monnier, Annelie A.; Wertheim, Heiman F. L.; Munguambe, Khatia; Sevene, Esperança Abstract: ackling the worldwide problem of antibiotic resistance requires addressing the lack of knowledge about antibiotics and understanding the impact of resistance. This study aimed to assess healthcare professionals' (HCP) knowledge about antibiotics and antibiotic resistance and the antibiotic prescription practices for outpatients at the Manhiça District Hospital in Mozambique. This cross-sectional study assessed the knowledge and practices of 20 HCPs about antibiotic use and resistance and evaluated quality indicators of antibiotic use of 200 prescriptions. We observed that 20% of the participants incorrectly placed amoxicillin in the cephalosporin group, and 10% considered antibiotic resistance a rejection reaction by the patient's body. However, the HCPs showed Knowledge level A. Antibiotics featured in 88% of prescriptions, with an average of one antibiotic per prescription. Cotrimoxazole (30.77%) and amoxicillin (26.15%) were the most frequently prescribed antibiotics. Cotrimoxazole was more prescribed for adults (21.54%) and amoxicillin for children (17.95%). Seasonal variation was observed with an increased winter consumption of cotrimoxazole and phenoxymethylpenicillin in summer. The results revealed a high level of knowledge of HCPs about how to use and identify antibiotics. A higher frequency of broad-spectrum antibiotic prescriptions was observed with cotrimoxazole and amoxicillin being the most prescribed.

Antibiotic prescription for HIV-positive patients in primary health care in Mozambique: A cross-sectional study

Mon, 28 Feb 2022 00:00:00 GMT

Title: Antibiotic prescription for HIV-positive patients in primary health care in Mozambique: A cross-sectional study Authors: Faiela, Candido; Sevene, Esperança Abstract: ntibiotic overuse is a major public health challenge worldwide and it can result in the emergence and spread of drug resistance. In Mozambique, there are limited data related to primary care physicians’ antibiotic prescription patterns. The aim of this study was to assess the antibiotic prescription patterns for HIV- positive patients in primary health care. Methods: A prospective cross-sectional quantitative study was conducted in eight primary health care units in Southern Mozambique. The study was based on recording outpatient prescriptions using a structured questionnaire. Three hundred and sixty-nine prescriptions and clinical records of HIV-positive patients from 31 prescribers were assessed. A total of eight general practitioners, 13 medical technicians and 10 nurses participated. Results: Antibiotics were used in 65.9% of prescriptions, with an average of 0.9 antibiotics per prescription. Of a total of 334 prescribed antibiotics, 69.8% were for the treatment of infections and 30.2% for prophylaxis. Penicillin (29.2%), sulphonamides (19.7%), and quinolones (16.3%) were the most prescribed classes of antibiotics for treatment. For prophylaxis, only sulphonamides (93.1%) and macrolides (6.9%) were prescribed. The diagnosis was the only variable that had a significant association with antibiotic prescription (p < 0.001). Most of penicillins (68.0%) and sulphonamides (21.4%) were prescribed to treat infections related to the respiratory tract. Conclusion: The prescription of antibiotics was high and influenced by patient clinical conditions. Antibiotics were prescribed either for treatment or prophylaxis of infections, mostly to treat respiratory tract infections. Prescribers should be encouraged to adopt a rational use of antibiotics to reduce unnecessary prescriptions

De-implementation strategy to reduce unnecessary antibiotic prescriptions for ambulatory HIV-infected patients with upper respiratory tract infections in Mozambique: a study protocol of a cluster randomized controlled trial

