Infectious diseases burden and antibiotic prescribing patterns among primary care patients in Harare, Zimbabwe – a cross-sectional analysis

Low- and middle-income countries (LMIC) continue to experience a high burden of infectious diseases and disparities in access to and use of antimicrobials, yet data on antibiotic prescribing in outpatient settings, where the majority of global prescriptions occur, remain scarce. The objective of this study is to provide data on diagnoses and antibiotic prescriptions among primary care patients in Harare, Zimbabwe. We conducted a retrospective study of medical records from eight primary care clinics in Harare, Zimbabwe. Clinics were selected based on the population they served and the availability of records. Patient consultations conducted between January 2016 and December 2022 were included. Antibiotic prescriptions were categorised into groups according to the AWaRe (Access, Watch and Reserve) classification. During the study period, 199,880 patient consultations were recorded. The median patient age was 9 years and 52.5% (105,035/199,880) were female. The most common causes of presentation were due to infectious diseases including, in order of frequency, gastroenteritis (15.2%; 30,352/199,880), acute respiratory infections (10.9%; 21,381/199,880) and pneumonia (10.5%; 20,889/199,880). Overall, antibiotics were prescribed in 70.5% (117,674/166,858) of patients who were not referred to hospital. Antibiotics commonly prescribed were amoxicillin (39.4%; 65,825/166,858), ciprofloxacin (10.3%; 17,162/166,858), metronidazole (9.4%; 15,681/166,858). Among those who were prescribed antibiotics and not referred, 70.6% (83,034/117,674) were prescribed ‘Access’ and 29.3% (34,472/117,674) ‘Watch’ group antibiotics. Patients with respiratory infections, including those with upper respiratory infections, and gastroenteritis were frequently prescribed antibiotics. This study shows that infectious diseases remain a common reason for primary care presentation and antibiotics were frequently prescribed. These findings highlight the need for increasing access to diagnostics in primary care, and for antibiotic stewardship and other context-adapted interventions aimed at optimising patient management and reducing unnecessary antibiotic prescriptions.