Knowledge, attitudes and practices relating to antibiotic use and resistance among prescribers from public primary healthcare facilities in Harare, Zimbabwe

Overuse of antibiotics is one of the main drivers for antimicrobial
resistance (AMR). Globally, most antibiotics are prescribed in the
outpatient setting. This survey aimed to explore attitudes and practices
with regards to microbiology tests, AMR and antibiotic prescribing among
healthcare providers at public primary health clinics in Harare, Zimbabwe.
Methods: This cross-sectional survey was conducted in nine
primary health clinics located in low-income suburbs of Harare between
October and December 2020. In Zimbabwe, primary health clinics provide
nurse-led outpatient care for acute and chronic illnesses. Healthcare
providers who independently prescribe antibiotics and order diagnostic
tests were invited to participate. The survey used self-administered
questionnaires. A five-point Likert scale was used to determined attitudes
and beliefs. Results: A total of 91 healthcare providers agreed
to participate in the survey. The majority of participants (62/91, 68%)
had more than 10 years of work experience. Most participants reported that
they consider AMR as a global (75/91, 82%) and/or national (81/91, 89%)
problem, while 52/91 (57%) considered AMR to be a problem in their
healthcare facilities. A fifth of participants (20/91, 22%) were unsure if
AMR was a problem in their clinics. Participants felt that the
availability of national guidelines (89/89, 100%), training sessions on
antibiotic prescribing (89/89, 100%), and regular audit and feedback on
prescribing (82/88, 93%) were helpful interventions to improve
prescribing. Conclusions: These findings support the need for
increased availability of data on AMR and antibiotic use in primary care.
Educational interventions, regular audit and feedback, and access to
practice guidelines may be useful to limit the overuse of antibiotics.