Tue, 16 Jul 2024 00:00:00 GMT

Title: De-implementation strategy to reduce unnecessary antibiotic prescriptions for ambulatory HIV-infected patients with upper respiratory tract infections in Mozambique: a study protocol of a cluster randomized controlled trial Authors: Faiela, Candido; Moon, Troy D.; Sidat, Mohsin; Sevene, Esperança Abstract: Antibiotics are globally overprescribed for the treatment of upper respiratory tract infections (URTI), especially in persons living with HIV. However, most URTIs are caused by viruses, and antibiotics are not indicated. De-implementation is perceived as an important area of research that can lead to reductions in unnecessary, wasteful, or harmful practices, such as excessive or inappropriate antibiotic use for URTI, through the employment of evidence-based interventions to reduce these practices. Research into strategies that lead to successful de-implementation of unnecessary antibiotic prescriptions within the primary health care setting is limited in Mozambique. In this study, we propose a protocol designed to evaluate the use of a clinical decision support algorithm (CDSA) for promoting the de-implementation of unnecessary antibiotic prescriptions for URTI among ambulatory HIV-infected adult patients in primary healthcare settings. Methods This study is a multicenter, two-arm, cluster randomized controlled trial, involving six primary health care facilities in Maputo and Matola municipalities in Mozambique, guided by an innovative implementation science framework, the Dynamic Adaption Process. In total, 380 HIV-infected patients with URTI symptoms will be enrolled, with 190 patients assigned to both the intervention and control arms. For intervention sites, the CDSAs will be posted on either the exam room wall or on the clinician´s exam room desk for ease of reference during clinical visits. Our sample size is powered to detect a reduction in antibiotic use by 15%. We will evaluate the effectiveness and implementation outcomes and examine the effect of multi-level (sites and patients) factors in promoting the de-implementation of unnecessary antibiotic prescriptions. The effectiveness and implementation of our antibiotic de-implementation strategy are the primary outcomes, whereas the clinical endpoints are the secondary outcomes. Discussion This research will provide evidence on the effectiveness of the use of the CDSA in promoting the de-implementation of unnecessary antibiotic prescribing in treating acute URTI, among ambulatory HIV-infected patients. Findings will bring evidence for the need to scale up strategies for the de-implementation of unnecessary antibiotic prescription practices in additional healthcare sites within the country.

Perfil Sociodemográfico e clínico dos pacientes com infecções origem odontogénica internados na enfermaria de cirurgia II- serviço de cirurgia oro-maxilo facial do Hospital Provincial de Tete de 2018 a 2023

Tue, 01 Apr 2025 00:00:00 GMT

Title: Perfil Sociodemográfico e clínico dos pacientes com infecções origem odontogénica internados na enfermaria de cirurgia II- serviço de cirurgia oro-maxilo facial do Hospital Provincial de Tete de 2018 a 2023 Authors: Domingos, Margarida Raúl Manuel Abstract: As doenças orais estão entre as doenças não transmissíveis (DNT) mais comuns e podem afectar as pessoas ao longo da sua vida, causando dor, incapacidade e até mesmo a morte. As infecções odontogênicas representam uma preocupação de saúde pública a nivel mundial, em Africa e em Moçambique, não só pela morbidade dos pacientes mas também pelos elevados custos hospitalares no tratamento, assim sendo há necessidade de realizar estudos que possam apoiar na percepçao do seu perfil dos pacientes com infecções odontogénicas por forma a apoiar na tomada de medidas de controlo e prevenção das mesmas. Objectivo: Analisar o perfíl socidemográfico e clínico das infecções odontogénicas em pacientes internados na enfermaria de cirurgia II - Serviço de Cirurgia Oro-Maxilo-Facial do Hospital Provincial de Tete, no período de 2018 a 2023. Material e Métodos: trata-se de um estudo observacional, analítico, transversal realizado no Hospital Provincial de Tete. Foram colhidos dados sociodemográficos e clínicos dos pacientes internados a partir de dados dos processos clinicos de 2028 a 2023. Os dados foram analisados com recurso ao software SPSS v20, tendo sido usado o teste qui-quadrado para verificar a existência da associação entre as variáveis de interesse com um nível de significância P <0,05. Resultados: De Janeiro de 2018 a Dezembro de 2023 foram internados 105 pacientes com infecções odontogénicas, com uma mediana de 27 anos (mínimo=4 e máximo=70), com 33,3% dos paciente na faixa etária dos 20-29 anos , 57, 1% do sexo masculino e 73% residentes na cidade de Tete. As principais infecções diagnosticadas foram: abcessos, celulites, angina de Ludwing, osteomielite e fasciite necrotizanta , onde os abcessos corresponderam a 55,2%. 67,6% estavam localizadas na mandíbula, com origem periapical. Os dentes implicados foram os terceiros molares (35,2%).Cerca de 90% dos pacientes foram medicados e operados, com o tempo médio de internamento de 10,11 dias. Noventa e quatro porcento dos pacientes teve alta clínica e 1 % resultou em óbito. Verificou-se que pacientes maiores de 18 anos tinham maior probabilidade de permanencerem internados por um periodo superior a 7 dias (P=0,003). Conclusões: A maioria das infecções odontogénicas nos pacientes internados entre 2018 a 2023 foi registada em homens e jovens, estavam localizadas na mandibula, com origem periapical (cárie xii Infecções de origem odontogénica em Pacientes Internados no Hospital Provincial de Tete, 2018 a 2023dentária) e os terceiros molares foram os dentes mais implicados. Medidas de prevençao da cárie dentária devem ser implementadas para reduzir as infecções odontogénicas.