Browsing by Author "Matsebula-Myeni, Zinhle"
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- ItemInvestigating 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(Stellenbosch : Stellenbosch University, 2019-04) Matsebula-Myeni, Zinhle; Rosenkranz, Bernd; Reuter, Helmuth; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine: Clinical Pharmacology.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.