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European Journal of Applied Sciences – Vol. 11, No. 3
Publication Date: June 25, 2023
DOI:10.14738/aivp.113.14686.
Idoko, L. O., Okafor, K. C., & Lolo, N. S. (2023). Assessment of Knowledge and Prevalence of Antimicrobial Use (AMU) Among
Patients in a District Hospital in Abuja, Federal Capital Territory, Nigeria. European Journal of Applied Sciences, Vol - 11(3). 182-
202.
Services for Science and Education – United Kingdom
Assessment of Knowledge and Prevalence of Antimicrobial Use
(AMU) Among Patients in a District Hospital in Abuja, Federal
Capital Territory, Nigeria
Idoko, Lucy O.
Department of Community Medicine & PHC
Bingham University, Karu, Nasarawa State, Nigeria
Okafor, Kingsley C.
(ORCID – 0000-0003-3796-2417)
Department of Community Medicine & PHC
Bingham University, Karu, Nasarawa State, Nigeria
Lolo, Nomsu S.
Department of Community Medicine & PHC
Bingham University, Karu, Nasarawa State, Nigeria
ABSTRACT
Background: Worldwide, antimicrobial use is a major contributor to the
development of antimicrobial resistance (AMR), withpeople and animals serving as
the primary drivers. Knowledge of antibiotic rational use includes not only
providers' actions in ensuring patients receive appropriate treatment for their
condition, at the right dose and duration, but also patients' actions in adhering to
the treatment protocols recommended, completing the full course, and not sharing
or storing medicines for future use. This study aims to determine the knowledge
and prevalence of antimicrobial use among patients in a District Hospital in Abuja,
Federal Capital Territory, Nigeria. Methods: This was descriptive, cross-sectional
study done in September, 2022 among 400 patients attending outpatient clinic at
Maitama District Hospital Abuja's. A multistage sampling technique was used in this
study. The data was analyzed using the IBM SPSS 28 (Statistical Package for the
Social Sciences) computer software (IBM SPSS Inc. 2021). Ethical approval was
granted by Bingham University Teaching Hospital, Jos, Plateau State. Results: The
prevalence of antimicrobial use in the last 1 month, 6month and last 1 year was
41.5%, 32.0% and 5.6% respectively. A majority (74.25%) of the participants had
gotten a prescription for the antibiotics from a doctoror nurse, 83.75% of them had
received advice from a doctor, nurse or pharmacist on how to take the antibiotics
while 16.25% of them had not. The antibiotics were sourced pharmacy (70.25%),
hospital (22.5%), clinic (4.25%) while 3% stated other sources. Respondents stated
that the conditions that can be treated with antibiotics, bladder infection or urinary
tract infection (UTI) (75.2%), followed by Skin or wound infection (70.8%), Sore
throat (62.4%) and Gonorrhea(55.9%) were the most selected. While other conditions
were Cold and flu (48.5%), Fever (33.7%), Malaria (34.2%), Measles (30.7%), Body
aches (21.3%), Headaches (11.9%) and HIV/AIDS (11.4%). Two thirds (63.25%) of
respondents had good knowledge of antimicrobial use, 17.25% fair knowledge of
antimicrobial use, and 19.5% poor knowledge of antimicrobial use. Test of
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183
Idoko, L. O., Okafor, K. C., & Lolo, N. S. (2023). Assessment of Knowledge and Prevalence of Antimicrobial Use (AMU) Among Patients in a District
Hospital in Abuja, Federal Capital Territory, Nigeria. European Journal of Applied Sciences, Vol - 11(3). 182-202.
URL: http://dx.doi.org/10.14738/aivp.113.14686.
association showed statistical significance for Age (χ2 (2, N=400) = 69.56, p < 0.003),
Marital status (χ2 (2, N=400) = 96.64, p < 0.001) and Education (χ2 (2, N=400) = 106.53, p <
0.01). Conclusion: The prevalence of antimicrobial use in the last 1 month was
41.5%, prevalence in last 6 months was 32.0% and in last 1 year was 5.6%
respectively.Two thirds of respondents had good knowledge of antimicrobial use,
17.25% fair knowledge of antimicrobial use, and 19.5% poor knowledge of
antimicrobial use. Individuals and communities should develop proper health- seeking behavior, such as consulting a physician or a licensed health workers
before using antimicrobials.
