Background Antibiotics are the most prescribed medications worldwide. Global consumption rose by 65% in 76 low and middle-income countries between the years 2000 and 2015. According to the World Health Organization, improper administration of antibiotics occurs in over 60% of people with upper respiratory tract infections. Inadvertent antibiotic use has been identified as a contributor to antimicrobial resistance. Outpatient antibiotic use accounts for around 80-90% of all antibiotic use in patients. Clinical officers are non-physician healthcare workers who have received less training, have a more restricted scope of practice than physicians. Clinical officers are key service providers in this country especially at the primary healthcare level. Objective The study assessed the factors that influence antibiotic prescribing for upper respiratory tract infections by clinical officers. Method A prospective study was carried out at 20 public hospitals in Kiambu County, on 36 clinical officers and 600 patient prescriptions. The parameters measured were patient factors, prescriber factors, institutional factors and how they affected the antibiotic prescribing practices by either being rational or irrational. Rational prescribing was identified as prescribing the right drug, at the right frequency, in the right duration, right dose for the right indication. Prescriptions were considered irrational if they did not satisfy any of the rational indices. Data was collected via a questionnaire from the clinical officers while WHO prescription checklist was used to collect data from patient encounters. Data was analyzed using Statistical Package for Social Sciences version 22.0 (SPSS v22.0) with P-value, Confidence Interval and Odds Ratio. Results A total of 600 patient encounters were recorded and 79.8% of the 479 encounters had an antibiotic prescription for URTI, 91% of the antibiotics prescribed were the right dose, 98% had the right frequency, 75% had the right duration, and only 23% had the right indication. Patients above 65 years were more likely to receive an antibiotic prescription OR 3.98 CI 0.91,17.41 P=0.17 compared to children under 12 years old. Males were more likely to receive an antibiotic, but this was not significant OR 1.06 CI 0.70, 1.59 P=0.79. A total of 28 (4.6%) patients had fever, and all received antibiotics. A total of 36 clinical officers were sampled and only 5 (13.8%) were found to have rational prescriptions (P=0.63), prescriber age (P=0.92), prescriber level of education (P=0.99) and prescriber work experience (P=0.22) were not associated with antibiotic prescription. As per institutional factors, availability of antibiotics (P=0.026) and availability of prescription guidelines (P=0.012) were associated with rational prescription of antibiotics. Conclusion The study indicated that there was a high antibiotic prescription rate deviating from the WHO standard. It demonstrated that most antibiotic prescriptions were irrational. Show less

With an emphasis on the implications for Grenada, this systematic study delves into the complexities of setting up a successful primary healthcare system in tiny island states. It is emphasized how crucial primary healthcare is as a community-based, preventative paradigm and how it improves general health outcomes. Many stories of success from similar small island nations show the value of proactive health education and community engagement. One important consideration is financial sustainability, which is demonstrated by the success of many funding schemes in maintaining basic healthcare. Key components identified include public-private partnerships, international collaborations, and novel funding structures. These provide Grenada with useful knowledge for the purpose of mobilizing resources strategically. It has been determined that effective organization frameworks and proactive stakeholder involvement are essential to primary healthcare success. In response to the particular requirements of tiny island populations, collaborative initiatives promote inclusive and responsive healthcare systems. Education initiatives and competitive pay are two tactics used to prevent brain drain that help keep qualified workers in the workforce and ensure the sustainability of the healthcare system. The requirements for infrastructure include the thoughtful positioning of medical facilities, the incorporation of technology, and creative approaches to transportation problems. Especially in rural locations, these factors are critical to improving accessibility and the general effectiveness of healthcare delivery. The review’s conclusions point to the need for a customised strategy for Grenada. Key elements include proactive health education, diverse funding options, cooperative governance, healthcare professional retention plans, and strategic infrastructure development. Grenada can set the stage for a robust and efficient primary healthcare system that takes into account the particular advantages and disadvantages of its tiny island setting by implementing these findings into policy and practise. Show less