Prevalence and Determinants of Antibiotic Prescription Among Children Admitted to Twelve Public Hospitals in Kenya

Abstract

Background- At least one antibiotic is given to 60% of children throughout their hospital stay, with broad-spectrum penicillins being the most prescribed worldwide. Injudicious antibiotic use in children’s hospitals has led to the emergence and transmission of antibiotic resistance, death, prolonged hospitalization, adverse drug events and increased treatment costs. So far, there are few studies carried out on the factors influencing prescription of antibiotics among hospitalized children in Sub-Saharan Africa. There is therefore an urgency to understand these factors in order to strengthen antibiotic stewardship programs in hospitals. Objectives- This study described the antibiotic prescription patterns and identified the determinants of antibiotic prescription among children admitted to hospitals in the Clinical Information Network (CIN) in Kenya. Methods- This was a cross-sectional analytic study carried out in 12 hospitals that are part of CIN across 11 counties in Kenya. Children older than two months and admitted in paediatric wards in CIN hospitals from 2014 to 2020 were included in the study. Patients with missing information on treatment were excluded. Data collected from hospital records were exported from REDCap and saved in an Excel spreadsheet. Both descriptive and inferential analyses were done using R software, version 4.1.2. Antibiotic prescription, a binary variable was the outcome of interest. Univariable and multivariable mixed-effects logistic regression were performed with the variable hospital added as a random effect to identify the determinants of antibiotic prescription. Results- The estimated period prevalence of antibiotic prescription between 2014 and 2020 was 81.1% (95% CI: 80.9 - 81.3%). Penicillins (42.6%), aminoglycosides (26.6%) and cephalosporins (19.6%) were the commonly prescribed classes of antibiotics among children admitted to the CIN hospitals. From the multivariable analysis, age (OR 0.8), duration of hospital stay (ORs 4.7; medium duration, 7.5; long duration) and diagnoses (ORs 162.0; pneumonia, 29.2; meningitis, 1.3; diarrhoea, 1.3; dehydration, 12.1; malnutrition) were found to be determinants of antibiotic prescription. Conclusion- The prevalence of antibiotic prescription was high, reflecting high usage of antibiotics in paediatric wards in public Kenyan hospitals. Age, duration of hospital stay and diagnoses were shown to influence the prescription of antibiotics among children. Recommendations- The clinicians should be trained on judicious antibiotic use , diagnostic support improved and strategies to ensure adherence to treatment guidelines adopted in the hospitals.