ArticlePloS one2019
Analyzing data from the digital healthcare exchange platform for surveillance of antibiotic prescriptions in primary care in urban Kenya: A mixed-methods study.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 20 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 3 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Prevalence of antibiotics prescription amongst patients with and without COVID-19 in low- and middle-income countries: a systematic review and meta-analysis.Pathogens and global health · 2023Pooled it
- Antimicrobial prescription patterns in East Africa: a systematic review.Systematic reviews · 2023Pooled it
- Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis.PLoS medicine · 2020Pooled it
- Patterns of antibiotic use for acute febrile illness in resource-limited settings: a multicenter study in DR Congo, Kenya and Uganda.Frontiers in public health · 2026Article
- Knowledge and attitudes towards antibiotics and antimicrobial resistance among patients in rural South Africa and the implications for future policies.Frontiers in pharmacology · 2026Article
- Prevalence and Associated Factors for Purchasing Antibiotics Without a Prescription Among Patients in Rural South Africa: Implications for Addressing Antimicrobial Resistance.Antibiotics (Basel, Switzerland) · 2025Article
- Inventory of Survey Instruments for Monitoring Antimicrobial Use in Primary Care Settings in Low- and Middle-Income Countries: A Narrative Review.Antibiotics (Basel, Switzerland) · 2025Review
- Knowledge, Attitudes, and Practices of Iraqi Parents Regarding Antibiotic Use in Children and the Implications.Antibiotics (Basel, Switzerland) · 2025Article
- Knowledge, Attitudes, Motivations, Expectations, and Systemic Factors Regarding Antimicrobial Use Amongst Community Members Seeking Care at the Primary Healthcare Level: A Scoping Review.Antibiotics (Basel, Switzerland) · 2025Review
- Clinical burden of community-associated infections caused by multidrug-resistant Pseudomonas aeruginosa: a propensity-matched longitudinal cohort study in Southern China.GMS hygiene and infection control · 2024Article
- A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications.Medicina (Kaunas, Lithuania) · 2023Review
- SERIES: eHealth in primary care. Part 6: Global perspectives: Learning from eHealth for low-resource primary care settings and across high-, middle- and low-income countries.The European journal of general practice · 2023Article
- A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance.Antibiotics (Basel, Switzerland) · 2023Article
- Digital financial services for health in support of universal health coverage: qualitative programmatic case studies from Kenya and Rwanda.BMC health services research · 2023Article
- Management of febrile illness in rural Guinea over a seven-year period: A retrospective study.PLOS global public health · 2022Article
- Antimicrobial Resistance in Endemic Enteric Infections in Kenya and the Region, and Efforts Toward Addressing the Challenges.The Journal of infectious diseases · 2021Article
- Connected diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya.BMC medical informatics and decision making · 2021Article
- Antimicrobial Resistance in Gram-negative bacteria from Urinary Specimens: a study of prevalence, risk factors and molecular mechanisms of resistance (ARGUS) in Zimbabwe - a study protocol.Wellcome open research · 2020Article
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Corrections and comments
- Erratum issued
Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundKnowledge of antibiotic prescription practices in low- and middle-income countries is limited due to a lack of adequate surveillance systems.
objectiveTo assess the prescription of antibiotics for the treatment of acute respiratory tract infections (ARIs) in primary care.
methodAn explanatory sequential mixed-methods study was conducted in 4 private not-for-profit outreach clinics located in slum areas in Nairobi, Kenya. Claims data of patients who received healthcare between April 1 and December 27, 2016 were collected in real-time through a mobile telephone-based healthcare data and payment exchange platform (branded as M-TIBA). These data were used to calculate the percentage of ARIs for which antibiotics were prescribed. In-depth interviews were conducted among 12 clinicians and 17 patients to explain the quantitative results.
resultsA total of 49,098 individuals were registered onto the platform, which allowed them to access healthcare at the study clinics through M-TIBA. For 36,210 clinic visits by 21,913 patients, 45,706 diagnoses and 85,484 medication prescriptions were recorded. ARIs were the most common diagnoses (17,739; 38.8%), and antibiotics were the most frequently prescribed medications (21,870; 25.6%). For 78.5% (95% CI: 77.9%, 79.1%) of ARI diagnoses, antibiotics were prescribed, most commonly amoxicillin (45%; 95% CI: 44.1%, 45.8%). These relatively high levels of prescription were explained by high patient load, clinician and patient perceptions that clinicians should prescribe, lack of access to laboratory tests, offloading near-expiry drugs, absence of policy and surveillance, and the use of treatment guidelines that are not up-to-date. Clinicians in contrast reported to strictly follow the Kenyan treatment guidelines.
conclusionThis study showed successful quantification of antibiotic prescription and the prescribing pattern using real-world data collected through M-TIBA in private not-for-profit clinics in Nairobi.
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