Evaluation of antibiotic prescription rates, Bono Region, Ghana, 2017-2022

Introduction: Approximately 50% of prescriptions globally, including antibiotics, are done improperly. Ghana and Bono Region recorded 47% and 52% antibiotic prescription rates, respectively, in 2021, above the WHO’s standard of 20.0%-26.8%. These high antibiotic prescription rates demonstrate poor antimicrobial stewardship and have a poor public health impact on the region and Ghana. We determined the rates of antibiotic prescription and the factors associated with it in the Bono Region. Methods: We evaluated the prescription rates of antibiotics in the Bono region using secondary data. Hospitals that submitted a Quarterly Rational Use of Medicine Report in the District Health Information Management System 2 from 2017-2022 were included in the evaluation, and these hospitals’ Rational Use of Medicine surveillance staff were selected for key informant interviews (KII). Quantitative data was analyzed by person, place and time. Recordings from the KII were aligned to themes and triangulated with quantitative results. Result: Only 4.4% of facilities reported on rational medicine use. Antibiotic prescription rates ranged from 34.8% to 55.1%, exceeding targets. Findings from both quantitative and qualitative data highlighted key drivers of high antibiotic use: nonadherence to treatment guidelines, inadequate diagnostics, limited trained prescribers, weak antimicrobial stewardship, supply chain issues, and poor community infection control. Conclusion: This evaluation revealed that antibiotic prescription in facilities in the Bono Region is high. We recommended that facility managers institute antimicrobial stewardship subcommittees, train prescribers on the rational use of antibiotics, and improve the capacities of laboratories to conduct culture and sensitivity testing.