National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Setting
2.2.1. General Setting
2.2.2. Specific Setting
Health System in Sierra Leone
Drug Procurement
Pharmacy Board of Sierra Leone (PBSL) and Drug Regulations
2.3. Study Population and Periods
2.4. Data Variables and Sources of Data
2.5. Data Collection and Validation
2.6. Data Analysis
2.6.1. Anatomical Therapeutic Chemical (ATC) Classification System
2.6.2. Defined Daily Dose (DDD)
2.6.3. Defined Daily Dose (DDD) per 1000 Inhabitants per Day
2.6.4. Access, Watch, and Reserve (AWaRe) Categories
3. Results
3.1. Consumption of Antiobiotics (DDD per 1000 Inhabitants per Day) Along with Their Subgroup, Route of Administration and AWaRe Categorisation
3.2. Most Commonly Consumed Antibiotic Substances by Route of Administration by Chemical Substance Group
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Laxminarayan, R.; Duse, A.; Wattal, C.; Zaidi, A.K.; Wertheim, H.F.; Sumpradit, N.; Vlieghe, E.; Hara, G.L.; Gould, I.M.; Goossens, H.; et al. Antibiotic resistance-the need for global solutions. Lancet Infect. Dis. 2013, 13, 1057–1098. [Google Scholar] [CrossRef] [Green Version]
- Laxminarayan, R.; Matsoso, P.; Pant, S.; Brower, C.; Røttingen, J.A.; Klugman, K.; Davies, S. Access to effective antimicrobials: A worldwide challenge. Lancet 2016, 387, 168–175. [Google Scholar] [CrossRef]
- Lim, C.; Takahashi, E.; Hongsuwan, M.; Wuthiekanun, V.; Thamlikitkul, V.; Hinjoy, S.; Day, N.P. Epidemiology and burden of multidrug-resistant bacterial infection in a developing country. eLife 2016, 5, e18082. [Google Scholar] [CrossRef] [PubMed]
- O’Neill, J. Review on Antimicrobial Resistance Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations; Wellcome Trust: London, UK, 2014. [Google Scholar]
- Dadgostar, P. Antimicrobial resistance: Implications and costs. Infect. Drug Resist. 2019, 12, 3903–3910. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Jonas, O.B.; Irwin, A.; Berthe, F.C.; Le Gall, F.G.; Marquez, P.V. Drug-Resistant Infections: A Threat to Our Economic Future (Vol. 2): Final Report (English). In HNP/Agriculture Global Antimicrobial Resistance Initiative; World Bank Group: Washington, DC, USA, 2017. [Google Scholar]
- WHO. Antibiotic Resistance. Fact Sheets. 31 July 2020. Available online: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance (accessed on 28 February 2021).
- Cecchini, M.L.J.; Slawomirski, L. Antimicrobial Resistance in G7 Countries and Beyond: Economic Issues, Policies and Options for Action; OECD: Paris, France, 2015. [Google Scholar]
- Goossens, H.; Ferech, M.; Vander Stichele, R.; Elseviers, M. Outpatient antibiotic use in Europe and association with resistance: A cross-national database study. Lancet 2005, 365, 579–587. [Google Scholar] [CrossRef]
- Fridkin, S.K.; Edwards, J.R.; Courval, J.M.; Hill, H.; Tenover, F.C.; Lawton, R.; Gaynes, R.P.; McGowan, J.E., Jr. The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 u.S. Adult intensive care units. Ann. Intern. Med. 2001, 135, 175–183. [Google Scholar] [CrossRef] [PubMed]
- Malhotra-Kumar, S.; Lammens, C.; Coenen, S.; Van Herck, K.; Goossens, H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: A randomised, double-blind, placebo-controlled study. Lancet 2007, 369, 482–490. [Google Scholar] [CrossRef]
- Klein, E.Y.; Van Boeckel, T.P.; Martinez, E.M.; Pant, S.; Gandra, S.; Levin, S.A.; Goossens, H.; Laxminarayan, R. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc. Natl. Acad. Sci. USA 2018, 115, E3463–E3470. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Jamiso, D.T.; Breman, J.G.; Measham, A.R.A.G.; Claeson, M.; Evans, D.B.; Jha, P.; Mills, A.; Musgrove, P. Disease Control Priorities in Developing Countries, 2nd ed.; Oxford University Press: New York, NY, USA, 2006. [Google Scholar]
- Mendelson, M.; Røttingen, J.A.; Gopinathan, U.; Hamer, D.H.; Wertheim, H.; Basnyat, B.; Butler, C.; Tomson, G.; Balasegaram, M. Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries. Lancet 2016, 387, 188–198. [Google Scholar] [CrossRef]
- WHO. Global Action Plan on Antimicrobial Resistance; WHO: Geneva, Switzerland, 2015. [Google Scholar]
- WHO. Essential Medicines and Health Products. WHO Releases the 2019 AWaRe Classification Antibiotics. 2019. Available online: https://www.who.int/medicines/news/2019/WHO_releases2019AWaRe_classification_antibiotics/en/ (accessed on 4 February 2021).
