INVESTIGATING RATIONAL ANTIBIOTIC PRESCRIBING IN PUBLIC HEALTH CARE FACILITIES OF ZANZIBAR TANZANIA

This study aims at assessing the rational antibiotic medicine prescribing in public health care facilities in Zanzibar, Tanzania. The study employed a descriptive and cross-sectional study with a quantitative approach in collecting and analyzing data. The study targeted all 30 health care facilities in the western urban region of Zanzibar together with all prescribers and prescriptions prescribed during the study period. Prescriptions were selected by using probability systematic sampling techniques from selected public health facilities. The study found that, 3,455 (99.9%) recorded prescription encounters had a documented diagnosis, indicating comprehensive record-keeping. On average, 1.1 (SD= {+/-}0.3) antibiotics were prescribed per prescription encounter, with 2,277 (65.9%) prescribed generic names. Injectable antibiotics were recorded in 166 (4.8%) of prescriptions, while 2,270 (65.7%) of prescriptions adhered to the Zanzibar Standard Treatment Guidelines (STG). The overall mean knowledge score among prescribers was 6.1 (SD = 0.89). 24.3% of prescribers had low knowledge ([≤]5 points), 41.4%had medium knowledge (6 points), and 34.3%had high knowledge ([≥]7 points). A majority of prescribers (90%) reported that they always adhere to the Zanzibar Standard Treatment Guidelines (ZSTG) and Zanzibar Essential Medicines List (ZEML) when prescribing antibiotics. 1.4% of prescribers acknowledged that they sometimes prescribe antibiotics even when unnecessary. Regarding antibiotic selection, 45.7% of prescribers prescribe only generic antibiotics. The study also found that Beta-Lactam antibiotics were the most prescribed, with 98.6% of prescribers confirming their frequent use. According to the results, most of the prescribing indicators in these health facilities did not meet the WHO's standard requirements, thus being irrational (poor rational prescribing).