A randomised experiment exploring antibiotic prescribing practices among private health facilities in Tanzania

This study, embedded in a wider evaluation of quality of care in private health facilities in Tanzania, aims to identify the role of patient knowledge and provider driven demand in over-prescription of antibiotics.

Tackling the irrational use of antibiotics in outpatient settings is seen as a cornerstone of the global fight against AMR, but the drivers of unnecessary antibiotic prescriptions are still poorly understood, particularly in low- and middle-income countries. This study, embedded in a wider evaluation of quality of care in private health facilities in Tanzania, aims to identify the role of patient knowledge and provider driven demand in over-prescription of antibiotics. A standardised patient, or mystery shopper, presented to each participating health facility with symptoms of an uncomplicated upper respiratory tract infection which did not merit antibiotics. Facilities were randomised to receive the standard case, or a patient who additionally demonstrated knowledge of correct prescription practices. All drugs prescribed and patient expenditure were recorded. An earlier facility survey allows further exploration of the role of health provider payment and incentives in prescription practices.

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