## 2 Results
### Reason for Prescribing Antimicrobials  
The main reasons for prescribing antimicrobials for each country are shown in Figure 2. Across all countries, antimicrobials were most often prescribed for prophylaxis for obstetric or gynaecological surgery, making up between 12 and 18% of total prescriptions (Figure 2). Antimicrobials were next most frequently prescribed for pneumonia or lower respiratory tract infections, in all but Tanzania, where drugs used as medical prophylaxis for new-born risk factors was the second most common reason for prescribing (15% of total). \begin{table}
\begin{tabular}{c c c c c} \hline \hline \multirow{2}{*}{**Therapeutic Subgroup**} & \multicolumn{4}{c}{**Proportional Antimicrobial Use (\% of Prescriptions)**} \\ \cline{2-5}  & **Ghana** & **Uganda** & **Zambia** & **Tanzania** \\ \hline Antibaterials for systemic use (J01) & 85.1 & 83.4 & 86.3 & 99.3 \\ Antimycotics and antifungals for systemic use (J02; D01 BA) & 0.8 & 1.3 & 2.2 & 0.3 \\ Drugs for treatment of tuberculosis (J04A) & 1.2 & 4.5 & 0.2 & 0 \\ Antibiotics used as intestinal anti-infectives (A07 AA) & 0.5 & 0.3 & 0.2 & 0 \\ Antiprotozoals used as antibacterial agents (P01 AB) & 8.3 & 4.2 & 10.2 & 0.3 \\ Antivirals for systemic use (J05) & 1.4 & 1.7 & 0 & 0 \\ Antimalarials (P01B) & 2.8 & 4.6 & 0.7 & 0 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Proportional antimicrobial use by country grouped by therapeutic subgroup. In Ghana, the third most common reason for prescribing was to treat skin and soft tissue infections (equal to prescriptions for completely unknown infections). Uganda had a higher prescription rate for prophylaxis for plastic or orthopaedic surgery than other countries (8%) and prescriptions for infections of the central nervous system were higher in Zambia (8%). Drugs were frequently prescribed for sepsis across all countries (7-9%). Across all four countries, antimicrobials were frequently prescribed for prophylaxis. This practice was highest in Tanzania, with 48% of all prescribed antimicrobials being for prophylaxis. This was followed by in Ghana (33%), Uganda (27%) and Zambia (27%). As mentioned above, one common indication for prescribing antimicrobials in all countries was for prophylaxis for obstetric or gynaecological surgery. The types of antimicrobials prescribed for this indication differed across the four countries. In participating hospitals in Ghana, 16 different drugs were prescribed for OBGY prophylaxis (Table 5), with metronidazolezople comprising 44% of prescriptions for this indication (186/425). This was split relatively evenly between oral (95/186; 22% of total number of prescriptions) and parenteral administration (91/186; 21.4% of total prescriptions). Of the 186 times metronidazolezople was prescribed, it was co-administered with another antimicrobial (88%; 164/186). When given orally, it was most commonly prescribed with co-amoxiclav; amoxicillin/clavulanic acid (42/95) and, when given parenterally, it was most commonly prescribed with co-amoxiclav (23/91) or ceftaxone (22/91). Again, in Ghana, co-amoxiclav was prescribed as a single agent on 19% of occasions (81/425) and, as described, frequently co-administered with metronidazolezople (65/186). Cerebrioxane was the next most frequently prescribed on 12% of occasions (50/425). The top two drugs that were most prescribed in the participating hospitals in Ghana were in the access category, whereas ceftaxone is in the Watch category. Whilst the most common reason for prescribing antimicrobials was the same for the other 3 countries, there was less variation in drug type (Figure 3). In Uganda, metronidazolezople and ceftaxone were prescribed together frequently for proph OBGY. Metronidazolezople was prescribed 47.1% of total prescriptions for proph OBGY (41/87) and ceftaxone 44% (38/87) (Figure 3). They were co-prescribed on 37 occasions, with ceftaxone only being prescribed alone once for this indication. All but two prescriptions for metronidazolezople were parenteral administration.