INVESTIGATING RATIONAL ANTIBIOTIC PRESCRIBING IN PUBLIC HEALTH CARE FACILITIES OF ZANZIBAR TANZANIA
This cross-sectional study of public health facilities in Zanzibar, Tanzania, reveals that despite high rates of documented diagnoses and self-reported adherence to guidelines, the overall antibiotic prescribing practices remain largely irrational and fail to meet WHO standards.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
In hospitals and clinics around the world, doctors face a daily decision that carries weight far beyond the immediate patient: choosing an antibiotic. These are powerful medicines designed to kill bacteria, the microscopic organisms that cause infections like pneumonia, urinary tract infections, and severe skin wounds. When used correctly, antibiotics save lives. However, when they are used too often, for the wrong reasons, or in the wrong way, bacteria learn to survive them. This survival skill is known as antimicrobial resistance. It is a quiet but growing crisis where common infections become harder to treat, leading to longer illnesses, higher medical costs, and even death. To fight this, health experts have developed a set of rules called "rational prescribing." This simply means giving the right antibiotic, at the right dose, for the right amount of time, and only when it is truly necessary. The goal is to protect these medicines for the future while treating the patient today.
In the semi-autonomous region of Zanzibar, part of Tanzania, researchers set out to see how well these rules were being followed in public health facilities. They focused on the western urban area, a region with thirty government-run health centers and dispensaries. The team, led by researchers from the University of Rwanda and Mzumbe University, did not just ask doctors what they thought they were doing; they looked at the actual paper trails. They examined thousands of prescriptions written by doctors and clinical officers over the course of a full year, from January to December 2023. They also spoke directly with the prescribers to understand their knowledge, their attitudes, and the challenges they face. The study aimed to uncover the gap between the ideal of rational use and the reality on the ground.
The researchers collected and analyzed nearly 3,500 prescriptions from outpatient departments. They found that the medical records were generally well-kept; almost every single prescription had a clear diagnosis written down, showing that doctors knew what they were treating. On average, a patient received just over one antibiotic per visit, a number that falls within the recommended safety limits. However, when the team looked closer at how those antibiotics were written and chosen, the picture became less clear. While most doctors claimed to follow the official treatment guidelines, the actual paperwork told a different story. Only about two-thirds of the prescriptions followed the Zanzibar Standard Treatment Guidelines, which are the local rules for choosing the best medicine. Furthermore, while the World Health Organization recommends that doctors write prescriptions using the generic name of a drug—the universal scientific name that ensures affordability and clarity—only about two-thirds of the prescriptions in this study did so. The rest used brand names, which can be more expensive and harder to track.
The study also revealed a heavy reliance on a specific group of antibiotics known as beta-lactams, which include common drugs like amoxicillin. These were the most frequently prescribed medicines, used by nearly all the doctors surveyed. While these drugs are effective, the study noted that overusing any single type of antibiotic can pressure bacteria to become resistant. Interestingly, the doctors themselves seemed aware of the need for better practices. When asked, ninety percent said they always followed the official guidelines, and almost all agreed that education on antibiotic resistance was necessary. In fact, nearly every single prescriber surveyed said they wanted more training on how to manage these medicines responsibly. Their knowledge scores were mixed; while many had a good grasp of the rules, nearly a quarter had low knowledge scores, suggesting that some doctors might not fully understand the nuances of rational prescribing.
Despite the doctors' good intentions and their desire to learn, the data suggests that the current system is not yet meeting the gold standard for rational antibiotic use. The researchers found that most of the key indicators used to measure success—such as writing prescriptions in generic names and strictly following treatment guidelines—fell short of the targets set by global health organizations. The study did not find evidence of a complete breakdown in the system, but rather a series of small gaps that add up to a larger problem. For instance, while injections of antibiotics were rare, which is a positive sign, the adherence to written guidelines was inconsistent. The researchers concluded that while the average number of antibiotics prescribed was appropriate, the quality of the decision-making process needs improvement.
The path forward, according to the study, lies in bridging the gap between what doctors know and what they practice. The authors suggest that regular training and education are critical, especially since almost every doctor surveyed expressed a need for it. They also recommend making the official treatment guidelines easier to access and ensuring that health facilities have a steady supply of generic medicines so doctors are not forced to use brand names due to shortages. By strengthening these foundations, the hope is that the prescribing habits in Zanzibar can shift closer to the ideal, protecting these vital medicines for the next generation. The study serves as a clear map of where the system stands today, highlighting that while the will to do right exists, the tools and habits to do so perfectly are still being built.
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