Determinants of Antibiotic Prescribing for Acute Respiratory Infections in Primary Care: A Retrospective Cross-Sectional Study at the Eduardo Mondlane University Health Center, Maputo, Mozambique

Background: Acute respiratory infections (ARIs) are among the most common reasons for primary healthcare consultations. Although most ARIs are viral, antibiotics are frequently prescribed, contributing to antimicrobial resistance. In Mozambique, evidence on factors associated with antibiotic prescribing for ARIs remains limited. Objective: To identify clinical factors associated with antibiotic prescribing among patients with ARIs attending the Eduardo Mondlane University Health Center (CS-UEM) between April and August 2024. Methods: We conducted a retrospective, observational, cross-sectional study using a convenience sample of 196 clinical records of patients with ARIs. Demographic, clinical, and prescriber-related variables were extracted from medical records. Associations with antibiotic prescribing were assessed using chi-square tests and Cramer's V. Multivariable logistic regression was used to identify factors independently associated with antibiotic prescribing, and model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: Antibiotics were prescribed in 69.4% (136/196) of consultations. Amoxicillin was the most frequently prescribed antibiotic (45.4%), followed by azithromycin (26.0%), while 43.4% of prescriptions belonged to the WHO AWaRe "Watch" category. In the multivariable model, clinical category and presenting signs and symptoms were independently associated with antibiotic prescribing (chi-square(8) = 36.58; p < 0.001; McFadden's pseudo-R2 = 0.151). Diagnosis, age, sex, and prescriber nationality were not significantly associated with prescribing. The model showed acceptable discriminative performance (AUC = 0.760). Conclusion: Antibiotic prescribing among patients with ARIs at CS-UEM was primarily associated with clinical presentation rather than demographic characteristics or formal diagnosis. These findings support the implementation of locally adapted antimicrobial stewardship interventions to promote more rational antibiotic prescribing in primary healthcare settings. Keywords: Acute respiratory infections; antibiotic prescribing; antimicrobial resistance; antimicrobial stewardship; primary health care; Mozambique.