Keywords: Knowledge, Antimicrobial use, Antibiotic Use
INTRODUCTION
Antimicrobial use is a major contributor to the development of antimicrobial resistance (AMR),
withpeople and animals serving as the primary drivers1. The imprudent use of Antimicrobials
hastens theemergence of antimicrobial resistance (AMR), reducing treatment efficacy and
putting the future of human and animal medical interventions at risk.2 Inadequate infection
prevention and control in healthcare institutions, contamination of the food supply with AMR
bacteria, limited access to drinkable water, and restrictions in public health preventative
programs, such as immunization, sanitation, and sexual health, all contribute to the spread of
AMR. 3
Antibiotic misuse by the general people hasbeen identified as a significant risk factor for
antimicrobial resistance4, 5 People have unfettered access to medicines, even for animals and
plants, and established rules addressing this practice are rarely enforced. In food animals and
plants, there is little to no adherence to adequate antibiotic use and antimicrobial withdrawal
times, resulting in the accumulation of antimicrobial residues on thesefood items, which are
then consumed by people, increasing the incidence of AMR. Furthermore, many communities
continue to have inadequate WASH systems in their houses, abattoirs, and animalfarms, with
most of them dumping effluent and feces contaminated with antimicrobials and AMR- resistant
microorganisms into both the land and aquatic environments. it is also worth noting that
Nigerians have a poor grasp of antimicrobial resistance and/or the safe use of antibiotics.
Health professionals lack the capacity and/or resources to promote AMR awareness and
antimicrobial stewardship, andthere are currentlyno limitedAMRsurveillance systems in place
for human, animal,or agricultural health systems, all of which contribute to AMR risk and
transmission.
6,7
To prevent further emergence and spread of antimicrobial resistance, public education, and
awareness about the judicious and appropriate use of existing antimicrobials is the core
approach to take. Evidence demonstrates that not only in low- and middle-income nations, but
even in wealthy ones, public knowledge about antimicrobial resistance is still lacking.7 Judicious
Antibiotic use entails ensuring that the most appropriate antimicrobial is administered while
treating illnesses. It demands that "patients receive medicines suited to their clinical needs, in
doses that satisfy their own individual requirements, and for an adequate period to guarantee
thatthey obtainthe benefit of the medicines.8
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European Journal of Applied Sciences (EJAS) Vol. 11, Issue 3, June-2023
This description adds to the WHO definition of rational medicine use: “Medicine use is rational
(appropriate, proper, correct) when patients receive the appropriate medicines, in doses that
meet their own individual requirements, for an adequate period of time, and at the lowest cost
both to them and the community. Irrational (inappropriate, improper, incorrect) use of
medicines is when one or more of these conditions is not met8.”
Knowledge of antibiotic rational use includes not only providers' actions in ensuring patients
receiveappropriate treatment for their condition, at the right dose and duration, but also
patients' actions in adhering to the treatment protocols recommended, completing the full
course, and not sharing or storing medicines for future use8. Some advantages of rational
antimicrobial use include reduced human and animal mortality and morbidity, shorter hospital
length of stay for patients, improved living standards, and economically feasible low-cost health
services 9.
The single most significant factor favoring the development of drug resistance in microbes,
includingbacteria, is excessive/ inappropriate antimicrobial usage (e.g., too wide, without
clinical indication, at too low a dose, for too short a duration). AMR is a natural evolutionary
reaction to antimicrobial/antibiotics use (AMU).10 Microorganisms that are subjected to
selective pressure evolve defense mechanisms to ward off predators. These mechanisms can
take the form of spontaneous mutations, horizontal gene transfer from bacteria, or the
acquisition of genetic elementsthat give resistance. As a result, bacteria become less susceptible
to medications that they previouslyresponded to11,12. AMR organisms are believed to have
emerged and spread recently because of a sharp increase in the use of antimicrobial agents in
humans, animals, and agriculture (both appropriately and inappropriately) and/or the failure
of infection control protocols to adequately stop the spread of resistant organisms13,14.
