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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.

A survey of RNA viruses in mosquitoes from Mozambique reveals novel genetic lineages of flaviviruses and phenuiviruses, as well as frequent flavivirus-like viral DNA forms in Mansonia

Wed, 01 Jan 2020 00:00:00 GMT

Title: A survey of RNA viruses in mosquitoes from Mozambique reveals novel genetic lineages of flaviviruses and phenuiviruses, as well as frequent flavivirus-like viral DNA forms in Mansonia Authors: Abílio, Ana Paula; Silva, Manuel; Kampango, Ayubo; Narciso, Inácio; Gudo, Eduardo Samo; Neves, Luís das; Sidat, Mohsin; Fafetine, José Manuel; Almeida, António Paulo Gouveia de; Parreira, Ricardo Abstract: Background: Mosquito-borne diseases involving arboviruses represent expanding threats to sub-Saharan Africa imposing as considerable burden to human and veterinary public health. In Mozambique over one hundred species of potential arbovirus mosquito vectors have been identified, although their precise role in maintaining such viruses in circulation in the country remains to be elucidated. The aim of this study was to screen for the presence of flaviviruses, alphaviruses and bunyaviruses in mosquitoes from different regions of Mozambique. Results: Our survey analyzed 14,519 mosquitoes, and the results obtained revealed genetically distinct insect- specific flaviviruses, detected in multiple species of mosquitoes from different genera. In addition, smaller flavivirus- like NS5 sequences, frequently detected in Mansonia seemed to correspond to defective viral sequences, present as viral DNA forms. Furthermore, three lineages of putative members of the Phenuiviridae family were also detected, two of which apparently corresponding to novel viral genetic lineages. Conclusion: This study reports for the first-time novel insect-specific flaviviruses and novel phenuiviruses, as well as frequent flavivirus-like viral DNA forms in several widely known vector species. This unique work represents recent investigation of virus screening conducted in mosquitoes from Mozambique and an important contribution to inform the establishment of a vector control program for arbovirus in the country and in the region.