Pharmaceutical perspective of drivers of antimicrobial resistance and control strategies in Ghana: a best-worst scaling experiment modeling

Background: Antimicrobial resistance (AMR) is an international health concern caused by the inappropriate use of antibiotics. This study sought to evaluate the perceived drivers of AMR and strategies for controlling it, supporting the World Health Organization’s (WHO) and Ghana’s national action plan on AMR. Methods: This cross-sectional study was conducted between July and August 2022 among 200 staff members in medicine sales outlets in the Greater Accra region using a two-stage clustering and simple random sampling method. They completed an interviewer-administered questionnaire. The study used the maximum difference model to determine the perceived drivers of AMR and strategies for controlling it. Results: The results showed that 68.5% of respondents were male. Among them, 83% had 1 to 5 years of experience, with 47.5% working as pharmacists in pharmacy stores. Additionally, 39% had participated in a Pharmacy Council-sponsored antimicrobial dispensing training program. The model results revealed that Non-adherence to antimicrobial prescription was highly prioritized as a driver of AMR (Utility estimate (UE) = 0.579, 95% CI 0.496, 0.664), followed by client’s familiarity with the availability of a pharmacist at the medicine outlet who can offer advice (UE = 0.115, 95% CI 0.038, 0.192), unnecessary antimicrobial prescribing and dispensing (UE = 0.111, 95% CI 0.034, 0.189), as well as random prescription of antibiotics (UE = 0.095, 95% CI 0.018, 0.173). These drivers can be effectively controlled by following medicine outlets’ staff advice for prescribed antibiotics (UE = 0.280, 95% CI 0.189, 0.372), organizing awareness campaigns and educative sessions for medical professionals (UE: 0.224, 95% CI 0.133, 0.316) and conducting antibiotic sensitivity testing before prescribing antibiotics (UE: 0.151, 95% CI 0.060, 0.242). Conclusions: This study offers quantitative information that can enhance the management of antimicrobial use and the implementation of strategies to control antimicrobial resistance, supporting the WHO’s and Ghana’s national action plan on AMR.