Investigating the effect of interventional programmes in combatting inappropriate use of antibiotics in managing and treating acute gastroenteritis in children younger than five years at the Raleigh Fitkin Memorial Hospital in ESwatini

Matsebula-Myeni, Zinhle (2019-04)

Thesis (MSc)--Stellenbosch University, 2019.

Thesis

ENGLISH ABSTRACT: Patients at the Raleigh Fitkin Memorial Hospital, ESwatini, especially children diagnosed with acute gastroenteritis, are mostly prescribed with antibiotics. Previous data suggest that inappropriate use of antibiotics results in higher antibiotic resistance, extended hospitalisation and increased medication costs. Antibiotic stewardship programmes and clinical practice guidelines can reduce the inappropriate use of antibiotics and improve patient outcomes. Despite increased theoretical awareness of the benefits of antibiotic stewardship programmes, none have been established in ESwatini, and limited comprehensive studies have evaluated their effect in paediatric settings globally. The knowledge, attitude and practices on antibiotic use and resistance have not been determined at the Raleigh Fitkin Memorial Hospital. An 18-month, single-centre process improvement study, comprising a six-month pre-intervention phase, a preparatory period of six months and a six-month intervention phase, was conducted at the Raleigh Fitkin Memorial Hospital to assess the effectiveness of a multifaceted intervention in combatting the inappropriate use of antibiotics and improving the management of acute gastroenteritis and its comorbidities in children aged less than five years. The intervention included the establishment of an antibiotic stewardship programme and the implementation of clinical practice guidelines related to the diagnosis, treatment and management of acute gastroenteritis and its associated comorbidities. Two hundred and thirteen patients participated in the study, with 87 patients in the pre-intervention phase and 126 in the intervention phase. Knowledge, attitude and practices of healthcare professionals were investigated by conducting a survey before and after the intervention phase. An improvement in the appropriateness of antibiotics use was observed in the intervention phase. A decrease in duration of hospitalisation, cost of antibiotics and mortality was observed. During the intervention phase, deaths were observed where severe acute malnutrition was present as comorbidity to acute gastroenteritis, whereas various causes of death were observed during the pre-intervention phase. Most recommendations by the antibiotic stewardship programme team were adopted during the intervention phase. An improvement in knowledge, attitude and practices on antibiotic use and resistance was observed after the intervention phase. The study demonstrates that an antibiotic stewardship programme can improve the appropriate use of antibiotics in children, with limited adverse effects. Clinical practice guidelines play a vital role in providing guidance to prescribers and harmonising therapies. Antibiotic stewardship programmes can improve healthcare professionals’ knowledge, attitude and practices on the appropriate use of antibiotics, and a decrease in antibiotic resistance.

AFRIKAANSE OPSOMMING: Pasiënte by die Raleigh Fitkin Memorial-hospitaal in ESwatini, veral kinders wat gediagnoseer is met akute gastroenteritis, ontvang meestal antibiotika as voorskrif. Vroeër ingesamelde data dui daarop dat die onvanpaste gebruik van antibiotika lei tot groter antibiotiese weerstandigheid, langer hospitaalverblyf en verhoogde medikasiekoste. Antibiotiese bestuursprogramme en kliniese riglyne kan die onvanpaste gebruik van antibiotika verminder en die kliniese uitkomste van pasiënte verbeter. Ten spyte van toenemende teoretiese bewustheid van die voordele van antibiotiese bestuursprogramme, is geen sodanige program nog in ESwatini ingestel nie, en min omvattende studies het nog die effek daarvan in pediatriese omgewings wêreldwyd ondersoek. Die kennis, ingesteldheid en praktyke oor die gebruik van antibiotika en antibiotiese weerstandigheid is nog nie by die Raleigh Fitkin Memorial-hospitaal bepaal nie. ’n Agtien-maandelange enkelsentrum-prosesverbeteringstudie, bestaande uit ’n pre-intervensie-fase van ses maande, ’n voorbereidende periode van ses maande en ’n intervensie-fase van ses maande, is by die Raleigh Fitkin Memorial-hospitaal uitgevoer om die effektiwiteit van ’n multi-faset-intervensie vir die teenkamping van onvanpaste antibiotikagebruik en die verbetering van die bestuur van akute gastroënteritis en sy medemorbiditeite in kinders van jonger as vyf jaar, te evalueer. Die intervensie het die vestiging van ’n antibiotiese bestuursprogram en die implementering van kliniese riglyne vir die diagnose, behandeling en bestuur van akute gastroenteritis en sy geassosieerde medemorbiditeite ingesluit. ’n Totaal van 213 pasiënte is by die studie ingesluit, met 87 pasiënte in die pre-intervensie-fase 126 in die intervensie-fase. Die kennis, ingesteldheid en praktyke van professionele gesondheidsorgwerkers is ondersoek deur ’n opname voor en na die intervensie-fase uit te voer. ’n Verbetering in die gepastheid van antibiotikagebruik is waargeneem gedurende die intervensie-fase. ’n Afname in hospitaalverblyf, koste van antibiotika en sterftes is waargeneem. Gedurende die intervensie-fase is sterftes, was ernstige akute wanvoeding as medemorbiditeit van akute gastroenteritis teenwoordig was, terwyl verskillende oorsake vir sterftes gedurende die pre-intervensie-fase waargeneem is. Die meeste aanbevelings wat deur die antibiotiese bestuursprogram-span gemaak is, is aanvaar gedurende die intervensie-fase. ’n Verbetering in die kennis, ingesteldheid en praktyke oor die gebruik van antibiotika en antibiotiese weerstandigheid is waargeneem na die intervensie-fase. Die studie het gedemonstreer dat ’n antibiotiese bestuursprogram die gepastheid van antibiotika-gebruik in kinders kan verbeter, met beperkte klinies nadelige uitkomste. Kliniese riglyne speel ’n onontbeerlike rol om leiding aan voorskrywers te verskaf en om behandeling te harmoniseer. Antibiotiese bestuursprogramme kan professionele gesondheidswerkers se kennis, ingesteldheid en praktyke oor gepaste antibiotikagebruik verbeter en ’n afname in antibiotiese weerstandigheid tot gevolg hê.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/106224
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