Suboptimal access to ceftriaxone among adult postoperative patients at Mulago National Referral Hospital, Uganda: Prevalence and associated factors

Abstract

<title>Abstract</title> <bold>Background</bold> An estimated 4.95 million deaths associated with bacterial antimicrobial resistance (AMR) occurred globally in 2019. Access to ceftriaxone is still low, causing 11.2% of patients not to complete their treatment in health facilities. Therefore, this study determined the prevalence and factors associated with suboptimal access to ceftriaxone among adult post-operative patients in Mulago National Referral Hospital, Uganda.<bold>Methods</bold> The study employed a cross-sectional design, and was conducted at Mulago National Referral Hospital, among 443 adult postoperative patients who received a prescription for ceftriaxone, from August to November 2023. Ethical approval was obtained from the Mulago Hospital Research and Ethics Committee (Ref: MHREC 2473), and permission was obtained from the Uganda National Council of Science and Technology (ref number: HS2936ES). Suboptimal access was a state where a patient received less than 100% of the prescribed amount of ceftriaxone vails for all postoperative days, from the hospital pharmacy; measured using self-reports and chart reviews. Data were collected from systematically sampled and consented patient caretakers using questionnaires. Data were entered into Epidata software and exported into STATA software version 14.0 for analysis, using Modified Poisson regression.<bold>Results</bold> The median age of 443 patients was 38 years (IQR: 28–50), and 77.9% (345/443) were male. The prevalence of suboptimal access to ceftriaxone was 79% (350/443), and 61% (270/350) of these had no access at all. Factors associated with suboptimal access included; the gender of the patient, knowledge of the pharmacy location, dispensers’ availability, and pharmacy working hours.<bold>Conclusion</bold> Suboptimal access to ceftriaxone among postoperative patients was high. Knowledge of the pharmacy location, gender of the patient, pharmacy dispensers’ availability, and appropriateness of working hours were positive predictors of suboptimal access. Ward emergency drug cabins should be refilled routinely, and hospital pharmacies should open for 24 hours daily. The hospital medicines and supplies budget should be increased, and rational antibiotic use should be investigated.