Antimicrobial resistance: learning lessons from antiparasitic, antibacterial and antimycobacterial drug resistance in low-income settings (2)

3 March, 2019

The point made in this posting about irrational antimicrobial prescription in LMICs reminds us about one of the major findings in the PACK Nigeria pilot findings, where it is reported that ‘Clinicians have also reported that PACK Nigeria has improved their clinical knowledge and skills. This improvement has been most pronounced in the reduction of polypharmacy and more appropriate use of laboratory tests observed in all three states since the introduction of PACK Nigeria: “Before PACK I used to prescribe 6-7 drugs per patient, but now I prescribe only 1-2 drugs per patient”. In Adamawa managers reported that the routine prescription of Amoxil antibiotics alongside ACTs (Artemisinin-based Combination Therapy) in the treatment of malaria has been eliminated in Fufore Local Government Area (LGA) since the pilot began (because PACK recommends confirming diagnosis in patients with fever using rapid diagnostic test strip).’’

It is a rampant bad practice across the country that most prescription of antimalaria ACT is accompanied by an antibiotics often to ‘cover for possible undiagnosed typhoid'!!. (BMJ Global Health Oct 2018, 3 (Suppl 5) e001079; DOI: 10.1136/bmjgh-2018-001079 )

Joseph Ana


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

National Implementing Organisation: PACK Nigeria Programme for PHC

Publisher: Medical and Health Journals; Books and Periodicals.

Nigeria: 8 Amaku Street, State Housing & 20 Eta Agbor Road, Calabar.

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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group:

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