Factors influencing antibiotic prescription for respiratory tract infections among prescribers in Jinja City, Uganda: A qualitative study

Abstract

Background: Inappropriate antibiotic prescription for respiratory tract infections (RTIs) is a major driver of antimicrobial resistance (AMR). In Uganda, 40-80% of RTI patients receive antibiotics (ABs) despite most of them being viral and self-limiting. Few studies have explored the multifaceted factors influencing prescribing behavior among Ugandan healthcare providers. This study aimed to identify factors influencing antibiotic prescription (ABP) for RTIs among prescribers in Jinja City, Uganda. Methods: We conducted an exploratory qualitative study using face-to-face in-depth interviews with 16 prescribers (10 medical clinical officers, 5 nurses, 1 medical officer) from 10 purposively selected public health facilities in Jinja City during June-July 2023. Interview topics included knowledge of RTI etiology, antibiotic (AB) prescribing practices, availability of standard treatment guidelines (STGs) and diagnostics, and continuous education on AB use. Audio-recorded responses were transcribed verbatim, coded, and analyzed thematically using the Social Ecological Model to identify multilevel factors influencing prescribing decisions. Results: The factors influencing ABP for RTIs were categorized into individual, interpersonal, institutional, community and ministry of health (MOH) and government policy factors. Individual level factors included prescriber related factors and state of the patient considerations. Interpersonal factors involved prescriber-patient relationship and interactions with drug sales representatives. Institutional factors included initiatives to promote rational AB use by the facility’s management. Community-level factors included AB access and socioeconomic environment. Ministry of health and government policy factors included healthcare delivery infrastructure, educational and training programs, STGs, enforcement of regulations for prescription and dispensing. ARTICLE IN PRESS Conclusions: Multiple interrelated factors at individual, interpersonal, institutional, community, and policy levels contribute to inappropriate AB prescribing for RTIs in Jinja City. Addressing this challenge requires multipronged interventions. These findings provide actionable evidence for 1 ARTICLE IN PRESS developing context-specific interventions to promote rational AB use and combat ABR in Uganda and similar low-resource settings.