The prevalence of antibiotic prescription among women attending antenatal care clinic in a sub-municipal hospital and its effect on birth outcomes and neonatal health

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Pregnant women are increasingly being exposed to antibiotics in the bid to reduce neonatal and maternal mortality which is of particular concern in sub-Saharan Africa. In spite of this, few studies have looked at the possible impact of the increased antibiotic exposure on the developing foetus and subsequent childhood health. The main objectives were to evaluate the prevalence of antibiotic use in pregnant women attending antenatal care clinic in a sub-municipal hospital and their appropriateness in pregnancy. Secondly to ascertain its subsequent impact on foetal and neonatal health using birth weight, birth defect and mean Apgar scores as indicators of foetal health and incidence of neonatal sepsis, dermatitis, respiratory tract diseases, neonatal jaundice, ophthalmia neonatorum and number of hospital visits as markers of neonatal health. The study was a retrospective cohort with primary source of data as health records of pregnancy and deliveries in the hospital. A total of 412 mother-infant pairs met the eligibility criteria out of the 2100 folders pre-selected. The prevalence of antibiotic prescriptions among pregnant women included in the study was 65.8 %. Of these, 3.4 % were given for non-bacterial indications whiles 3.4 % received antibiotics potentially unsafe in pregnancy. A woman was about 14 (95 % CI, 5.88 - 32.46, P<0.001) times likely to receive antibiotics if delivered by caesarean section compared to natural birth. General Antibiotic exposure showed no statistically significant association with birthweight (P = 0.80), congenital birth defect (P = 0.97) and mean Apgar scores (P = 0.42). However, antibiotic exposure less than 24 hours to delivery was associated with lower Apgar scores (P = 0.002). Babies exposed to antibiotics intrapartum were at higher risk of dermatitis (RR = 2.6, 95 % CI, 1.3 - 4.9, P = 0.005), respiratory tract diseases (RR = 4.3, 95 % CI, 1.89 - 9.71, P<0.001), neonatal sepsis (RR = 4, 95 % CI, 2.1 - 7.36, P<0.001) ophthalmia neonatorum v | P a g e (RR=2.5, 95 % CI, 1.09 - 5.90, P = 0.024) and neonatal jaundice (RR= 2.5, 95 % CI, 0.93 - 6.71, P = 0.059) compared to non-exposed neonates. Additionally, it was observed that intrapartum antibiotic exposure was associated with a higher mean number of non-review hospital visits (P<0.001). The antibiotic prescription rate of 65.8 % was in excess of the limit of not more than 30 % recommended by the World Health Organisation. Antibiotic use was not associated with any risk of birth defect or intra uterine growth retardation. Perinatal antibiotic exposure and caesarean birth however, were associated with lower mean Apgar scores. Antibiotic exposure with or without caesarean birth were associated with adverse health outcomes in early childhood. Rational use of antibiotic should be re-enforced in the hospital.
A thesis submitted in fulfilment of the requirements for the award of master of philosophy in Clinical Pharmacology in the Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences.