UC Irvine

Background: Resistance of bacterial pathogens to antibiotic therapy threatens to derail progress made to reduce the global burden of infectious diseases, with the largest impact in countries such as Ghana where populations are vulnerable to pathogenic exposures. However, the level of antibiotic use and knowledge about antibiotic resistance among communities is inadequately quantified. This research aimed to identify gaps and priorities for strategies to improve antibiotic stewardship.

Methods: A cross-sectional study of four hundred individuals residing in the urban Greater Accra and rural Upper West regions of Ghana was conducted to investigate knowledge, attitudes, and practices regarding antibiotics and antibiotic resistance. The determinants of antibiotic stewardship were assessed through associations between level of knowledge, attitudes, and utilization behaviors and demographic characteristics. Principal component and regression analyses were conducted to determine the different dimensions of knowledge and their association with antibiotic use. Eight semi-structured in-depth interviews with key personnel from the policy, research, and practice programs in Ghana’s public health sector were conducted to investigate stakeholder roles and institutional capacity to promote prudent use of antibiotics at the community level.

Results: The results revealed that 70% of study participants (278/400) had used at least one antibiotic in the year prior to the survey. The most frequently used antibiotics were Amoxicillin, Amoxicillin-clavulanic acid, Ampicillin, Ciprofloxacin, and Metronidazole. Women and older adults had higher knowledge compared to their respective counterparts (p < 0.01). Prudent antibiotic use was significantly more prevalent in women than in men (p < 0.05). Most participants (63%) were unaware of antibiotic resistance. The determinants of antibiotic stewardship revealed two main principal components: knowledge about treatment of common illnesses showed that women and older individuals had higher knowledge about appropriate therapies for malaria, headaches, and body aches; and knowledge about prudent use of antibiotics indicated better knowledge about prudent use of antibiotics among older adults, persons with higher educational attainment, and residents of the Greater Accra region. Stakeholder analysis revealed four themes: national burden of disease and antibiotic resistance; policy development; implementation barriers; and strategies. All respondents expressed concern about the increasing proliferation of antibiotic-resistant bacteria, which they attributed in part to the inappropriate use of antibiotics in communities. Stakeholders acknowledged the importance of strengthening cross-sectoral collaboration, and the need to leverage resources from the animal and environmental sectors through a One Health approach.

Conclusion: Findings from my research can improve knowledge about the public’s understanding of antibiotic resistance to better inform implementation of the Global Action Plan on Antimicrobial Resistance, particularly in low-resource settings.