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Nemat A, Sherzad AG, Ehsan E, Hassnzai A, Naderi M, Zaki N, Essar MY, Mowlabaccus WB, Head MG, Asady A. Knowledge, attitude, and practices toward malaria among hospital outpatients in Nangarhar, Afghanistan: A cross-sectional study. SAGE Open Med 2024; 12:20503121241251758. [PMID: 38764536 PMCID: PMC11100381 DOI: 10.1177/20503121241251758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/09/2024] [Indexed: 05/21/2024] Open
Abstract
Background In the Eastern Mediterranean region, Afghanistan ranks third for the world's highest burden of malaria. The vast majority (95%) of malaria cases in Afghanistan are attributed to Plasmodium falciparum and 5% to Plasmodium vivax. Most cases occur in low-altitude regions, especially in the eastern province of Nangarhar, where agriculture and farming are predominant. To better understand the public sentiment toward malaria, this study aimed to understand the knowledge, attitude, and practice of patients toward malaria who visited public and private hospitals of Nangarhar province. Methods A cross-sectional descriptive study was conducted on Nangarhar residents who visited the adult Outpatient departments of eight local public and private health facilities. Data collection took place from 1st August 2022 to 15th September 2022. Results Of 700 participants, 37.9% (n = 265) identified as male and 62.1% (n = 435) identified as female. The majority of participants (84.6 %) were within the (18-40) age range, followed by 12.7% in the (41-60) age range, and 2.7% were aged 61 years or older. Moreover, 99.7% (n = 698) of the participants had heard of malaria. The main sources of information about malaria were family members (31.3%, n = 219), television (32.6%, n = 228), Internet (12.6%, n = 88), school (11.3%, n = 79), and health facilities (31.4%, n = 220). Most respondents correctly identified mosquito bites as the primary mode of malaria transmission (72.6%, n = 508). Others suggested that transmission could occur by close contact with a malaria patient (14.0%, n = 98) and drinking contaminated water (17.3%, n = 121). The majority of participants (70.6%) agreed that malaria is a serious and life-threatening disease. A significant number of participants (96.6%) reported owning an insecticide-treated mosquito net at home, and 87.0% reported using the net. Conclusion Overall, participants reported good knowledge, attitude, and practice toward malaria. This may be linked to the awareness campaigns and preventive programs in Nangarhar province that have contributed to participant's willingness to prevent malaria and treat themselves if they get infected. Public health campaigns are difficult in Afghanistan with weak governance and conflict, and thus, populations may find themselves at risk if health promotion activities are stopped.
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Affiliation(s)
- Arash Nemat
- Department of Microbiology, Kabul University of Medical Sciences, Kabul, Afghanistan
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Ghafar Sherzad
- Faculty of Medicine, Department of Biochemistry, Nangarhar University, Jalalabad, Nangarhar, Afghanistan
| | - Ehsanullah Ehsan
- Department of Dermatology, Alberoni University, Kohistan, Kapisa, Afghanistan
| | - Asadullah Hassnzai
- Faculty of Medicine, Department of General Surgery, Nangarhar University, Nangarhar, Afghanistan
| | - Mehrab Naderi
- Nangarhar Provincial Hospital, Jalalabad, Nangarhar, Afghanistan
| | - Naqeebullah Zaki
- Department of Public Health, Tata Institute of Social Sciences, Mumbai, India
| | - Mohammad Yasir Essar
- Kabul University of Medical Sciences, Kabul, Afghanistan
- Department of Global Health, McMaster University, Hamilton, ON, Canada
| | | | - Michael G Head
- Faculty of Medicine, Clinical Informatics Research Unit, University of Southampton, Southampton, UK
| | - Abdullah Asady
- Department of Microbiology, Kabul University of Medical Sciences, Kabul, Afghanistan
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Qu W, Wang X, Liu Y, Mao J, Liu M, Zhong Y, Gao B, Zhao M, Gao Y. Self-Medication with Antibiotics Among Children in China: A Cross-Sectional Study of Parents' Knowledge, Attitudes, and Practices. Infect Drug Resist 2023; 16:7683-7694. [PMID: 38144221 PMCID: PMC10741740 DOI: 10.2147/idr.s431034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/30/2023] [Indexed: 12/26/2023] Open
Abstract
