Antibiotic use among patients with malaria and co-existing diagnoses in tertiary hospitals in Uganda
- 1Uganda Public Health Fellowship Program, Uganda National Institute of Public Health
- 2Infectious Diseases Institute, Makerere University
Abstract
Introduction Inappropriate antibiotic use is a major contributor to antimicrobial resistance (AMR) worldwide, especially in settings with high disease burden. This study used Point Prevalence Survey (PPS) data to determine the rate and factors associated with antibiotic use among hospitalized patients with a recorded malaria diagnosis and at least one additional recorded diagnosis in selected regional referral hospitals in Uganda. Methods We conducted a secondary analysis of antibiotic use data from the PPS conducted between October 2020 and November 2023 at nine regional referral hospitals across Uganda. We analyzed data from 1,092 patient records in which malaria was recorded with at least one additional diagnosis. We defined non-adherence to standard treatment guidelines as any antibiotic prescription that did not comply with one or more of the 5Rs of Antimicrobial Stewardship (AMS) and used modified Poisson regression to estimate prevalence ratios (PRs) for factors associated with non-adherence to national antibiotic prescribing guidelines. Results We reviewed 9,008 records, among which 1,092 (12%) had malaria as part of the diagnosis. Among the 1,092, the median age was 7 (IQR:3–16), 581 (53%) were female, 738 (68%) were admitted to pediatric wards, and 464 (42%) received antibiotic prescriptions that were not adherent to national guidelines. Non-adherence to the Uganda Clinical Guidelines varied significantly, with the highest level (48%) observed in the medical ward. “Other” was the most common indication for non-adherent antibiotic prescription. Most (61%) prescribed antibiotics fell into the Watch category of the WHO AWaRe classification, and general practitioners made 923 (84.5%) of all prescriptions. Multivariable analysis indicated that medical prophylaxis (aPR = 1.81, 95% CI = 1.47–2.24), having an infectious syndrome (aPR = 2.15, 95% CI = 1.76–2.63), and other indications (aPR = 1.97, 95% CI = 1.65–2.37) were significantly associated with non-adherence to national guidelines. Conclusion Nearly half of patients hospitalized with malaria and co-existing diagnoses received antibiotics outside the national prescription guidelines, often for non-specific indications, mostly by general practitioners. Targeted stewardship interventions, such as prescriber training, improved point-of-care diagnostics, routine audits and feedback, and integrating stewardship support into malaria programming, may help optimize antibiotic use and support broader AMR containment efforts in similar settings.
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BibTeX
@article{katumba2026antibiotic,
title = {{Antibiotic use among patients with malaria and co-existing diagnoses in tertiary hospitals in Uganda}},
author = {Hannington Katumba and Suzan Nakasendwa and Vivian Twemanye and Conrad Tumwine and Richard Migisha and Benon Kwesiga and Lillian Bulage and Jonathan Mayito and Daniel Bulwadda and Mackline Hope and J. P. Waswa and Reuben Kiggundu and Richard Walwema and Dathan M. Byonanebye and Francis Kakooza and Alex Riolexus Ario and Andrew Kambugu},
journal = {Discover Medicine},
year = {2026},
month = oct,
doi = {10.1007/s44337-026-00734-1},
url = {https://doi.org/10.1007/s44337-026-00734-1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Antibiotic use among patients with malaria and co-existing diagnoses in tertiary hospitals in Uganda
AU - Hannington Katumba
AU - Suzan Nakasendwa
AU - Vivian Twemanye
AU - Conrad Tumwine
AU - Richard Migisha
AU - Benon Kwesiga
AU - Lillian Bulage
AU - Jonathan Mayito
AU - Daniel Bulwadda
AU - Mackline Hope
AU - J. P. Waswa
AU - Reuben Kiggundu
AU - Richard Walwema
AU - Dathan M. Byonanebye
AU - Francis Kakooza
AU - Alex Riolexus Ario
AU - Andrew Kambugu
PY - 2026
DA - 2026/10/25
JO - Discover Medicine
DO - 10.1007/s44337-026-00734-1
UR - https://doi.org/10.1007/s44337-026-00734-1
AB - Introduction Inappropriate antibiotic use is a major contributor to antimicrobial resistance (AMR) worldwide, especially in settings with high disease burden. This study used Point Prevalence Survey (PPS) data to determine the rate and factors associated with antibiotic use among hospitalized patients with a recorded malaria diagnosis and at least one additional recorded diagnosis in selected regional referral hospitals in Uganda. Methods We conducted a secondary analysis of antibiotic use data from the PPS conducted between October 2020 and November 2023 at nine regional referral hospitals across Uganda. We analyzed data from 1,092 patient records in which malaria was recorded with at least one additional diagnosis. We defined non-adherence to standard treatment guidelines as any antibiotic prescription that did not comply with one or more of the 5Rs of Antimicrobial Stewardship (AMS) and used modified Poisson regression to estimate prevalence ratios (PRs) for factors associated with non-adherence to national antibiotic prescribing guidelines. Results We reviewed 9,008 records, among which 1,092 (12%) had malaria as part of the diagnosis. Among the 1,092, the median age was 7 (IQR:3–16), 581 (53%) were female, 738 (68%) were admitted to pediatric wards, and 464 (42%) received antibiotic prescriptions that were not adherent to national guidelines. Non-adherence to the Uganda Clinical Guidelines varied significantly, with the highest level (48%) observed in the medical ward. “Other” was the most common indication for non-adherent antibiotic prescription. Most (61%) prescribed antibiotics fell into the Watch category of the WHO AWaRe classification, and general practitioners made 923 (84.5%) of all prescriptions. Multivariable analysis indicated that medical prophylaxis (aPR = 1.81, 95% CI = 1.47–2.24), having an infectious syndrome (aPR = 2.15, 95% CI = 1.76–2.63), and other indications (aPR = 1.97, 95% CI = 1.65–2.37) were significantly associated with non-adherence to national guidelines. Conclusion Nearly half of patients hospitalized with malaria and co-existing diagnoses received antibiotics outside the national prescription guidelines, often for non-specific indications, mostly by general practitioners. Targeted stewardship interventions, such as prescriber training, improved point-of-care diagnostics, routine audits and feedback, and integrating stewardship support into malaria programming, may help optimize antibiotic use and support broader AMR containment efforts in similar settings.
SN - 3004-8885
ER -