The prevalence and patterns of self-medication with antibiotics in Jordan: A community-based study

Prevalence of self-medication with antibiotics and its related factors among the general public and health professionals during the COVID-19 pandemic: A cross-sectional study in China

BACKGROUND

Self-medication with antibiotics (SMA) is a common public health concern. This study aimed to assess the prevalence of SMA in the general public and health professionals during the COVID-19 pandemic and identify the associated factors.

METHODS

A cross-sectional study was conducted from October 28, 2022, to November 6, 2022. Logistics regression analysis was used to examine the associated factors.

RESULTS

The rate of SMA was 10.25% in the general public and 12.69% in health professionals. For the public, those who perceived themselves as average or good health, had moderate antibiotic knowledge, and had easy access to nearby health facilities were less likely to SMA; while those who live in rural areas, found it easy to purchase antibiotics without prescriptions, and those who frequently encountered antibiotics recommended by pharmacy staff were more likely to SMA. For health professionals, those who were female, perceived themselves as good health, had moderate or high antibiotic knowledge, and had easy access to health facilities were less likely to SMA; while those who found it easy to purchase antibiotics without prescriptions were more likely to SMA.

CONCLUSIONS

SMA is prevalent in both the general public and health professionals. Promoting the rational use of antibiotics requires joint participation and effort.

The hidden dangers lurking at home: Unveiling the prevalence of leftover antibiotics and its associated factors among Lebanese households

Background

Antimicrobial Resistance (AMR) is a major global concern. Irrational use of antibiotics including self-medication (SM) with leftovers without a medical prescription can be a leading cause. This study aimed to investigate the prevalence and related factors of leftover antibiotics (LA) in Lebanese households.

Study design

A cross-sectional study of the Lebanese population was conducted between March and October 2022.

Methods

Through random proportional stratified sampling, a total of 494 families participated in this study. Data collection was carried out through phone calls using a comprehensive and reviewed questionnaire. The data was then analyzed using SPSS version 26. Logistic regression was utilized to identify the factors associated with LA, with the presence of LA in households as the dependent variable and other factors such as age, region of residence, and presence of elderly individuals at home as the independent variables.

Results

Among selected households, 118 households (23.89%) had LA. The most common type of antibiotic found was penicillin (59.84%). Most of the LA were in the form of tablets and capsules (94%) with valid expiration dates (87%). Antibiotics were mainly prescribed by doctors (61%), and the main reason for prescribing was acute respiratory tract infections (47.46%). SM was reported by 42.37% of the families with LA. A family with elderly patients (p = 0.002; OR = 2.23; 95% CI = 1.33-3.73) and those residing in Mount Lebanon (p = 0.019; OR = 2.28; 95% CI = 1.14-4.56) had significantly higher odds of having LA.

Conclusion

Leftover antibiotics were found in nearly a quarter of the addressed Lebanese families. Therefore, public educational campaigns should be launched to limit injudicious antibiotic use including SM, and to promote proper disposal of any leftovers. It is also crucial to adopt the One Health approach by developing national programs for the safe disposal of LA and implementing regulations to restrict the distribution of antibiotics in pharmacies without a prescription.

The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review

BACKGROUND

Antimicrobial stewardship programs (ASP) have been proposed as an opportunity to optimize antifungal use. The antifungal resistance is a significant and emerging threat. The literature on antifungal stewardship (AFS) and its influence on performance and clinical outcome measures is scarce. This study aimed to examine global evidence of the impact of AFS on patients and performance measures.

METHODS

The "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) was used for the flow of identification, screening, eligibility, and inclusion. PubMed and MEDLINE were searched using the term ''antifungal stewardship'' on 15 February 2023. Search terms included antifungal stewardship, antimicrobial stewardship, candida, candidemia, candiduria, and invasive fungal disease. Of the 1366 records, 1304 were removed since they did not describe an antifungal stewardship intervention. Among the 62 full texts assessed, 21 articles were excluded since they were non-interventional studies and did not include the outcome of interest. Thus, 41 articles were eligible for systematic review. Eligible studies were those that described an AFS program and evaluated clinical or performance measures.

