East African medical graduates ‘lack antibiotics knowledge’ — Research report

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Most medical graduates from various universities in East Africa were found to have very little practical knowledge on the use of antibiotics in clinical scenarios and other hospital settings, according to a study in PLOS One. The situation might be widespread in the region, writes Wachira Kigotho for University World News.

The study also revealed a knowledge gap between medicine and pharmacy students when it came to the use of antibiotics. Pharmacy students were found to be more knowledgeable in basic pharmacology than their counterparts in medicine.

The study, Knowledge, attitudes and perceptions about antibiotic use and antimicrobial resistance among final-year undergraduate medical and pharmacy students at three universities in East Africa, was conducted jointly by researchers at Makerere University in Uganda, Mount Kenya University in Kenya and the Catholic University of Health and Allied Sciences in Tanzania.

It found that only about 37% of sampled final-year students had a good general knowledge of antibiotics.

The researchers included Dr Margaret Lubwama, a microbiology lecturer at Makerere University, Dr Jackson Onyuka, the head of the department of medical laboratory sciences at Mount Kenya University, and Dr Martha Mushi, a senior lecturer in microbiology at Catholic University of Health and Allied Sciences.

A study sample of 328 students from the three regional universities was used to assess the readiness of final-year medical students to combat antimicrobial resistance, says the University World News story published on 3 May 2021.

Antimicrobial resistance is reaching alarming levels in most parts of the world, according to the World Health Organization. This is mainly because of the unsafe use of antibiotics and is likely to increase the cost of health-care services in most countries in Sub-Saharan Africa by 2050.

Resistant drugs

According to a World Bank report, Drug-Resistant Infections: A threat to our economic future, many bacteria are not just resistant to the older generations but also to third-generation antibiotics.

“Bearing this in mind, efforts to minimise the emergence and spread of antimicrobial threats cannot be one-off or limited to a temporary action plan,” the World Bank report noted.

The East Africa study was led by Lubwama and published in the PLOS ONE journal in May. It indicates an urgent need to address some of the exposed gaps in the training of medical professionals in various universities in Eastern Africa.

One such gap is that, while 82% of the students indicated that they knew when to start antimicrobial treatment, 34% did not know how to select the appropriate antibiotic drugs.

“About 30% did not know the antibiotic dose to give, while 34% did not know when to switch from an intravenous antibiotic to an oral regimen,” the report notes.

While most of the respondents were found to have a good general knowledge about antibiotics, only 44.8% had adequate knowledge about antimicrobial resistance, and only 17% were well informed about antibiotic use in clinical settings.

The researchers were surprised to learn that even some of the respondents who had not performed well in the knowledge questions still felt they knew how to use antibiotics appropriately in district hospitals, where most of them expected to work after graduating.

In their findings, the researchers highlighted antimicrobial resistance as a health problem in East African countries, mostly caused by inappropriate use of antibiotics.

Knowledge and attitude

One of the drivers for antimicrobial resistance, they noted, is the indiscriminate and irrational use of antibiotics because of a lack of knowledge and the poor general attitude of the clinicians that prescribe antibiotic drugs, as well as the dispensers.

“As demonstrated in our study, knowledge of antibiotic use for different resistance mechanisms was poor at all three universities,” the researchers said.

The researchers cite a similar study conducted in Nigeria, Knowledge of antibiotic use and resistance among students of a medical school in Nigeria, which noted that, while about 97% of respondents knew that ineffective treatment could occur due to indiscriminate use of antibiotics, 44% of them did not know how such drugs should be correctly used.

This study was conducted among medical undergraduate students at Nigeria’s Ebonyi University.

It suggests high knowledge levels, yet also a lot of ignorance about the correct use of antibiotics. For instance, 20% of respondents said they would keep leftover antibiotic medication for future use.

The East African study also revealed a knowledge gap between medicine and pharmacy students when it came to the use of antibiotics. Pharmacy students were found to be more knowledgeable in basic pharmacology than their counterparts in medicine.

Gap between theory and practice

As the researchers pointed out, however, doctors and not pharmacists are, in practice, the first to encounter patients and direct the management of infections.

The East African study argues that low scores in knowledge of antibiotic use in clinical scenarios reflect the gap between theory and practice in the training of doctors at the region’s universities.

If students are not prepared to apply practical microbiology when managing the use of antibiotics in a clinical scenario, then the unsafe use of antibiotics to combat infections is likely to increase in future, the researchers said.

In other words, poor practical skills can eventually lead to more inappropriate antibiotic prescription, which, in turn, is one of the key drivers for antimicrobial resistance in most African countries.

Attitudes and perceptions add to the problem. For instance, while about 66% of respondents agreed that antibiotics were overused in hospitals, 61% indicated that they have bought antibiotics over the counter without a prescription from a doctor.

