Benin; antibiotic prophylaxis practices; beliefs; cesarean section; healthcare professionals; knowledge; Microbiology; Biochemistry; Pharmacology, Toxicology and Pharmaceutics (all); Microbiology (medical); Infectious Diseases; Pharmacology (medical); General Pharmacology, Toxicology and Pharmaceutics
Abstract :
[en] A low adherence to recommendations on antibiotic prophylaxis has been reported worldwide. Since 2009, cesarean sections have been performed under user fee exemption in Benin with a free kit containing the required supplies and antibiotics for prophylaxis. Despite the kit, the level of antibiotic prophylaxis achievement remains low. We conducted a convergent parallel design study in 2017 using a self-administered questionnaire and interviews to assess the knowledge and explore the beliefs of healthcare professionals regarding antibiotic prophylaxis in three hospitals. Of the 35 participants, 33 filled out the questionnaire. Based on the five conventional criteria of antibiotic prophylaxis, the mean level of knowledge was 3.3 out of 5, and only 15.2% scored 5 out of 5. From the verbatim of 19 interviewees, determinants such as suboptimal patient status health, low confidence in antibiotics, some disagreement with the policy, inappropriate infrastructures and limited financial resources in hospitals, poor management of the policy in the central level, and patient refusal to buy antibiotics can explain poor practices. Because of the dysfunction at these levels, the patient becomes the major determinant of adequate antibiotic prophylaxis. Policymakers have to consider these determinants for improving antibiotic prophylaxis in a way that ensures patient safety and reduces the incidence of antimicrobial resistance.
Disciplines :
Pharmacy, pharmacology & toxicology
Author, co-author :
Dohou, Angèle Modupè ; Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium ; Faculté des Sciences de la Santé, Université d'Abomey Calavi, Cotonou 01 BP 188, Benin
Buda, Valentina Oana ; Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
Anagonou, Severin; Faculté des Sciences de la Santé, Université d'Abomey Calavi, Cotonou 01 BP 188, Benin
Van Bambeke, Françoise ; Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium
UCL - Université Catholique de Louvain [BE] ARES - Académie de Recherche et d'Enseignement Supérieur [BE]
Funding text :
Funding: This work was funded in frame of PhD research by Commission de l’Action International of Université catholique de Louvain, Belgium and Académie de la Recherche et d’Enseignement Supérieur, Belgium.
World Health Organization. Caesarean Section Rates Continue to Rise, amid Growing Inequalities in Access. https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access (ac-cessed on 30 May 2022).
De Nardo, P.; Gentilotti, E.; Nguhuni, B.; Vairo, F.; Chaula, Z.; Nicastri, E.; Nassoro, M.; Bevilacqua, N.; Ismail, A.; Savoldi, A.; et al. Post-caesarean section surgical site infections at a Tanzanian tertiary hospital: A prospective observational study. J. Hosp. Infect. 2016, 93, 355–359. https://doi.org/10.1016/j.jhin.2016.02.021.
Ye, J.; Zhang, J.; Mikolajczyk, R.; Torloni, M.R.; Gülmezoglu, A.M.; Betran, A.P. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: A worldwide population-based ecological study with longitudinal data. BJOG Int. J. Obstet. Gynaecol. 2015, 123, 745–753. https://doi.org/10.1111/1471-0528.13592.
Schantz, C.; Aboubakar, M.; Traoré, A.B.; Ravit, M.; de Loenzien, M.; Dumont, A. Caesarean section in Benin and Mali: Increased recourse to technology due to suffering and under-resourced facilities. Reprod. Biomed. Soc. Online 2020, 10, 10–18. https://doi.org/10.1016/j.rbms.2019.12.001.
Richard, F.; Ouattara, F.; Zongo, S. Fear, guilt, and debt: An exploration of women’s experience and perception of cesarean birth in Burkina Faso, West Africa. Int. J. Women's Health 2014, 6, 469–478. https://doi.org/10.2147/ijwh.s54742.
UN-DESA. Sustainable Development goal 3. 2017. Available online: https://www.un.org/sustainabledevelopment/health/(ac-cessed on 28 July 2020).
Ravit, M.; Audibert, M.; Ridde, V.; de Loenzien, M.; Schantz, C.; Dumont, A. Removing user fees to improve access to caesarean delivery: A quasi-experimental evaluation in western Africa. BMJ Glob. Health 2018, 3, e000558. https://doi.org/10.1136/bmjgh-2017-000558.
