Fig 1.
Flow of antimicrobial resistance through the health care system. *Includes distributors as well; # includes CMS: Central Medical Store; CPS – Central Purchasing Store; and NPS – National Pharmacy Supply.
Fig 2.
Backfilling strategy for the AMC data collection at national level.
Data from central medical stores (CMS, public) were collected in first intention, whenever feasible. Pre-existing MIDAS-IQVIA data were included in the analysis. Data from the tax revenue authorities (import) were included only if no data from central medical stores or from MIDAS-IQVIA were available. The source of national AMC data represented one of the following (i) CMS only; (ii) MIDAS-IQVIA only; (iii) import only; (iv) combined CMS & MIDS-IQVIA; or (v) not available.
Table 1.
Sources providing AMC data to the study.
Fig 3.
DDD per 1,000 inhabitants per day (DID) in available data sources from 11 participating countries.
Fig 4.
Proportion of ATC categories contribution to 66% AMC.
Percentage of ten sub-categories of the JO1 ATC class of antibiotics relative to the total national AMC expressed in DDD. Only the largest sub-categories contributing 66% of the total AMC are shown. Sub-categories with smaller relative contributions to the total AMC are aggregated as ‘others’. Author analysis based on IQVIA private sector pharmaceutical sales data 24 months up to and including the month of December 2018, IQVIA Solutions (Pty)Ltd. All right reserved; S1 Appendix.
Fig 5.
Percentage of Access antibiotic consumption at facilities and at national level: distribution per country.
Percentages of Access drugs in AMC were calculated out of total antibiotic consumption. For each country, the distribution (mean, and 95% CI) of percentage Access drugs across participating facilities is shown alongside the percentage of Access drugs within the national consumption (in red). *No national AMC data were available in Ghana, Nigeria and Zambia. Values above the dotted lines are compliant with the WHO AWaRe target of at least 60% consumption from Access drugs. Author analysis based on IQVIA private sector pharmaceutical sales data 24 months up to and including the month of December 2018, IQVIA Solutions (Pty)Ltd. All right reserved; S2 Appendix.
Fig 6.
Spectrum and frequency of molecules constituting the DU75 at facility level.
(a) Country drug utilization index 75% (DU75) is calculated from aggregated values reported by all participating facilities in individual countries. (b) the bars represent the number of countries where a given antibiotics makes the top 2 of the DU75.
Fig 7.
WHO categorized (Access, Watch and Reserve) and uncategorized antibiotics included in national EML or circulating in country.
The top part of the graphs describes the situation of antibiotics listed in the WHO EML, i.e., (i) documented in the national EML; and/or (ii) documented in the field; or (iii) not documented. The bottom part of the graphs describes the situation of antibiotics not listed in the WHO EML, i.e., (i) documented in the national EML; and/or (ii) documented in the field.