KNOWLEDGE, ATTITUDES AND PRACTICES ON ANTIBIOTICS PRESCRIBING FOR ACUTE UPPER RESPIRATORY TRACT INFECTIONS AMONG CLINICIANS IN HEALTH CENTERS IN THE CITY OF KIGALI, RWANDA

Abstract

The WHO Global Report on Surveillance of 2014 estimated that at least 700,000 people worldwide die each year due to drug-resistant infections. This number could rise to 10 million deaths per year by 2050 if urgent action is not taken. Antibiotic consumption is recognized as a primary and unequal contributor to this resistance phenomenon. The conducted studies relating to antibiotic utilization and resistance in Rwanda have brought to light concerning patterns. Specifically, a noteworthy surge in resistance to Imipenem and Colistin has been identified among gram-negative bacteria at a tertiary healthcare facility in Kigali during the timeframe of 2009 to 2013 and a substantial proportion (2.1%) of multi-drug-resistant tuberculosis (MDR-TB) strains. Furthermore, research conducted in Gisagara district health centers demonstrated that antibiotic prescription rates exceeded the WHO recommendation of 30%, with the primary indication being Acute upper respiratory tract infections. The studies revealed the necessity to understand the level of awareness and understanding that prescribers possess regarding appropriate antibiotic prescription practices, including factors influencing their decision-making processes, to address the gaps identified that may contribute to improper antibiotic use. The study's main goal was to assess the level of knowledge, attitudes, and practices regarding prescription of antibiotics for acute upper respiratory tract infections by clinicians practicing in health centers in Kigali City. The study was cross-sectional, and it utilized quantitative methods through structured questionnaires. Study questionnaires were administered to 191 clinicians. All 36 health centers in the City of Kigali were sampled, and all clinicians on duty were invited to participate until the desired number was obtained. Data collection authorization letter was sought from Mount Kenya University, confidentiality was granted to participants, and the willing participants signed the consent form before filling out the questionnaire. SPSS program version 29.0 was used to clean, manage, and analyze data. The fundamental descriptive statistics were performed to produce percentages, proportions, and frequencies. Chi-square test and regression analysis were used to examine the association between dependent and independent variables. The study revealed significant gaps in clinicians' knowledge of appropriate antibiotic use, with 61.8% showing poor knowledge, 36.6% moderate, and only 1.6% demonstrating good knowledge. 59% of clinicians incorrectly believed that incomplete antibiotic courses do not reduce effectiveness, while 52.4% of trained respondents showed better understanding. Positive attitudes were held by 70.7%, while 29.3% had negative attitudes. Practice levels were also concerning, with only 25.1% showing good practices. Knowledge and attitudes significantly influenced practice scores, with attitudes having the strongest impact (β = 0.561, p < 0.001), and knowledge also playing a notable role (β = 0.174, p = 0.005). These insights underline the need for targeted educational interventions and continuous professional development to improve antibiotic prescribing practices and mitigate the threat of antimicrobial resistance. The study findings will improve the knowledge and prescribing practices of antibiotics for acute upper respiratory tract infections among primary healthcare clinicians in Kigali city, and the information generated could be used by policymakers in developing policies and appropriate interventions to promote the rational antibiotic prescribing and halt the spread of antibiotic resistance.