Witter, S.; Team, F.; Boukhalfa, C.; Cresswell, J.A.; Daou, Z.; Filippi, V.; Ganaba, R.; Goufodji, S.; Lange, I.L.; Marchal, B.; et al. Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco. Int. J. Equity Health 2016, 15, 123. https://doi.org/10.1186/s12939-016-0412-y.
Ouedraogo, T.L.; Kpozehouen, A.; Gléglé-Hessou, Y.; Makoutodé, M.; Saizonou, J.; Tchama-Bouraima, M. Évaluation de la mise en œuvre de la gratuité de la césarienne au Bénin. SantéPublique 2013, 25, 507–515. https://doi.org/10.3917/spub.134.0507.
Centre de Recherche en Reproduction Humaine et en Démographie. L’évaluation De La Polotique De Gratuité De La Césarienne Dabs Cinq Zones Sanitaires, Bénin. FEMhealth, March 2014. Available online: extension://elhekieabhbkpmcefcoobjd-digjcaadp/https://www.abdn.ac.uk/smmsn/documents/femhealth-PAC00117_Policy_Document_Benin-FRENCHLO.pdf (ac-cessed on 1 June 2022).
UNICEF. Data Warehouse. UNICEF DATA, 2019. Available online: https://data.unicef.org/resources/data_explorer/uni-cef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=.MNCH_CSEC..&startPeriod=2015&endPeriod=2018 (accessed on 1 June 2022).
UNICEF. Maternal Mortality—UNICEF DATA. UNICEF DATA, September 2019. Available online: https://data.unicef.org/to-pic/maternal-health/maternal-mortality/(accessed on 29 May 2022).
Dossou, J.-P.; Cresswell, J.A.; Makoutodé, P.; De Brouwere, V.; Witter, S.; Filippi, V.; Kanhonou, L.G.; Goufodji, S.B.; Lange, I.L.; Lawin, L.; et al. ‘Rowing against the current’: the policy process and effects of removing user fees for caesarean sections in Benin. BMJ Glob. Health 2018, 3, 1–14. https://doi.org/10.1136/bmjgh-2017-000537.
Mongbo, V.; Godin, I.; Mahieu, C.; Ouendo, E.M.; Ouédraogo, L. La césarienne dans le contexte de gratuité au Bénin. Santé Publique 2016, 28, 399–407. https://doi.org/10.3917/spub.163.0399.
Ravit, M.; Audibert, M.; Ridde, V.; de Loenzien, M.; Schantz, C.; Dumont, A. Do free caesarean section policies increase inequalities in Benin and Mali? Int. J. Equity Health 2018, 17, 71.
Dohou, A.M.; Buda, V.O.; Yemoa, L.A.; Anagonou, S.; Van Bambeke, F.; Van Hees, T.; Dossou, F.M.; Dalleur, O. Antibiotic Usage in Patients Having Undergone Caesarean Section: A Three-Level Study in Benin. Antibiotics 2022, 11, 617. https://doi.org/10.3390/antibiotics11050617.
World Health Organization. WHO Recommendation on Prophylactic Antibiotics for Women Undergoing Caesarean Section; World Health Organization: Geneva, Switzerland, 2021; pp. 1–64. Available online: https://apps.who.int/iris/handle/10665/341865 (ac-cessed on 10 April 2022).
de Tejada, B. Antibiotic Use and Misuse during Pregnancy and Delivery: Benefits and Risks. Int. J. Environ. Res. Public Health 2014, 11, 7993–8009. https://doi.org/10.3390/ijerph110807993.
van Schalkwyk, J.; van Eyk, N. Antibiotic Prophylaxis in Obstetric Procedures. J. Obstet. Gynaecol. Can. 2017, 39, e293–e299. https://doi.org/10.1016/j.jogc.2017.06.007.
Mylonas, I. Antibiotic chemotherapy during pregnancy and lactation period: Aspects for consideration. Arch. Gynecol. Obstet. 2011, 283, 7–18. https://doi.org/10.1007/s00404-010-1646-3.
