## 2 Results
### Prevalence of Antimicrobial Use  
The prevalence of antimicrobial use (AMU) was 50% from the 17 sites across the four countries (Table 2). The proportion of patients treated with antimicrobials at the time of the survey was highest in Zambia (57%), followed by Ghana (55%) and Uganda (45%), and was lowest in Tanzania (30%). There was a total of 3838 prescriptions recorded in the survey, 2435 (63%) of which were reported from hospitals in Ghana, 710 (18.5%) from Uganda, 402 (10.5%) from Zambia, and 290 (7.5%) from Tanzania. Of these prescriptions, those in the ATC J01 category (antibacterials for systemic use) were further classified into each of the WHO AWaRe categories (Figure 1). There was no reported use (0%) of the Reserve category of antibiotics in any of the four countries. \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Characteristics** & **Ghana** & **Uganda** & **Zambia** & **T Tanzania** \\ \hline
**Number of Hospitals** & 10 & 4 & 2 & 1 \\ \hline
**Number of Treated Patients** & 1366 & 386 & 238 & 179 \\ \hline
**Patient Age** & & & & \\ Neonate (\(\leq\)1 month) & 150 (11\%) & 20 (5\%) & 32 (13\%) & 34 (19\%) \\ Child (\(>\)1 month-\(\leq\)17 years) & 261 (19\%) & 136 (35\%) & 35 (15\%) & 29 (16\%) \\ Adult (\(\geq\)18 years) & 955 (70\%) & 214 (56\%) & 171 (72\%) & 116 (65\%) \\ Unknown & - & 16 (4\%) & - & - \\ \hline
**Patient Gender** & & & & \\ Male & 570 (41.7\%) & 162 (42\%) & 96 (40\%) & 93 (52\%) \\ Female & 794 (58.1\%) & 205 (53\%) & 142 (60\%) & 84 (46.9\%) \\ Unknown & 2 (0.2\%) & 19 (5\%) & - & 2 (1.1\%) \\ \hline
**Ward Activity** & & & & \\ Medicine & 76 (46\%) & 28 (54\%) & 9 (45\%) & 7 (35\%) \\ Surgery & 74 (45\%) & 22 (42\%) & 7 (35\%) & 10 (50\%) \\ Intensive Care & 15 (9\%) & 2 (4\%) & 4 (20\%) & 3 (15\%) \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Characteristics of wards and patients (treated with at least one antimicrobial) in PPS conducted at 17 hospitals. \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Country** & **Admitted Patients** & **Treated Patients** & **Prevalence of AMU (\%)** \\ \hline Ghana & 2502 & 1366 & 55 \\ Uganda & 862 & 386 & 45 \\ Zambia & 418 & 238 & 57 \\ Tanzania & 594 & 179 & 30 \\ \hline Total & 4376 & 2169 & 50 \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Prevalence of antimicrobial use in four countries included in PPS. Figure 1: The proportion of antibiotics in the ACT J01 group prescribed in each of four countries. Antibiotics in the WHO access category were prescribed more frequently than those in other categories across all countries and were prescribed at similar rates, accounting for 60% of the total of ATC J01 antibiotics prescribed in Ghana (1212/2071), 52% in Uganda (309/592), 58% in Zambia (201/347), and 59% in Tanzania (170/288) (Figure 1). Antibiotics in the Watch category were the second most frequently prescribed, again with proportions being similar for all countries (Ghana 42%; \(n=851\), Uganda 39%; \(n=232\), Zambia 41% \(n=143\), Tanzania 38%; \(n=109\)). There was no reported use (0%) of the Reserve category antibiotics in any of the four countries. 'Not Recommended' antibiotic combinations were prescribed in Uganda, Tanzania, and Ghana. Ugandan hospitals had the highest prescription rate of these drugs (8%; 48/592) with 47 prescriptions of Ampiclov(@0) (ampicillin and cloxacillin) (7% of total prescriptions) and one of ciprofloxacin and metronidazolezo. In Tanzania, Ampiclov(@0) was prescribed on 9 occasions (3% of total prescriptions). In Ghana, the \"Not Recommended\" group of antibiotics made up 0.2% of antibiotic prescriptions (4/1212) with ceftaxone/beta-lactamase inhibitor being prescribed twice, ceftaxone in combination with another unspecified antibiotic prescribed once and penicillin in combination with another, unspecified antibacterial also prescribed once. Unclassified antibiotics were prescribed very infrequently in all countries.