Examples of inappropriate use include overprescribing antibiotics by doctors, patient misuse,
using antibiotics to promote growth in animals, self-medicationand/or medication of family
members (family medication) without prescription from health professionals, and using
antibiotics in nursing homes and long-term care institutions, 15 Other examplesofinappropriate
use include giving a non-first-line antibiotic or an antibiotic with extremelybroad-spectrum
action for a sensitive infection or an infection that can be treated with a narrow- spectrum
medication. The most common improper use of antibiotics in outpatient facilities occurs when
antibiotics are recommended for viral respiratory diseases such as viral bronchitis, otitis, and
sinusitis16
.
Antimicrobial use (AMU) and antimicrobial resistance (AMR) awareness levels among
residents must be determined in order to optimize the use of antimicrobials in order to improve
patient outcomes, ensure cost-effective therapy, and reduce adverse consequences of
antimicrobial use (including antimicrobial resistance) among hospitalized patients, the general
public, and agricultural professionals where there is a high rate of antimicrobial misuse to
combat infections brought about by AMR and delay further emergence and spread of resistance
6,7, 16. Only a few research data on public awareness and knowledge of antimicrobials use in
Nigeria are available presently, as a result, it is critical to examine public knowledge of
antimicrobial use in Abuja, in order to determine what kind of intervention the public might
require. This study aims to determine the knowledge and prevalence of antimicrobial use
among patients in a District Hospital in Abuja, Federal Capital Territory, Nigeria.
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Idoko, L. O., Okafor, K. C., & Lolo, N. S. (2023). Assessment of Knowledge and Prevalence of Antimicrobial Use (AMU) Among Patients in a District
Hospital in Abuja, Federal Capital Territory, Nigeria. European Journal of Applied Sciences, Vol - 11(3). 182-202.
URL: http://dx.doi.org/10.14738/aivp.113.14686.
METHODS
This study was done in the Abuja Municipal Area Council of Abuja, Nigeria. Abuja is the Federal
Capital Territory with a population of 2,702,443 17,18 The Abuja Federal Capital Territory (FCT)
is located between latitudes 8° 25' and 9° 25' N and longitudes 6° 45' and 7° 45' E, with a
geographical mass of approximately 8000sq km in the country's center and is bordered on all
sides by four states: Niger, Nasarawa, Kogi, andKaduna. The Federal Capital City (FCC) occupies
around 250 square kilometersof the landmass, with a population count of 778,567 for the Abuja
Municipal Area Council19.
Abuja Municipal Area Council (AMAC) established in 1984, is the most populated area council,
inhabited by more than half (55%) of the total population in Abuja, the other area councils
being Abaji, Bwari, Gwagwalada, Kuje, and Kwali.It has five districts namely Asokoro, Garki,
Karu, Maitama, and Wuse Districts and twelve Wards: City Centre, Garki, GUI, Gwagwa,
Gwarimpa, Jiwa, Karshi, Kabusa, Karo, Nyanya, Orozo, and Wuse. An Elected Councilor
represents each of these wards. The Area Council'sLegislative Arm is made up of Councilors.
The Executive Arm is made up of an elected Chairman and Vice Chairman, as well as an
appointed Secretary and other supervisory councilors and special advisers19,20,22.
Majority of the residents in AMAC are civil servants, low-middle-income earners, primarily
small traders and low-ranking civil officials which reside in remote areas. Those with a higher
socioeconomic position, on the other hand, live in the urban settlement.Somework inNGOs and
private sectorswhile others engage in commercial activities liketrading and transportation20, 21.