- Ministry of Health and Sanitation. National Strategic Plan for Combating Antimicrobial Resistance (2018–2022); Government of Sierra Leone, Ministry of Health and Sanitation: Freetown, Sierra Leone, 2018. [Google Scholar]
- WHO. Who Methodology for a Global Programme on Surveillance of Antimicrobial Consumption; World Health Organization: Geneva, Switzerland, 2016. [Google Scholar]
- Statistics Sierra Leone. 2015 Population and Housing Census. Summary of Final Results; Statitistics Sierra Leone: Freetown, Sierra Leone, 2017; Available online: https://www.statistics.sl/images/StatisticsSL/Documents/final-results_-2015_population_and_housing_census.pdf (accessed on 4 February 2021).
- Elston, J.W.; Cartwright, C.; Ndumbi, P.; Wright, J. The health impact of the 2014-15 ebola outbreak. Public Health 2017, 143, 60–70. [Google Scholar] [CrossRef] [PubMed]
- Government of Sierra Leone. Sierra Leone Basic Package of Essential Health Services, 2015–2020; Government of Sierra Leone: Freetown, Sierra Leone, 2015. [Google Scholar]
- Ministry of Health and Sanitation. National Essential Medicines List for Sierra Leone 2020; Government of Sierra Leone: Freetown, Sierra Leone, 2020. [Google Scholar]
- Government of Sierra Leone. The Sierra Leone Service Availability and Readiness Assessment (SARA) Report; Government of Sierra Leone: Freetown, Sierra Leone, 2017. [Google Scholar]
- Government of Sierra Leone. The Pharmacy and Drugs Act 2001; Government of Sierra Leone: Freetown, Sierra Leone, 2001; Available online: http://www.sierra-leone.org/Laws/2001-12.pdf (accessed on 4 February 2021).
- WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC Classification and DDD Assignment, 2019; World Health Organization: Oslo, Norway, 2018. [Google Scholar]
- WHO. Report on Surveillance of Antibiotic Consumption. 2016–2018 Early Implementation; World Health Organization: Geneva, Switzerland, 2019. [Google Scholar]
- Statistics Sierra Leone. Sierra Leone 2015 Population and Housing Census Thematic Report on Population Projections; Stiatistics Sierra Leone: Freetown, Sierra Leone, 2017. [Google Scholar]
- WHO Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) Classification Index with DDDs; World Health Organization: Oslo, Norway, 2020. [Google Scholar]
- Statistics Sierra Leone. Sierra Leone 2015 Population and Housing Census: National Analytical Report; Statistics Sierra Leone: Freetown, Sierra Leone, 2015. [Google Scholar]
- WHO. World Health Organization Model List of Essential Medicines, 21st List; World Health Organization: Geneva, Switzerland, 2019; Available online: https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf?ua=1 (accessed on 6 September 2019).
- Klein, E.Y.; Milkowska-Shibata, M.; Tseng, K.K.; Sharland, M.; Gandra, S.; Pulcini, C.; Laxminarayan, R. Assessment of WHO antibiotic consumption and access targets in 76 countries, 2000–2015: An analysis of pharmaceutical sales data. Lancet Infect. Dis. 2021, 21, 107–115. [Google Scholar] [CrossRef]
- Robertson, J.; Iwamoto, K.; Hoxha, I.; Ghazaryan, L.; Abilova, V.; Cvijanovic, A.; Pyshnik, H.; Darakhvelidze, M.; Makalkina, L.; Jakupi, A.; et al. Antimicrobial medicines consumption in eastern europe and central asia—An updated cross-national study and assessment of quantitative metrics for policy action. Front. Pharmacol. 2018, 9, 1156. [Google Scholar] [CrossRef] [Green Version]
- Mbwasi, R.; Mapunjo, S.; Wittenauer, R.; Valimba, R.; Msovela, K.; Werth, B.J.; Khea, A.M.; Nkiligi, E.A.; Lusaya, E.; Stergachis, A.; et al. National consumption of antimicrobials in Tanzania: 2017–2019. Front. Pharmacol. 2020, 11, 585553. [Google Scholar] [CrossRef] [PubMed]
- Kargbo, M.S.; Massaquoi, L.D.; Samura, S.K.; Meng, X.; Zou, F. The relative prevalence of typhoid and malaria in febrile patients in Freetown, Sierra Leone. Open J. Prev. Med. 2014, 4, 338–346. [Google Scholar] [CrossRef] [Green Version]
