Determinants of Antibiotic Prescribing for Acute Respiratory Infections in Primary Care: A Retrospective Cross-Sectional Study at the Eduardo Mondlane University Health Center, Maputo, Mozambique
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Introduction
Acute respiratory infections (ARIs) constitute one of the leading reasons for primary care consultations and, despite being frequently viral in etiology, continue to be inappropriately treated with antibiotics, contributing to the rise of antimicrobial resistance. In Mozambique, evidence on the clinical factors associated with antibiotic prescribing in patients with ARIs remains scarce, particularly in studies conducted in the general population.
Objective
To identify the clinical factors associated with antibiotic prescribing in patients with ARIs attended at the Eduardo Mondlane University Health Center (CS-UEM) between April and August 2024.
Methods
An observational, descriptive, cross-sectional, retrospective study with a quantitative approach, based on a convenience sample of 196 clinical records of patients with ARIs. Demographic, clinical, and prescriber-related variables were collected. Bivariate associations were assessed using chi-square (χ 2 ) tests and Cramér’s V. A multivariable logistic regression model was subsequently fitted, whose discriminative capacity was evaluated using the area under the ROC curve (AUC).
Results
The prevalence of antibiotic prescribing was 69.4% (136/196), substantially higher than the range recommended by the World Health Organization (20–26.8%). Amoxicillin was the most frequently prescribed antibiotic (45.4%), followed by azithromycin (26.0%); 43.4% of prescriptions belonged to the WHO AWaRe “Watch” category. In the final multivariable model, clinical category and presenting signs and symptoms were independently and significantly associated with antibiotic prescribing (χ 2 (8) = 36.58; p < 0.001; McFadden’s pseudo-R 2 = 0.151), whereas diagnosis, age, sex, and prescriber nationality showed no statistically significant association. The model demonstrated acceptable discriminative capacity (AUC = 0.760).
Conclusion
At CS-UEM, antibiotic prescribing for patients with ARIs appears to be determined chiefly by the clinical presentation at the time of consultation, rather than by the formal diagnosis or the patient’s demographic characteristics. These findings reinforce the need to implement antimicrobial stewardship interventions tailored to the local context, aimed at promoting the rational use of antibiotics.
