Tackling antimicrobial resistance across dentistry in Sub-Saharan Africa.

What's the challenge?

Tackling antimicrobial resistance (AMR) is crucial for global health and sustainable development. Low- and middle-income countries (LMICs), like Ghana and Uganda, are particularly affected. UK Government has pledged to play a leading role in improving health to deliver a safer and more prosperous world, including through an improved response to AMR.

Globally, dental professionals are responsible for one-in-ten antibiotic prescriptions across human healthcare. In Sub-Saharan Africa (SSA), dental teams are among the highest prescribers of antibiotics, with some studies finding nine out of ten prescriptions outside of guidance. Dental teams in SSA have an essential role to play in keeping antibiotics working.

What are the aims and objectives of our research?

We aim to develop and test ways for dental teams to play their part in tackling AMR in SSA. Our first objective is to understand what influences unnecessary dental antibiotic use in Ghana and Uganda. Our second objective is to work with dental teams and patients as well as policy makers, healthcare service managers and the general public to develop an evidence-based way to reduce antibiotic prescribing by dental professionals.

Our final objective is to prepare for an African-led clinical trial to test whether our proposed approach works. How are we approaching it?

First, to understand what drives unnecessary antibiotic prescribing by dental professionals, we will ask a range of people and observe dental visits in hospitals and community healthcare settings in Ghana and Uganda. The observed dental teams and patients will be invited to interview to share their experience and insights about what influenced decision making during the visit.

To gain wider perspectives on managing dental infections, policy makers, healthcare service managers and members of the public will be invited to take part in interviews and/or focus groups. Next, we will work with our stakeholders to develop evidence-based ways to reduce unnecessary antibiotic prescribing using information gathered in the first stage.

Whilst we are not yet sure what these interventions will be, we think they might relate to hygiene and sterilisation procedures in dental clinics, prescribing guidelines, and education for dental teams. Finally, we will undertake eight in-depth case studies in urban and more rural areas of Ghana and Uganda to check whether the intervention is acceptable to dental teams and patients, and to prepare for a clinical trial by testing some of the details needed to make a trial practical.

What will be the applications and benefits?

The study results will form the basis of a grant application to conduct a clinical trial that evaluates the impact of the interventions on safely reducing antibiotic prescribing by dental professionals across SSA whilst still addressing patients' dental issues. The benefits of this research include expanding scientific knowledge about the factors influencing antibiotic prescribing by dental professionals in LMICs.

Developing interventions to reduce antibiotic prescribing is just the first step; further testing will be needed. Ultimately, by reducing antibiotic prescribing in dentistry, this research will have a positive impact on global health and sustainable development by addressing AMR. Publicity

To ensure visibility of the study and its findings, our research team members and collaborators will engage our stakeholders and audience through various channels, including their expert professional networks, social and other media, academic publications/conferences, and more novel ways using local traditional arts, story, illustrations and visual aids. Lay members from the UK, Ghana and Uganda will help create a plain English summary (and translation to local languages) for the public, and will ensure messaging promotes broader understanding and awareness of the important role of dental teams to keep antibiotics working.