Determinants of inappropriate antibiotic prescribing in primary healthcare facilities in the Golfe District, Togo, 2024

Introduction: Inappropriate prescribing of antibiotics is one of the main drivers of antimicrobial resistance (AMR). Due to the lack of national data, this study described the determinants of inappropriate antibiotic prescribing to promote better optimisation of antibiotic prescribing and combat antibacterial resistance. Methods: A cross-sectional study with a mixed approach was conducted in December 2024 in primary health care facilities in the Golfe district. After the day consultation, data were collected from patient health records and in-depth interviews with health professionals were conducted. Quantitative data were analyzed using SPSS 25 software, and qualitative data were analysed using NVivo QRS 14. Results: Of 640 antibiotic prescriptions, 84.4 % were inappropriate, with 53.3 % in the ” Access” class. Patients with pharyngitis (aOR: 0.04; 95%CI:0.01- 0.181) and pneumonia (aOR: 0.003; 95%CI: 0.001- 0.041) had lower odds of receiving an inappropriate antibiotic prescription. Female sex (aOR: 2.07; 95%CI: 1.21- 3.54), uncomplicated malaria (aOR: 89.19; 95%CI: 12.17- 653.72), and the prescription of at least two antibiotics (aOR: 8.48; 95% CI:2.81–25.59) increased the odds of inappropriate antibiotic prescribing. The socioeconomic status of patients, the lack of training of prescribers and the absence of an antibiotic prescription guide were reported as contributory factors during our individual interviews. Conclusion: The percentage of inappropriate prescription of antibiotics is high in the district. Strategies for continuing education of health professionals, the development of clear guidelines for the prescription of antibiotics, as well as patient awareness, need to be implemented to strengthen antimicrobial stewardship.