Determinants of antibiotic prescription pattern and appropriateness in paediatric care in Ghana: a generalized estimating equation approach.

Authors

Abena Kaare Aduful, Mame Yaa Nyarko, Margaret L Neizer, Naa Adei Neequaye, Nana Ama Gyabaa, Mirabel S Awuku, Charity A Acheampong, George B Nketiah, Priscilla Tete-Donkor, Fathia E Atadza, Edem M A Tette

Published in

BMJ paediatrics open. Volume 10. Issue 1. Aug 21, 2026. Epub Aug 21, 2026.

Abstract

Rising antibiotic resistance threatens to reverse health gains from antibiotic access, especially in low- and middle-income countries. Identifying factors influencing prescribing patterns and appropriateness is vital to optimising antibiotic use and strengthening antimicrobial stewardship. However, evidence on this in paediatric outpatient care in Ghana is limited.
To identify patient-related and prescriber-related factors associated with antibiotic prescribing patterns and the appropriateness of antibiotic use among paediatric patients.
A retrospective review of outpatient records at the Princess Marie Louise Children's Hospital in Ghana was conducted from 1 April to 30 June 2022. Logistic regression and generalised estimating equations analyses were used, where appropriate, to assess associations between patient age and sex, prescriber rank, prior antibiotic use, fever status and the appropriateness of antibiotic prescribing by indication, choice, dosage, duration, antibiotic tier and multiple-antibiotic use.
Among 16 555 outpatient consultations, 3244 (20%) resulted in an antibiotic prescription, of which 2862 records were analysed. Most patients were male (54%). Male sex was associated with antibiotic prescribing when not indicated (p=0.007), whereas older children (p=0.030) and patients presenting with fever (p=0.036) were less frequently prescribed antibiotics when not indicated. Compared with house officers, specialised nurses and physician assistants were associated with inappropriate use of antibiotics (p<0.001 and p=0.005, respectively); however, they were less likely to prescribe multiple or higher-tier antibiotics. Medical officers and residents were associated with appropriate antibiotic dosing and duration (p=0.004 and p=0.005, respectively), and prior antibiotic use doubled the odds of receiving higher-tier antibiotics (p<0.001).
Patient and prescriber characteristics were significantly associated with antibiotic prescribing patterns and appropriateness. Targeted interventions leveraging these findings are needed to improve prescribing and strengthen antimicrobial stewardship.

PMID:
42629162
Bibliographic data and abstract were imported from PubMed on 22 Aug 2026.

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