Particularly worrying is that low scores in knowledge about antibiotic use in clinical scenarios seem to go hand in hand with overconfidence in prescribing all sorts of antibiotics.

Such overconfidence, the researchers noted, has, in most countries, been associated with over-prescribing, which leads to even more inappropriate use of antibiotics.

“Furthermore, our studies showed that the students were not very confident in the microbiology fields that influence the choice of antibiotic prescribed.”

As a result of their findings, the researchers recommend the introduction of courses that focus on antimicrobial resistance in the final year medicine and pharmacy programmes.

The researchers also urge governments in the region to establish national policies on the prescribing and dispensing of drugs at all levels to counter the growing threat of antimicrobial resistance.

They also called for the establishment of a multidisciplinary and practical approach, involving medical schools across the East African region, for educating final-year undergraduate students in antimicrobial resistance and antimicrobial stewardship programmes.


Study details

Knowledge, attitudes, and perceptions about antibiotic use and antimicrobial resistance among final year undergraduate medical and pharmacy students at three universities in East Africa

Margaret Lubwama, Jackson Onyuka, Kirabo Tess Ayazika, Leoson Junior Ssetaba, Joseph Siboko, Obedi Daniel, Martha F Mushi

Author affiliations: Makere University, Mount Kenya University and Catholic University of Health and Allied Sciences.

Published by PLOS One on 7 May 2021


Proper measures to combat antimicrobial resistance development and spread in Sub Saharan Africa are very crucial bearing in mind the projected burden of antimicrobial resistance which is expected to be increase by 2050. Training of medical doctor and pharmacy students in antimicrobial stewardship is vital to combat antimicrobial resistance.

This study was designed to evaluate the knowledge, attitude, and perception of final year medical and pharmacy students on antimicrobial use and antimicrobial resistance at three universities in Uganda, Kenya, and Tanzania.
A cross-sectional survey was carried out among final year undergraduate medical and pharmacy students at three universities in East Africa. A Self-administered questionnaire was developed which included dichotomous questions and questions using a 4-point Likert scale.

The questions were based on knowledge and attitude about antibiotics, and preparedness to use antibiotics in clinical scenarios. Data were analyzed using STATA version 16 following the objective of the study.
Three hundred and twenty-eight final year students participated in the survey from MUK 75, MKU 75 and CUHAS 178. Slightly majority of participants were male 192(58.5%) and their median age was 25 [23 – 27] years. In general, 36.6% (120/328) of students had good overall total knowledge. More students at MUK had good knowledge compared to MKU, and CUHAS (72% vs, 40% vs. 20.2%; p<0.001).

The mean scores for overall good total knowledge, general knowledge about antibiotics, knowledge about antibiotic resistance, and knowledge about antibiotic use in clinical scenarios were 58% (CI: 57%– 60%), 95% (CI: 94%– 97%), 54% (CI: 52% – 56%), and 46% (CI:44% – 48%) respectively. More pharmacy students compared to medical students had a good attitude and perception on antibiotic use (79.6% vs. 68.4%; p = 0.026). The students at CUHAS perceived being more prepared to use antibiotic in district hospitals compared to MKU and MUK (75.3% vs. 62.7% vs. 65.3%; p = 0.079).

While two hundred and seventy (82.3%) students perceived knowing when to start antimicrobial therapy, 112 (34.2%) did not know how to select the appropriate antibiotic (p<0.0001), 97 (29.6%) did not know the antibiotic dose to give (p<0.0001), and 111 (33.8%) did not know when to switch form an intravenous antibiotic to oral regimen (p<0.0001).
Final year students have low scores in knowledge about antimicrobial resistance and antibiotic use in clinical scenarios. This has exposed gaps in practical training of students, while they may feel confident, are not fully prepared to prescribe antibiotics in a hospital setting.

A multidisciplinary and practical approach involving medical schools across the East African region should be undertaken to train final year undergraduate students in antimicrobial resistance and antimicrobial stewardship programs. Antimicrobial resistance and antimicrobial stewardship courses should be introduced into the curriculum of final year medicine and pharmacy programs.

* This article is republished from University World News, which is an open access publication, under a Creative Commons 4.0 Licence. See the link to the original article below.


University World News story — Medical graduates ‘lack knowledge on antibiotics’ (Open access)

PLOS One article — Knowledge, attitudes, and perceptions about antibiotic use and antimicrobial resistance among final year undergraduate medical and pharmacy students at three universities in East Africa (Open access)




WHO report highlights lack of progress towards new antibiotics

Stories from the frontlines of antimicrobial resistance during COVID-19

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WHO fight against antimicrobial resistance

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