Knowledge, attitudes, and practice survey about antimicrobial resistance and prescribing among physicians in a hospital setting in Nairobi, Kenya

Antimicrobial resistance (AMR) is an increasing threat to global health security, potentially compromising gains made in public health worldwide. Resistance has been reported for entire classes of antibiotics, and untreatable multi- drug resistant bacteria are increasingly documented. This study, using a Knowledge, Attitude and Practice (KAP) survey, aimed to describe AMR and antimicrobial prescribing among medical doctors from the Kenyatta National Teaching and Referral Hospital in Nairobi, Kenya. A total of 160 questionnaires were distributed to the four departments of Internal Medicine, Paediatrics, Obstetrics, and Surgery. A total of 107 of the 160 questionnaires were completed (response rate, 66.88%). All the participants agreed that knowledge about antibiotics and their appropriate use is important in their daily work and 64.5% declared that they prescribed antibiotics more than once a day. Participants strongly agreed that AMR is a problem worldwide (97.2%), locally (93.4%), and in daily practice (75.9%). About one third of the participants (33.6%) agreed that they had difficulties choosing an antibiotic. Overall, 85.9 % of the study participants had had fewer than four lectures on antibiotic use as part of academic activities within their departments during the previous year. The majority of the participants also identified that antibiotics are being overused in hospitals across Kenya (91.5%) and in local communities (93.4%) as a whole. Patient demand for antibiotics in outpatient practice was perceived by 88.8% of the participants to contribute to their overuse. Half of the participants (52.4%) suspected that some antibiotics available in their hospital are of poor quality and for that reason do not work. The awareness of AMR as a worldwide and national problem was very high among the participants. The present KAP survey has shown that there is a clear need to carry out research on local AMR rates, to promote confidence in the quality of locally available AMs, and to expand the current residency curriculum to include AM use in greater detail. The lack of standard implementation of local AM guidelines is another issue that should be addressed.