Short Report – Special Collection: African Health Systems

Burden of upper respiratory tract infections in primary care facilities and excessive antimicrobial over-prescription: A community-oriented primary care project in rural Kenya

Nelson Nyamu, Florence Mbatia, Pieter van den Hombergh, Simone Jaarsma, Felix Agoi, Jacob Shabani, Michaela Mantel, Fleur O. de Meijer
African Journal of Primary Health Care & Family Medicine | Vol 13, No 1 | a3107 | DOI: https://doi.org/10.4102/phcfm.v13i1.3107 | © 2021 Nelson Nyamu, Florence Mbatia, Pieter van den Hombergh, Simone Jaarsma, Felix Agoi, Jacob Shabani, Michaela Mantel, Fleur O. de Meijer | This work is licensed under CC Attribution 4.0
Submitted: 25 June 2021 | Published: 29 November 2021

About the author(s)

Nelson Nyamu, Department of Family Medicine, Aga Khan University, Nairobi, Kenya
Florence Mbatia, Department of Family Medicine, Aga Khan University, Nairobi, Kenya
Pieter van den Hombergh, Werkgroep Internationale Gezondheidszorg (WHIG), Netherlands
Simone Jaarsma, Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
Felix Agoi, Department of Population Health, Aga Khan University, Nairobi, Kenya
Jacob Shabani, Department of Family Medicine, Aga Khan University, Nairobi, Kenya
Michaela Mantel, Department of Population Health, Aga Khan University, Nairobi, Kenya
Fleur O. de Meijer, Department of Family Medicine, Aga Khan University, Nairobi, Kenya; Postgraduate Medical Education, Aga Khan University, Nairobi, Kenya


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Abstract

During their community oriented primary care (COPC) rotation in rural coastal Kenya, residents of the Family Medicine programme at the Aga Khan University–Nairobi, identified a high burden of upper respiratory tract infections (URTI) in the dispensaries with high prescription of antimicrobials (AMs) in over 80% of the patients presenting with URTI. An interactive participatory education intervention, designed based on principles of community participation and capacity building, reduced AM prescription in the under 5-year age group with 44% in the 2 weeks after the intervention, and with 18% at week 8 and 9. In the over 5-year age group, this was reduced with 18% and 8%, respectively. Key challenges for upholding AM stewardship after the intervention included the high patient workload in the clinics, difficulties in addressing patient’s concerns regarding the prognosis, inaccessibility to ingredients for home therapies, and easy availability of AMs without prescription at local chemists. Interventions addressing improper prescription at the facility level should include provision of continuous training, including communication training, for health facility staff, as well as audits on prescription practices. Collaboration with Community Health Volunteers (CHVs) can help in increasing community awareness on antimicrobial resistance (AMR). This study demonstrates the value of family physicians in clinical governance and improving the quality of care through implementation of guidelines and training. Joint action with the Kilifi county Ministry of Health and the private sector is needed to address mal-regulated access to AMs beyond health facility control.

Keywords

upper respiratory tract infections; antimicrobials; Kenya; community oriented primary care; family medicine; antimicrobial stewardship; antimicrobial resistance

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