Gindre, S.; Carles, M.; Aknouch, N.; Jambou, P.; Dellamonica, P.; Raucoules-Aimé, M.; Grimaud, D. Antibioprophylaxie chirur-gicale: Évaluation de l’application des recommandations et validation des kits d’antibioprophylaxie. Ann. Françaises D’anesthé-sie Et De Réanimation 2004, 23, 116–123. https://doi.org/10.1016/j.annfar.2003.12.016.
Kayihura, V.; Osman, N.B.; Bugalho, A.; Bergström, S. Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low-income countries: A cost-benefit study in Mozambique. Acta Obstet. Gynecol. Scand. 2003, 82, 636–641. https://doi.org/10.1034/j.1600-0412.2003.00205.x.
Ocran, I.; Tagoe, D.N.A. Knowledge and attitude of healthcare workers and patients on healthcare associated infections in a regional hospital in Ghana. Asian Pac. J. Trop. Dis. 2014, 4, 135–139. https://doi.org/10.1016/S2222-1808(14)60330-3.
Ravit, M.; Philibert, A.; Tourigny, C.; Traore, M.; Coulibaly, A.; Dumont, A.; Fournier, P. The Hidden Costs of a Free Caesarean Section Policy in West Africa (Kayes Region, Mali). Matern. Child Health J. 2015, 19, 1734–1743. https://doi.org/10.1007/s10995-015-1687-0.
Baadani, A.M.; Baig, K.; Alfahad, W.A.; Aldalbahi, S.; Omrani, A.S. Physicians’ knowledge, perceptions, and attitudes toward antimicrobial prescribing in Riyadh, Saudi Arabia. Saudi Med. J. 2015, 36, 613–619. https://doi.org/10.15537/smj.2015.5.11726.
Traore, I.A.; Dakouré, P.W.H.; Zaré, C.; Ki, K.B.; Kambou, T.; Joachim, S.; Nazinigouba, O. Evaluation Des Connaissances Et Des Pratiques Sur L’antibioprophylaxie Chirurgicale Dans La Ville De Bobo-Dioulasso (Burkina-Faso). Available online: https://web-saraf.net/Evaluation-des-connaissances-et.html (accessed on 25 May 2016).
Tóth, H.; Fésűs, A.; Kungler-Gorácz, O.; Balázs, B.; Majoros, L.; Szarka, K.; Kardos, G. Utilization of Vector Autoregressive and Linear Transfer Models to Follow Up the Antibiotic Resistance Spiral in Gram-negative Bacteria From Cephalosporin Con-sumption to Colistin Resistance. Clin. Infect. Dis. 2018, 69, 1410–1421. https://doi.org/10.1093/cid/ciy1086.
Nair, M.; Tripathi, S.; Mazumdar, S.; Mahajan, R.; Harshana, A.; Pereira, A.; Jimenez, C.; Halder, D.; Burza, S. Knowledge, attitudes, and practices related to antibiotic use in Paschim Bardhaman District: A survey of healthcare providers in West Ben-gal, India. PLoS ONE 2019, 14, e0217818. https://doi.org/10.1371/journal.pone.0217818.
Gouvêa, M.; Novaes, C.D.O.; Pereira, D.M.T.; Iglesias, A.C. Adherence to guidelines for surgical antibiotic prophylaxis: A re-view. Braz. J. Infect. Dis. 2015, 19, 517–524. https://doi.org/10.1016/j.bjid.2015.06.004.
Liabsuetrakul, T.; Chongsuvivatwong, V.; Lumbiganon, P.; Lindmark, G. Obstetricians’ attitudes, subjective norms, perceived controls, and intentions on antibiotic prophylaxis in caesarean section. Soc. Sci. Med. 2003, 57, 1665–1674. https://doi.org/10.1016/s0277-9536(02)00550-6.
Vahdat, S.; Hamzehgardeshi, L.; Hessam, S.; Hamzehgardeshi, Z. Patient Involvement in Health Care Decision Making: A Re-view. Iran. Red. Crescent Med. J. 2014, 16, e12454. https://doi.org/10.5812/ircmj.12454.
Ray, R. Designing and Conducting Mixed Methods Research [Book Review]. Qual. Res. J. 2007, 7, 90–91. https://doi.org/10.3316/qrj0702090.
Bengtsson, M. How to plan and perform a qualitative study using content analysis. NursingPlus Open 2016, 2, 8–14. https://doi.org/10.1016/j.npls.2016.01.001.