- Dat, V.Q.; Toan, P.K.; Van Doorn, H.R. Purchase and use of antimicrobials in the hospital sector of vietnam, a lower middle-income country with an emerging pharmaceuticals market. PLoS ONE 2020, 15, e0240830. [Google Scholar] [CrossRef] [PubMed]
- WHO. Joint External Evaluation of IHR Core Capacities of the Republic of Sierra Leone; World Health Organization: Geneva, Switzerland, 2017. [Google Scholar]
- von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. J. Clin. Epidemiol. 2008, 61, 344–349. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Therapeutic/Pharmacological Subgroup (ATC3) | DDD per 1000 Inhabitants per Day | |||||
---|---|---|---|---|---|---|
Total | Oral | Parenteral | ||||
(%) | (%) | (%) | ||||
J01A Tetracyclines | 0.9 | (5.1) | 0.9 | (5.2) | 0.0 | (0.0) |
J01B Amphenicols | 0.1 | (0.6) | 0.1 | (0.6) | 0.0 | (0.7) |
J01C Beta-lactam antibacterials/penicillins | 2.9 | (15.5) | 2.7 | (15.0) | 0.1 | (45.3) |
J01D Other beta-lactam antibacterials | 1.2 | (6.2) | 1.1 | (6.0) | 0.1 | (19.4) |
J01E Sulfonamides-trimethoprim | 2.2 | (11.7) | 2.2 | (11.8) | 0.0 | (0.0) |
J01F Macrolides, lincosamides and streptogamins | 1.9 | (10.4) | 1.9 | (10.6) | 0.0 | (0.0) |
J01G Aminoglycosides | 0.0 | (0.2) | 0.0 | (0.0) | 0.0 | (14.7) |
J01M Quinolones | 2.7 | (14.7) | 2.7 | (14.9) | 0.0 | (3.4) |
J01R Combinations | 0.2 | (1.0) | 0.2 | (1.0) | 0.0 | (0.0) |
J01X Other antibacterials 1 | 6.4 | (34.6) | 6.3 | (34.9) | 0.1 | (16.6) |
WHO AWaRe Category | DDD per 1000 Inhabitants per Day | |||||
---|---|---|---|---|---|---|
Total | Oral | Parenteral | ||||
(%) | (%) | (%) | ||||
Access | 12.0 | (64.8) | 11.8 | (64.6) | 0.2 | (77.2) |
Watch | 5.7 | (30.7) | 5.6 | (30.9) | 0.1 | (22.8) |
Reserve | 0.0 | (0.0) | 0.0 | (0.0) | 0.0 | (0.0) |
Other | 0.8 | (4.5) | 0.8 | (4.6) | 0.0 | (0.0) |
Antibiotic Substance (ATC5 Code) | DDD per 1000 Inhabitants per Day | Percent of All Oral Antibiotics Consumed |
---|---|---|
Metronidazole (P01AB01) | 6.3 | 34.9 |
Ciprofloxacin (J01MA02) | 2.7 | 14.6 |
Sulfamethoxazole and trimethoprim (J01EE01) | 2.2 | 11.8 |
Erythromycin (J01FA01) | 1.9 | 10.6 |
Amoxicillin (J01CA04) | 1.7 | 9.4 |
Tetracycline (J01AA07) | 0.9 | 5.2 |
Cefuroxime (J01DC02) | 0.9 | 5.1 |
Combinations of penicillins (J01CR50) | 0.6 | 3.5 |
Amoxicillin and enzyme inhibitor (J01CR02) | 0.2 | 1.0 |
Ampicillin (J01CA01) | 0.2 | 0.9 |
Antibiotic Substance (ATC5 Code) | DDD per 1000 Inhabitants per Day | Percent of All Parenteral Antibiotics Consumed |
---|---|---|
Procaine benzylpenicillin (J01CE09) | 0.19 | 31.7 |
Ceftriaxone (J01DD04) | 0.06 | 19.4 |
Metronidazole (J01XD01) | 0.05 | 16.6 |
Gentamicin (J01GB03) | 0.04 | 14.7 |
Benzylpenicillin (J01CE01) | 0.03 | 9.7 |
Ciprofloxacin (J01MA02) | 0.01 | 3.4 |
Ampicillin (J01CA01) | <0.01 | 2.2 |
Benzathine benzylpenicillin (J01CE08) | <0.01 | 1.6 |
Chloramphenicol (J01BA01) | <0.01 | 0.7 |
Amoxicillin (J01CA04) | <0.01 | <0.1 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Kanu, J.S.; Khogali, M.; Hann, K.; Tao, W.; Barlatt, S.; Komeh, J.; Johnson, J.; Sesay, M.; Vandi, M.A.; Tweya, H.; et al. National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): A Cross-Sectional Study. Trop. Med. Infect. Dis. 2021, 6, 77. https://doi.org/10.3390/tropicalmed6020077
Kanu JS, Khogali M, Hann K, Tao W, Barlatt S, Komeh J, Johnson J, Sesay M, Vandi MA, Tweya H, et al. National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): A Cross-Sectional Study. Tropical Medicine and Infectious Disease. 2021; 6(2):77. https://doi.org/10.3390/tropicalmed6020077
Chicago/Turabian StyleKanu, Joseph Sam, Mohammed Khogali, Katrina Hann, Wenjing Tao, Shuwary Barlatt, James Komeh, Joy Johnson, Mohamed Sesay, Mohamed Alex Vandi, Hannock Tweya, and et al. 2021. "National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): A Cross-Sectional Study" Tropical Medicine and Infectious Disease 6, no. 2: 77. https://doi.org/10.3390/tropicalmed6020077