Background Self-medication with antibiotics (SMA) among children is a common practice in low-income and middle-income countries, which has accelerated antibacterial abuse. Objective This study aimed to estimate the prevalence and associated factors of SMA among children in China, including parents' knowledge, attitudes, and practices towards antibiotic use. Methods A cross-sectional study based on a structured questionnaire survey of parents was conducted in Nantong between July and September 2020. A total of 1699 respondents participated. Information on participants' demographic and family characteristics, knowledge, attitudes, and practices towards antibiotics use was collected. Hierarchical binary logistic regression was used to examine the predictors of SMA among children. Results Among 1699 participants, 23.31% practiced SMA to their children in the past year. Cough (59.6%) was the most common symptom leading to self-medication and penicillins (85.4%) were the most commonly used drugs. Hierarchical regression indicated that parents with higher level of antibiotic knowledge scores (OR=1.163, 95% CI: 1.067-1.268) and buying antibiotics without a prescription from pharmacy (OR=1.475, 95% CI: 1.097-1.983) were more likely to practice SMA to their children both in urban and in rural areas. Storing antibiotics at home resulted in an increased likelihood of self-medication in urban areas but not in rural areas. In addition, there was also a higher probability of non-prescribed antibiotics in children without chronic diseases (OR=1.959, 95% CI:1.072-3.578). Conclusion The prevalence of SMA in children is high in China. Higher knowledge scores and practices of buying and storing non-prescribed antibiotics behaviors increased parents' antibiotic self-medication in their children. Practical and effective education intervention for children's rational use of antibiotics is urgently strengthened.
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Affiliation(s)
- Wenjie Qu
- Department of Health Management, School of Public Health, Nantong University, Nantong, People’s Republic of China
- Institute for Health Development, Nantong University, Nantong, People’s Republic of China
| | - Xinyu Wang
- Department of Health Management, School of Public Health, Nantong University, Nantong, People’s Republic of China
| | - Yufei Liu
- Faculty of Health Sciences, University of Macau, Macau, People’s Republic of China
| | - Jinfeng Mao
- Institute for Health Development, Nantong University, Nantong, People’s Republic of China
| | - Mengchi Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yaqin Zhong
- Department of Health Management, School of Public Health, Nantong University, Nantong, People’s Republic of China
- Institute for Health Development, Nantong University, Nantong, People’s Republic of China
| | - Bella Gao
- Ulink College of Suzhou Industrial Park, Suzhou, Jiangsu, People’s Republic of China
| | - Miaomiao Zhao
- Department of Health Management, School of Public Health, Nantong University, Nantong, People’s Republic of China
| | - Yuexia Gao
- Department of Health Management, School of Public Health, Nantong University, Nantong, People’s Republic of China
- Institute for Health Development, Nantong University, Nantong, People’s Republic of China
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Nemat A, Rezayee KJ, Essar MY, Mowlabaccus WB, Ahmad S, Mubarak MY. A report of Kabul internet users on self-medication with over-the-counter medicines. Sci Rep 2023; 13:8500. [PMID: 37231061 DOI: 10.1038/s41598-023-35757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 05/23/2023] [Indexed: 05/27/2023] Open
Abstract
Self-medication (SM) with over-the-counter (OTC) medications is a prevalent issue in Afghanistan, largely due to poverty, illiteracy, and limited access to healthcare facilities. To better understand the problem, a cross-sectional online survey was conducted using a convenience sampling method based on the availability and accessibility of participants from various parts of the city. Descriptive analysis was used to determine frequency and percentage, and the chi-square test was used to identify any associations. The study found that of the 391 respondents, 75.2% were male, and 69.6% worked in non-health fields. Participants cited cost, convenience, and perceived effectiveness as the main reasons for choosing OTC medications. The study also found that 65.2% of participants had good knowledge of OTC medications, with 96.2% correctly recognizing that OTC medications require a prescription, and 93.6% understanding that long-term use of OTC drugs can have side effects. Educational level and occupation were significantly associated with good knowledge, while only educational level was associated with a good attitude towards OTC medications (p < 0.001). Despite having good knowledge of OTC drugs, participants reported a poor attitude towards their use. Overall, the study highlights the need for greater education and awareness about the appropriate use of OTC medications in Kabul, Afghanistan.
