Western and coastal Kenya sick visit data 2019-2022

Antimicrobial resistant pathogens are a leading cause of morbidity and
mortality worldwide, with overuse and misuse of antimicrobials being key
contributors. We aimed to identify factors associated with antibiotic
prescriptions among patients presenting to clinics in Kenya. We performed
a retrospective, descriptive cohort study of persons presenting to
outpatient clinics in Western and Coastal Kenya, including symptoms,
physical exams, clinician assessments, laboratory results and
prescriptions. We reviewed 1,526 visits among 1,059 people who sought care
from December 2019-February 2022. Median age was 16 (IQR 6-35) and 22%
were under 5. 30% of malaria RDTs were positive and 3% of dengue RT-qPCRs
were positive. Antibiotics were prescribed in 73% of encounters overall
and in 84% among children under 5. In 48% of visits antibiotics were
prescribed without a provisional bacterial diagnosis. In the multivariable
model, factors associated with increased odds of an antibiotic
prescription were the clinic in Western Kenya (OR 5.1, 95% CI 3.0-8.8),
age less than or equal to 18 (OR 2.1, 95% CI 1.4-3.2), endorsement of
cardiorespiratory symptoms (OR 5.2, 95% CI 3.2-8.3), a negative malaria
RDT (OR 4.0, 95% CI 2.5-6.8), and a provisional diagnosis that could be
bacterial in etiology (OR 5.9, 95% CI 3.5-10.3). High rates of antibiotic
prescriptions are common even when associated diagnoses are not bacterial.
Compared to our 2014-2017 cohort, we found higher rates of antibiotic
prescriptions among children. Improved diagnostics to rule in alternative
diagnoses as well as stewardship programs are needed.