From our preliminary data exploration, we can see some evidence of potentially irrational use of antibiotics, although this is only scratching the surface. In Ghana and Nigeria, we see antibiotics commonly dispensed with antimalarials, and in Zambia we see antibiotics commonly dispensed with cold medicine/antihistamines. Additionally, the large percentage of dispensations for a single molecule in Ghana and Nigeria suggests that antibiotic dispensations are not tailored to specific patient presentations or treatment guidelines.

1. Insights on Antibiotics in Ghana,
Nigeria, Zambia and Zimbabwe
Graham Kaplan
February 3rd, 2019
Product Manager, Analytics

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Overuse and irrational prescribing of
antibiotics is a global problem
Use of antibiotics for non-bacterial infections, lack of patient adherence to prescribed
regimen, patient self-prescribing, and poor quality medicines contribute to increased anti-
microbial resistance
Anti-microbial resistance increases health-care costs, length of stay in hospitals, morbidity
and mortality in both developed and developing countries
Discovery of new antibiotics has stagnated, while anti-microbial resistance continues to grow
Without good antibiotic stewardship, we could lose the most effective tools we have against
infectious diseases

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What can we learn about the problem
using mPharma’s data?
For this initial data exploration, we will be looking at antibiotic dispensations by generic
molecule to try and answer three main questions:
Which antibiotics are being dispensed?
Are antibiotic dispensations changing over time?
What other drugs are antibiotics commonly dispensed with?

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Caveats
This is based on mPharma’s pharmaceutical dispensation data from our network of hospitals
and pharmacies, and the completeness and quality of that data varies by country and facility
Data comes from 88 facilities in Ghana, 45 in Nigeria, 22 in Zambia, and 1 in Zimbabwe
The geographic reach of our providers is limited to a small number of cities and towns in these
countries
In most cases we do not have information about what a patient was diagnosed with or the
results of any lab work, which makes it difficult to tell whether prescribing is rational

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Antibiotic share by country
The large share of a single type of antibiotic (particularly in GH & NG) suggests antibiotic
dispensations are not tailored to specific patient presentations or treatment guidelines

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Antibiotic category share by country

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Antibiotic share by month, Ghana

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Antibiotic share by month, Nigeria

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Antibiotic share by month, Zambia

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Frequently
Dispensed
Together,
Ghana
A potential explanation for high prevalence of Amoxicillin/Clavulanic Acid &
Artemether/Lumefantrine co-dispensation is the widespread use of the Widal test to
diagnose typhoid and its high rate of false positives

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Frequently
Dispensed
Together,
Nigeria
Amoxicillin/Clavulanic Acid & Artemether/Lumefantrine co-dispensation is again
highly prevalent

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Frequently
Dispensed
Together,
Zambia
While antibiotics are not frequently dispensed with anti-malarials in Zambia, they are
frequently dispensed with cold medicine/antihistamines (marked with orange dots)

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Frequently
Dispensed
Together,
Zimbabwe
High use of Ceftriaxone administered intramuscularly is unusual but perhaps only
reflective of the single health facility for which we have data in Zimbabwe

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Takeaways
From our preliminary data exploration, we can see some evidence of potentially irrational
use of antibiotics, although this is only scratching the surface!
In Ghana and Nigeria, we see antibiotics commonly dispensed with antimalarials, and in
Zambia we see antibiotics commonly dispensed with cold medicine/antihistamines
Additionally, the large percentage of dispensations for a single molecule in Ghana and
Nigeria suggests that antibiotic dispensations are not tailored to specific patient
presentations or treatment guidelines
With additional work, we will be better able to understand the extent of the issue