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Affiliation(s)
- Arash Nemat
- Department of Microbiology, Kabul University of Medical Sciences, 3rd District, Kabul, 1001, Afghanistan.
- Department of Global Public Health, Karolinska Institutet, 17177, Solna, Sweden.
| | - Khalid Jan Rezayee
- Department of Medical Laboratory Technology, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Mohammad Yasir Essar
- Kabul University of Medical Sciences, Kabul, Afghanistan
- Department of Global Health, McMaster University, Hamilton, ON, Canada
| | | | - Shoaib Ahmad
- Department of Medicine, District Headquarters Teaching Hospital, Faisalabad, Pakistan
| | - Mohammad Yousuf Mubarak
- Department of Microbiology, Kabul University of Medical Sciences, 3rd District, Kabul, 1001, Afghanistan
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Hussain MA, Mohamed AO, Abdelkarim OA, Yousef BA, Babikir AA, Mirghani MM, Mohamed EA, Osman W, Mothana RA, Elhag R. Prevalence and Predictors of Antibiotic Self-Medication in Sudan: A Descriptive Cross-Sectional Study. Antibiotics (Basel) 2023; 12:antibiotics12030612. [PMID: 36978479 PMCID: PMC10045343 DOI: 10.3390/antibiotics12030612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Self-medication with antibiotics (SMA) is one of the common factors which precipitate antimicrobial resistance, yet if effective implementations are amended it can be effortlessly controlled. The present study aimed to estimate the prevalence and predictors of SMA in Sudan. METHODS The study adopted a cross-sectional study design conducted in all Sudan states between June and December 2021. Multi-stage stratified cluster sampling was used. A semi-structured questionnaire was used for data collection. Descriptive statistics were used to present the data. Binary logistic regression was computed to investigate the possible factors which associated with SMA. RESULTS Out of 1492 participants surveyed, 71.3% utilize antibiotics as self-medication. The derived reasons for SMA were convenience (63.3%) and cost-saving (34.8%). Tonsillitis was the most common ailment behind SMA (55.5%). Log-binominal regression revealed that non-insured and low level of education participants were more likely to predict SMA. Regarding the practice, 40% changed the dose and/or antibiotics mainly owing to improvement (53.7%) or worsening of the condition (37.9%). The most commonly used antibiotic was amoxicillin/clavulanic acid (32.5%). CONCLUSIONS Two out of three individuals in Sudan practice SMA mainly to manage upper respiratory tract ailments. Thus, the necessity of implementing an antimicrobial stewardship program throughout the country, as well as implementing effective legislation to prohibit dispensing antibiotics without prescription is urgently required.
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Affiliation(s)
- Mohamed A Hussain
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum P.O. Box 2469, Sudan
| | - Ahmed O Mohamed
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum P.O. Box 2469, Sudan
| | - Omalhassan A Abdelkarim
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, International University of Africa, Khartoum P.O. Box 2469, Sudan
| | - Bashir A Yousef
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum P.O. Box 1996, Sudan
| | - Asma A Babikir
- Department of Pharmaceutical Microbiology, Pharmacy Program, Al-Yarmouk College, Khartoum P.O. Box 11111, Sudan
| | - Maysoon M Mirghani
- Department of Pharmaceutical Microbiology, Pharmacy Program, Al-Yarmouk College, Khartoum P.O. Box 11111, Sudan
| | - Entsar A Mohamed
- Department of Pharmaceutical Microbiology, Pharmacy Program, Al-Yarmouk College, Khartoum P.O. Box 11111, Sudan
| | - Wadah Osman
- Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Khartoum P.O. Box 1996, Sudan
| | - Ramzi A Mothana
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Rashid Elhag
- Department of Biology, College of Science and Technology, Florida A & M University, Tallahassee, FL 32307, USA
