Community antibiotic usage and the characterization of antibiotic resistance among common bacterial isolates in selected rural and urban districts of the DODOMA Region, Central TANZANIA

Abstract

Antibiotic resistance threatens the treatment of bacterial infections globally. This cross- sectional study was conducted from August 2019 to May 2021 in Dodoma. The aim was to

understand the prevalence and determinants of self-medication with antibiotics (SMA), antibiotic dispensing in community drug outlets, antibiotic prescribing in primary health care facilities and determine resistance profiles of bacterial pathogens in primary health care facilities (PHCF). Regarding SMA, 430 respondents were interviewed in Chemba District Council (rural) (161/430) and Dodoma City Council (urban) (269/430). The prevalence of SMA was 23.6% (38/161) and 23.4% (63/269) in the rural and urban respondents respectively. A shorter perceived distance to a health care facility than to a drug outlet was associated with decreased SMA practices among participants. Furthermore, 643 drug purchases were recorded in Accredited Drug Dispensing Outlets (ADDO) and community pharmacies, 84.1 % (541/643) were in Dodoma City Council (urban) and only 24.9% (160/643) purchased antibiotics. Antibiotics were dispensed in ADDO without prescriptions and beyond jurisdiction. Children <5 years accounted for over 45% (474/1021) of all the consultations recorded in the primary health care facility (PHCF); 76.3% (779/1021) of the consultations had an antibiotic with up to 55% (429/779) adherence to Standard Treatment Guidelines (STG). Pneumonia and respiratory symptoms were 16 times (adjusted OR=15.918; 95% CI: 2.151, 17.973; p = 0.007) and almost 2 times (adjusted OR=1.709; 95% CI: 1.129, 2.587; p = 0.011) more likely to prompt antibiotics, respectively. Furthermore, 621 clinical specimens were collected from out-patients in Chemba District Council (38.1%; 237/621) and Dodoma City Council (61.9%; 384/621) respectively. S. aureus (44) and E. coli (35) were the most prevalent isolates. There were high resistance rates of E. coli and S. aureus against ampicillin, ciprofloxacin and trimethoprim/sulfamethoxazole: 31.8% (14/44) of S. aureus were methicillin-resistant (MRSA). This study reports high SMA among those living close to community drug outlets, high un-prescribed antibiotic dispensing in ADDO, poor adherence to STG and relatively lower methicillin-resistant Staphylococcus aureus (MRSA) levels in PHCF. The study calls for more concerted efforts against the misuse of antibiotics as a means of confronting the emergence and spread of antibiotic resistance.