Assessment on Practice of Antibiotics Prescription among General Practitioners in Yangon

Abstract

Introduction: The antimicrobial resistant issue becomes the world concern and antibiotic resistant problem is contributing it. In the WHO report 2014, South-east Asia region was recognized as the region with expanded resistant problems of antibiotics. WHO is now calling a collaborative action among the countries and pointing out that many more advanced researches and greater investments are highly demanded (WHOs first global report on antibiotic resistance reveals serious, worldwide threat to public health, 2014). Myanmar is one of the developing countries, facing loads of health related problems nowadays. Furthermore, Myanmar health expenditure was only 2.3% of Gross Domestic Product while WHO was demanding the countries to have 5% minimum (World Health Organization, 2018). Insufficient investment in health sector delays the reform process. There private health facilities are playing the huge role medical care service in countrys healthcare system as most of the public health facilities are mainly running for disease prevention and health education (Nyi Nyi Latt, 2018). However, this antibiotics resistance problem remained neglected by the Ministry of Health and Sports and these private health facilities are poor controlled especially in quality of care. However, in Myanmar, there are very few data which explore the threats of antibiotics resistance problem.

Objective and Methodology: The main objective of the study was to investigate the daily practice of clinicians working at General Practitioner (GP) setting by exploring the factors influencing upon the antibiotics prescription behaviours of general practitioners in Yangon. It was a cross-sectional descriptive study and were carried out by interviewing the clinicians working at GP setting in Yangon by using the semi-structured questionnaires. It demonstrated the practice of general practitioners; identified the most common antibiotics used in GP setting, explored factors influencing the irrational antibiotics prescription of clinicians and assessed knowledge and awareness of clinicians upon the threats of antibiotics resistance problem.

Results: Irrational antibiotics use was discovered. Among the reasons for antibiotics prescription, 59% of responses accounts for r prophylaxis purpose, 45% were contributed to the expectation for speedy recovery and/or prior exposure to one type of antibiotics for the particular episode and 29% of responses described the request of patients. Many clinicians were not using any clinical guideline to support their practice. It was found that 55 clinicians injected antibiotics only once in one episode of the illness. Out of them, 50 (90.9%) general practitioners were applying no clinical guideline. Moreover, 38% of clinicians were switching antibiotic during the course of treatment with irrational reasons and many of them were the clinicians who had less experience. The influence of pharmaceutical companies was also identified.

Conclusion: The study highlighted the irrational prescription of antibiotics among general practitioners and influencing factors on their prescription behavior. It also addressed the inadequate knowledge and low awareness of clinicians on antibiotic resistance problem in the context. According to the findings, it is important to have strong and active national platform and stewardship of the government to control the antimicrobial resistance problem. The knowledge and awareness of general practitioners have to be improved through medical seminars or workshops and media. Moreover, community education about the antibiotics resistance problems and consequences have to be conducted by health authorities. The laws for controlling medicines should be legislated and enforced to regulate the pharmaceutical companies in inappropriate marketing and importing antibiotics.

KEY WORDS: Antibiotics resistance, Antimicrobial resistance, Influencing factors, Rational and Irrational, Knowledge, Practice, Behavior, Clinicians, General Practitioners