Abuja was chosen for this study as it is now one of Nigeria's ten most populous cities and one
of the world's fastest growing cities with an increasing number of the population with
representation of all tribes living in Nigeria who have easy access to antimicrobials. According
toNigeria’s legislation21,22antimicrobials and other antibacterial should only be dispensed with
prescription Notwithstanding, a combination of factors ranging from a relative paucity of
licensed prescribers, pharmacies, and accessto quality medicines to the proliferation of poorly
regulated patent medicine vendors, drug markets, and hawkers means that the country faces
severe access issues while also dealing with an irrational drug use crisis. The ease with which
antimicrobials can be accessed and purchased over the counter flourishes in an environment
characterized by a poorly regulated antimicrobial market and insufficient enforcement of
prescription-only access to antibiotics when necessary. In many cases, over-the-counter access
is not limited to first- or second-line antibiotics alone, but also includes the critically important
class of antimicrobials, which are "peddled" all over the streets of the country, and even though
certain antimicrobials are prescribed by a doctor, patients and their families frequently press
healthcare personnel for antimicrobials and, in most cases, self-medicate with antimicrobials
including for mild viral infections. Antimicrobials are widely utilized therapeuticallyand for
livestock growth promotion in the agricultural industry, resulting in widespread drug misuse.
Maitama District Hospital, one of the largest government-owned hospitals in Abuja. Outpatient
services, as well as Surgical, Medial, Pediatrics, Obstetrics, and Gynecology services, are
available at the two-story, 101-bed hospital. Laboratory, X-ray services and Accident &
Emergency service are also available.
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Maitama District Hospital (MDH) has a high patient load (average general outpatient
attendance of over 1,500/month i.e., 160 per clinic day). The GOPD is visited daily by anaverage
of 160 patients presenting with all kinds of symptoms and illnesses. It also provides full- scale
clinical and diagnostic services in various areas of specialties to patients from all the districts
within AMAC as well as other area councils within the FCT23.
A descriptive, cross-sectional design was done in September, 2022 among adults who reside in
Abuja, that attend Maitama district Hospital Abuja's General Out-Patient Clinic for care,
assistance, and treatment. Patients aged 18 andabove who fulfill the inclusion criteria and give
informed consent will be enrolled in the trial.
For this study, Sample Size was determined using the Cochran’s formula24 n= Z
2Pq/e2 n =
the desired sample size; Z = the standard normal deviate usually set at 1.96 which corresponds
to a 95% confidence level.P = prevalence of residents (18 and above) = 50%. q = 1-P; E = degree
of accuracy desired, set at 0.05Therefore N = 1.962 *(0.5) *(0.5) /0.0052.Thus, the minimal
sample size obtained for this study population was 384. Then, 10% was added to the sample
size to take care of attrition for residents who refused to participate or incompletely answered
the interview, thus making the sample size 423.
Respondents were selected using a multistage sampling method.
• First stage: Abuja Municipal Area Council (AMAC) was selected using simple random
sampling technique by balloting without replacement from the list of five districts in
AMAC LGA namely Asokoro, Garki, Karu, Maitama, and Wuse Districts and Maitama
district was selected.
• Second Stage: Selection of General hospital from Maitama District. Maitama district
hospital was selected as it was the only general hospital in this district.
• Third Stage 3: Selection of Participants. One in every two patients who came seeking
care at the Maitama hospital general outpatient clinic was systematically recruited into
the study from all eligible adult patients found in the waiting area of the outpatient clinic
before the commencement of consultation. 800 patients were expected basedon the
average weekly attendance at OPD, so 20 people were interviewed daily giving a
sampling interval of 2 (i.e., formula K= N/n was used, whereby N=the total number of
patients attending OPDper week and n=the estimated sample size. K = 800/423, K = 1.89
which was approximated to 2). thesystematic sampling technique was carried out as
follows: Simple random sampling was done for the first two patients in the waiting room
to get the startingpoint.
Thereafter, every 2nd patient was selected and recruited into the study if consent was given
until the required sample size was obtained.
Inclusion Criteria:
The criteria for eligibility for the study included (1.) Adults (18 years and above) visiting the
OPD as patients (2.) both males and females who were medically stable and willing to
participate.