Factors associated with antibiotic prescription among healthcare workers at tertiary hospitals in Nairobi County, Kenya

  • OW Mbuthia Mount Kenya University
  • EN Ndonga
  • SO Odiwour
  • MW Muraguri
Keywords: Antibiograms, Antibiotic prescription, Antibiotic resistance, Kenya Essential Medicines List, Policy


Background: Globally, there has been an overall decline in the effectiveness of antibiotics resulting in an upsurge in bacterial resistance, increased cost of healthcare and consequent high morbidity and mortality rates.

Objective: To determine antibiotic prescription practices among healthcare workers at the Kenyatta National Hospital, Mbagathi, Pumwani Maternity and Mama Lucy Kibaki Hospitals, Nairobi, Kenya.

Methods: The study design was a mixture of quantitative and qualitative methods. Self-administered questionnaires were used to gather information from 230 prescribing healthcare workers. Interviews and Focus Group Discussions (FGDs) were conducted purposively with the prescribing healthcare workers and patients to obtain qualitative data.

Results: There was a significant difference in the distribution of study participants with regards to the availability of antibiotics prescribing policy (p = 0.05). Only 53 (23%) prescribers prescribed antibiotics as per the policy guide while 51 (22.2%) did not and 126 (54.8%) were not sure. Oral antibiotics (OR = 0.5, 95%CI 0.3-0.9), always referring to the 2016 Kenya Essential Medicines List (KEML) to prescribe antibiotics (OR = 4.2, 95%CI 1.3-13.1), separating antibiograms for inpatient and outpatient departments (OR = 4.3, 95%CI 1.11-15.5), and confidence of healthcare workers to prescribe antibiotics without laboratory tests (OR = 0.3, 95%CI 0.2-0.8) were associated with the prescription of antibiotics.

Conclusion: There is need to improve antibiotic prescription practices among healthcare workers in public tertiary hospitals in Nairobi County to promote rational antibiotic use and control bacterial resistance.


World Health Organization. Essential medicines and health products: The Pursuit of Responsible Use of Medicines: Sharing and Learning from Country Experiences 2017. Available at: http://www.who.int/medicines/areas/rational_use/en/ Accessed in October 2018.

Means AR, Weaver MR, Burnett SM, Mbonye MK, Naikoba S, McClelland RS. Correlates of inappropriate prescribing of antibiotics to patients with malaria in Uganda. PLoS ONE 2014; 9: e90179.

Isah A, Ross-Degnan D, Quick J, Laing R, Mabadeje A. The development of standard values for the WHO drug use prescribing indicators. International Conferences on Improving Use of Medicines 2014; 1–6.

Ofori-Asenso R, Brhlikova P, Pollock AM. Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995–2015). BMC Public Health 2016; 16: 724.

Risk R, Naismith H, Burnett A, Moore SE, Cham M, Unger S. Rational prescribing in paediatrics in a resource-limited setting. Arch Dis Child 2013; 98: 503–509.

Gulliford MC, Dregan A, Moore MV, Ashworth M, Staa T, McCann G, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: a survey of 568 UK general practices. BMJ Open 2014; 4: e006245.

Braykov NP, Morgan DJ, Schweizer ML, Uslan DZ, Kelesidis T, Weisenberg SA, et al. Assessment of empirical antibiotic therapy optimisation in six hospitals: An observational cohort study. The Lancet Infect Dis 2014; 14: 1220–1227.

World Health Organization. WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health. World Health Organization 2014. Available at https://www.who.int/mediacentre/news/releases/2014/amr-report/en/ Accessed on 13th August 2018.

Mulwa NC, Osanjo GO, Ndwigah SN, Kaburi AN, Muriuki G. Patterns of Prescribing Practices in Makueni County Referral Hospital, Kenya. Afr J Pharmacol Therap 2015; 4: 161–168.

Nairobi County Government. Nairobi City County, Pumwani Maternity Hospital. 2019. Available at https://nairobi.go.ke/pumwani-maternity-hospital/.

Daniel W. Biostatistics: A Foundation for Analysis in the Health Sciences (7th edition). Technometrics. John Wiley & Sons. 1999..

Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core Elements of Outpatient Antibiotic Stewardship. Morbidity and Mortality Weekly Report. Recommendations and Reports 2016: 65; 1–12.

Om C, Vlieghe E, McLaughlin JC, Daily F, McLaws ML. Antibiotic prescribing practices: A national survey of Cambodian physicians. Am J Infect Control 2016; 44: 1144–1148.

Ntšekhe M and Tjipura D. Antibiotic Prescribing Patterns at Six Hospitals in Lesotho. Submitted to the US Agency for International Development by the Strengthening Pharmaceutical Systems (SPS) Program. Arlington, VA: Management Sciences for Health. Strengthening 2011; 1-40

Tunger O, Karakaya Y, Cetin CB, Dinc G, Borand H. Rational antibiotic use. J Infect Developing Ctries 2009; 3: 88-93.

Holloway KA. Promoting the rational use of antibiotics. Regional Health Forum 2011; 15: 122-130.

Babalola CPI, Awoleye SA, Akinyemi JO, Olayinka K. Evaluation of prescription pattern in Osun State (Southwest) Nigeria. J Public Health Epidemiol 2001; 3: 94–98.

Pulcini C, Botelho-Nevers E, Dyar OJ, Harbarth S. The impact of infectious disease specialists on antibiotic prescribing in hospitals. Clin Microbiol Infect 2014; 20: 963-972.

Wang KY, Seed P, Schofield P, Ibrahim S, Ashworth M. Which practices are high antibiotic prescribers? A cross-sectional analysis. Brit J Gen Pract 2009; 59: 724–727.

MacKenzie FM, Gould IM, Bruce J, Mollison J, Monnet DL, Krcmery V, et al. The role of microbiology and pharmacy departments in the stewardship of antibiotic prescribing in European hospitals. J Hosp Infect 2007; 65: 73–81.

Pulcini C, Williams F, Molinari N, Davey P, Nathwani D. Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: A survey in France and Scotland. Clin Microbiol Infect 2011; 17: 80–87.

Sivagnanam G, Thirumalaikolundusubramanian P, Mohanasundaram J, Raaj AA, Namasivayam KRS. A survey on current attitude of practising physicians upon usage of antimicrobial agents in southern part of India. MedGenMed : Medscape Gen Med 2004; 6: 1.

Original Research