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Ahmed I, King R, Akter S, Akter R, Aggarwal VR. Determinants of antibiotic self-medication: A systematic review and meta-analysis. Res Social Adm Pharm 2023; 19:1007-1017. [PMID: 37019706 DOI: 10.1016/j.sapharm.2023.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Decreasing the prevalence of antibiotic self-medication among the public requires proper understanding of the risk factors involved. However, the determinants of antibiotic self-medication are not well defined. OBJECTIVES To identify patient and health system-related determinants of antibiotic self-medication among the public. METHODS A systematic review of quantitative observational studies and qualitative studies was undertaken. PubMed, Embase, and Web of Science were searched to identify studies on determinants of antibiotic self-medication. The data were analyzed using meta-analysis, descriptive analysis, and thematic analysis. RESULTS Sixty-eight studies were included in the review. From meta-analyses, male sex (pooled odds ratio [POR]: 1.52, 95% confidence interval [CI]: 1.19-1.75), lack of satisfaction with healthcare services/physicians (POR: 3.53, 95% CI: 2.26-4.75) were associated with antibiotic self-medication. In subgroup analysis, lower age was directly associated with self-medication in high-income countries (POR: 1.61, 95% CI: 1.10-2.36). In low- and middle-income countries, people with greater knowledge of antibiotics were less likely to self-medicate (POR: 0.2, 95% CI: 0.08-0.47). Patient-related determinants identified from descriptive and qualitative studies included previous experience with antibiotics and similar symptoms, perceived low severity of disease, intention to save time and get better quickly, cultural beliefs about curative power of antibiotics, advice from family/friends, and having home stock of antibiotics. Health system-related determinants included high cost of consulting physicians and low cost of self-medication, lack of access to physician/medical care, lack of trust/confidence in physicians, greater trust in pharmacists, long distance of physicians/healthcare facilities, long waiting time at healthcare facilities, easy access to antibiotics from pharmacies, and convenience associated with self-medication. CONCLUSIONS Patient and health system-related determinants are associated with antibiotic self-medication. Interventions to decrease antibiotic self-medication should incorporate community programs along with appropriate policies and healthcare reforms targeting these determinants with specific attention to population at high risk of self-medication.
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Goetzman H, Guadalupe NH, Enujioke SC. Early Management of Afghan Evacuees. Pediatrics 2022; 150:189681. [PMID: 36205072 DOI: 10.1542/peds.2022-056633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 02/25/2023] Open
Affiliation(s)
- Henry Goetzman
- Department of Pediatrics, Walter Reed Military Medical Center, Bethesda, Maryland
| | - Nelson H Guadalupe
- Department of Nutrition, Navy Medical Center Camp Lejeune, Camp Lejeune, North Carolina
| | - Sharon C Enujioke
- Department of Pediatrics, Division of Adolescent Medicine, Navy Medical Center Portsmouth, Portsmouth, Virginia
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Edessa D, Assefa N, Dessie Y, Asefa F, Dinsa G, Oljira L. Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis. J Pharm Policy Pract 2022; 15:57. [PMID: 36180895 PMCID: PMC9524137 DOI: 10.1186/s40545-022-00454-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries. METHODS A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage. RESULTS In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40-50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49-62%) than those studies with community surveys (40%; 95% CI: 34-46%) (P = 0.001). It was also varied by the recall period of antibiotics use-56% (95% CI: 50-62%) for instantly observed practice, 36% (95% CI: 22-50%) for within two week recall, 35% (95% CI: 26-45%) for 1-6 months recall, and 46% (95% CI: 37-54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets. CONCLUSIONS We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries. TRIAL REGISTRATION NUMBER CRD42021288971 (PROSPERO). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .
