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Assessing Antimicrobial Usage in Sub-Saharan Africa: A Systematic Review of Clinical Practices

Excessive and improper use of antibiotics has been identified as a primary driver of antimicrobial resistance, posing a serious threat to global health. Hospitals in sub-Saharan Africa (SSA) have been found to demonstrate the highest prevalence of antibiotic use. A comprehensive systematic review and meta-analysis have endeavored to ascertain the pooled point prevalence (PPP) of evidence-based antimicrobial use among hospitalized patients in this region. The databases utilized for data retrieval included CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science. 

Meta-analysis was conducted utilizing STATA version 17, and forest plots, adopting the random-effect model, were used to illustrate the findings. Evaluation measures included heterogeneity, assessed via the I2 statistics, and publication bias, gauged through Egger’s test. The study incorporated 26,272 participants from twenty-eight studies spanning ten countries in SSA. The PPP of antimicrobial use in SSA was determined to be 64%. Intensive care units exhibited the highest antibiotic application at 89%. The most common clinical indication for antibiotic use was community acquired infection, revealed at 41%. The PPP of antimicrobial use among hospitalized patients was comparatively higher in SSA, with the most considerable antibiotic consumption recorded in intensive care units. 

In response to these findings, health institutions across SSA are urged to develop digital health interventions that would align with evidence-based prescribing guidelines enhancing antimicrobial stewardship. Therefore, it is increasingly imperative that healthcare facilities consistently evaluate antibiotic prescribing patterns for identifying opportunities to promote appropriate usage. Point prevalence studies, in particular, offer critical insights into the state of antibiotic use within healthcare settings, making them a valuable tool in advancing the quality and effectiveness of an overall healthcare regime.


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