Infections prevention and control in caesarean section : multifacet analysis of determinants of rational use of antibiotics in Benin

The inappropriate utilization of antibiotics drove to a global public health threat: the antimicrobial resistance. Several strategies were set up to fight the problem such as Infection Prevention and Control which aims to improve the use of antibiotic. Our work identified the bottlenecks of the rational use of antibiotics in Benin in the context of the user fees exemption policy in caesarean section with a national free kit. The findings of our five studies showed: - a misuse, overuse, and underuse of antibiotics before, during and after caesarean section, - a low level of knowledge of antibiotic prophylaxis in healthcare professionals, a lack of confidence in the kit, and some general disagreement with the policy, - some cases of overdosage of active ingredient, - a mixed knowledge of antibiotics and their utilization by patients, - a low involvement of end-implementers during the policy formulation, a mixed-consensual context without scientific evidence-based considerations in the choice of antibiotics in the kit. The analysis of these findings revealed that the bottlenecks of the rational use of antibiotics were in all levels of the Benin healthcare system (healthcare professionals, patients and policymakers). Considering the burden the inappropriate use of antibiotics induces for patient and public health, it is imperative to implement actions to improve the use of antibiotics. Based on the literature, a program named “antimicrobial stewardship” permits to coordinate a set of actions for promoting the prudent use of antimicrobials, with the ultimate goal of optimizing clinical outcomes while minimizing unfavorable consequences including resistance selection as well as adverse drug reactions. This program includes various actions for all actors of the healthcare system such as patient education, healthcare professional training and involvement in Infection Prevention and Control strategies, and policymakers’ commitment. The implementation of this kind of program in hospitals could help to promote the rational use of antibiotics in Benin.