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Affiliation(s)
- Dumessa Edessa
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. .,School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center-Oak Ridge National Laboratory (UTHSC-ORNL, Memphis, TN, USA
| | - Girmaye Dinsa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Zeb S, Mushtaq M, Ahmad M, Saleem W, Rabaan AA, Naqvi BSZ, Garout M, Aljeldah M, Al Shammari BR, Al Faraj NJ, Al-Zaki NA, Al Marshood MJ, Al Saffar TY, Alsultan KA, Al-Ahmed SH, Alestad JH, Naveed M, Ahmed N. Self-Medication as an Important Risk Factor for Antibiotic Resistance: A Multi-Institutional Survey among Students. Antibiotics (Basel) 2022; 11:antibiotics11070842. [PMID: 35884096 PMCID: PMC9312266 DOI: 10.3390/antibiotics11070842] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 01/25/2023] Open
Abstract
Self-medication is an important issue, especially in developing countries. Self-medication is the concept in which individuals use medicine to ease and manage their minor illnesses. The current survey was designed to conduct interviews at different universities based on the availability of the students from August 2021 to October 2021 in Hazara region of Khyber Pakhtunkhwa (KPK), Pakistan. Overall, 1250 questionnaires were distributed to students from various departments. Students of microbiology (n = 305, 24.4%) and agriculture 236 (n = 18.8%) were the most elevated members in this study, while other participants were from medical lab technology (n = 118, 9.4%), chemistry (n = 103, 8.2%), food science (n = 92, 7.3%), business administration (n = 83, 6.6%), sociology (n = 78, 6.2%), math/physics (n = 6, 14.8%), Pak study (n = 58, 4.6%), English (n = 47, 3.7%), and psychology (n = 19, 1.5%). Students working towards their Bachelor numbered (n = 913, 73.0%), Master (minor) numbered (n = 80, 6.4%), Master (major) numbered (n = 221, 17.6%), and Doctorate numbered (n = 36, 2.8%). The age group of participants was majorly 20–25 years (61.0%), while others belonged to the age groups 25–30 years (20.6%), 30–35 years (9.8%), and 35–40 years (8.4%). The mean and standard deviation of daily practices of self-medication were observed (M = 416.667, SD = 1,026,108.667) and p = 0.002. The mean and standard deviation of daily practices of antibiotic knowledge was (M = 431.5, SD = 1,615,917) and p = 0.002. Antimicrobial agents were leading over others with 631 (50.4%), followed by anti-inflammatory with 331 (26.4%), multivitamins with 142 (11.3%), gynecological purpose with 59 (4.7%), and analgesic with 72 (5.7%), while the lowest frequency rate was observed against herbal remedies with 15 (1.2%). The results of the current study concluded that students practiced self-medication for reasons such as convenience to obtain these medications from cheap sources and to avoid the fee of a physician. They searched for the medicine on social media platforms and purchased it blindly from the pharmacy without any prescription from a physician.
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Affiliation(s)
- Shah Zeb
- Department of Microbiology, Faculty of Biomedical and Health Science, The University of Haripur, Haripur 22610, Pakistan; (S.Z.); (B.S.Z.N.)
- Department of Microbiology, Pakistan Kidney and Liver Institute & Research Center, Lahore 54000, Pakistan;
| | - Mariam Mushtaq
- Department of Medical Education, King Edward Medical University, Lahore 54000, Pakistan;
| | - Muneeb Ahmad
- Department of Medical Education, Rawalpindi Medical University, Rawalpindi 46000, Pakistan;
| | - Waqas Saleem
- Department of Microbiology, Pakistan Kidney and Liver Institute & Research Center, Lahore 54000, Pakistan;
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
- Correspondence: (A.A.R.); (M.N.); (N.A.)
| | - Bibi Salma Zahid Naqvi
- Department of Microbiology, Faculty of Biomedical and Health Science, The University of Haripur, Haripur 22610, Pakistan; (S.Z.); (B.S.Z.N.)
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Mohammed Aljeldah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39831, Saudi Arabia; (M.A.); (B.R.A.S.)
| | - Basim R. Al Shammari
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39831, Saudi Arabia; (M.A.); (B.R.A.S.)
| | - Nehad J. Al Faraj
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif 32654, Saudi Arabia; (N.J.A.F.); (N.A.A.-Z.); (M.J.A.M.); (T.Y.A.S.); (K.A.A.); (S.H.A.-A.)
| | - Nisreen A. Al-Zaki
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif 32654, Saudi Arabia; (N.J.A.F.); (N.A.A.-Z.); (M.J.A.M.); (T.Y.A.S.); (K.A.A.); (S.H.A.-A.)
| | - Mona J. Al Marshood
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif 32654, Saudi Arabia; (N.J.A.F.); (N.A.A.-Z.); (M.J.A.M.); (T.Y.A.S.); (K.A.A.); (S.H.A.-A.)
| | - Thuria Y. Al Saffar
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif 32654, Saudi Arabia; (N.J.A.F.); (N.A.A.-Z.); (M.J.A.M.); (T.Y.A.S.); (K.A.A.); (S.H.A.-A.)
| | - Khadija A. Alsultan
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif 32654, Saudi Arabia; (N.J.A.F.); (N.A.A.-Z.); (M.J.A.M.); (T.Y.A.S.); (K.A.A.); (S.H.A.-A.)
| | - Shamsah H. Al-Ahmed
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif 32654, Saudi Arabia; (N.J.A.F.); (N.A.A.-Z.); (M.J.A.M.); (T.Y.A.S.); (K.A.A.); (S.H.A.-A.)
| | - Jeehan H. Alestad
- Immunology and Infectious Microbiology Department, University of Glasgow, Glasgow G1 1XQ, UK;
- Microbiology Department, Collage of Medicine, Jabriya 46300, Kuwait
| | - Muhammad Naveed
- Department of Biotechnology, Faculty of Life Sciences, University of Central Punjab, Lahore 54000, Pakistan
- Correspondence: (A.A.R.); (M.N.); (N.A.)
| | - Naveed Ahmed
- Department of Biotechnology, Faculty of Life Sciences, University of Central Punjab, Lahore 54000, Pakistan
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (A.A.R.); (M.N.); (N.A.)
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Burtscher D, Van den Bergh R, Nasim M, Mahama G, Au S, Williams A, Sattar A, Penfold S, Van Overloop C, Bajis S. 'They eat it like sweets': A mixed methods study of antibiotic perceptions and their use among patients, prescribers and pharmacists in a district hospital in Kabul, Afghanistan. PLoS One 2021; 16:e0260096. [PMID: 34797865 PMCID: PMC8604360 DOI: 10.1371/journal.pone.0260096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a growing public health threat. In Afghanistan, high levels of indiscriminate antibiotic use exist, and healthcare programmes are not informed by understanding of local attitudes towards rational antibiotic use. Médecins Sans Frontières is an international non-governmental organization providing healthcare services to the Ahmad Shah Baba (ASB) District Hospital in Kabul, Afghanistan, since 2009. This mixed-methods study aimed to explore the perceptions and attitudes toward antibiotics among patients, prescribers, and pharmacists in the ASB District hospital outpatient department. METHODS AND FINDINGS Knowledge of antibiotics including their purpose and function, how and why they are used, and drivers for choice of antibiotic was examined at patient, prescriber, and provider-level. The first phase of the study, an exploratory qualitative component using an interpretative approach, was used to inform the second phase, a structured survey. Thirty-six interviews were conducted with 39 participants (21 patients or caretakers and 18 hospital health workers). Three hundred and fifty-one (351) patients and caretakers completed the second phase, the structured survey. This study found that poor knowledge of antibiotics and antibiotic resistance is a driving factor for inappropriate use of antibiotics. Participant perceptions of living in a polluted environment drove the high demand and perceived 'need' for antibiotics: patients, doctors and pharmacists alike consider dirty and dusty living conditions as causes of 'disease' in the body, requiring antibiotics to 'clean' and 'strengthen' it. CONCLUSIONS Findings highlight the need for strategies to improve awareness and knowledge of the general public, improve practice of doctors and pharmacists, regulate antibiotic dispensing in private pharmacies, and implement antibiotic stewardship in hospitals.
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Affiliation(s)
- Doris Burtscher
- Vienna Evaluation Unit, Médecins Sans Frontières, Vienna, Austria
| | | | - Masood Nasim
- Médecins Sans Frontières Afghanistan, Kabul, Afghanistan
| | - Gbane Mahama
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Sokhieng Au
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Anita Williams
- Operational Research (LuxOR) Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
- Middle East Medical Unit (MEMU), Médecins Sans Frontières, Beirut, Lebanon
| | - Abdul Sattar
- Ahmad Shah Baba Hospital, Ministry of Public Health, Kabul, Afghanistan
| | - Suzanne Penfold
- Independent Public Health Research Consultant, Trnava, Slovakia
| | | | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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