RESULTS

Of the 41 included studies, the primary performance measure collected was antifungal consumption (22 of 41), and mortality (22 of 41), followed by length of stay (11 of 41) and cost (9 of 41). Most studies were single-center, quasi-experimental, with varying interventions across studies. The principal finding from most of the studies in this systematic review is a reduction in mortality expressed in different units and the use of antifungal agents (13 studies out of 22 reporting mortality). Antifungal consumption was significantly blunted or reduced following stewardship initiation (10 of 22). Comparing studies was impossible due to a lack of standard units, making conducting a meta-analysis unfeasible, which would be a limitation of our study.

CONCLUSION

It has been shown that AFS interventions may improve antifungal consumption and other performance measures. According to available published studies, antifungal consumption and mortality appear to be the possible performance measures to evaluate the impact of AFS.

Awareness and Knowledge of Antibiotic Resistance and Risks of Self-Medication With Antibiotics Among the Aseer Region Population, Saudi Arabia, 2023

BACKGROUND

Antibiotics are a groundbreaking discovery that revolutionized the treatment of infectious diseases in both humans and animals during the 20th century. However, their overuse and misuse led to serious public health threats, causing widespread concern and significant social and economic consequences. Microorganisms have a natural ability to develop resistance to antibiotics over time through genetic mechanisms, which has further exacerbated the problem. Unfortunately, in the last two decades, there has been a dearth of new antibacterial substances discovered, which has only worsened the situation.

AIM

This study aims to assess the awareness and knowledge of antibiotic resistance and risks of self-medication with antibiotics among the Aseer region population, Saudi Arabia 2023.

METHODS

An observational cross-sectional survey was conducted in Saudi Arabia targeting persons aged 18 to 80 years old living in the Aseer region, Southern of Saudi Arabia. The data were collected using a pre-structured questionnaire after an intensive literature review and expert's consultation. The questionnaire was distributed throughout the social medial channels. The study questionnaire was uploaded online till no more new cases participated and no new answers were obtained.  Results: A total of 300 participants completed the study questionnaire. Participants' ages ranged from 18 to 80 years with a mean age of 31.5 ± 12.9 years old. Exactly 200 participants (66.7%) were females. As for the educational level, 209 (69.7%) had a university level of education. Two-hundred and three (67.7%) participants had an overall poor knowledge and awareness about antibiotic resistance and risks of self-medication. Also, 103 (34.3%) participants used antibiotics without prescription before and 100 (33.3%) used leftover antibiotics from a previous infection.

CONCLUSION

In conclusion, the current study showed that nearly one out of three participants in the Aseer region had unprescribed antibiotics. Another unsafe practice was that the same percent used leftover antibiotics from a previous infection. As for participants' knowledge of antibiotic resistance, also one-third of the respondents had good knowledge about the issue.

Four years after the implementation of antimicrobial stewardship program in Jordan: evaluation of program's core elements

Objectives

To combat antimicrobial resistance, the World Health Organization (WHO) urged healthcare organizations in Low- and Middle-Income Countries (LMICs) to implement the core elements of the antimicrobial stewardship (AMS) programs. In response, Jordan took action and developed a national antimicrobial resistance action plan (NAP) in 2017 and commenced the AMS program in all healthcare facilities. It is paramount to evaluate the efforts to implement the AMS programs and understand the challenges of implementing a sustainable and effective program, in Low-Middle Income Country (LMIC) contexts. Therefore, the aim of this study was to appraise the compliance of public hospitals in Jordan to the WHO core elements of effective AMS programs after 4 years of commencement.

Methods

A cross-sectional study in public hospitals in Jordan, using the WHO AMS program core elements for LMICs was carried out. The questionnaire comprised 30 questions that covered the program's six core elements: leadership commitment, accountability and responsibility, AMS actions, education and training, monitoring, and evaluation, and reporting and feedback. A five-point Likert scale was employed for each question.

Results

A total of 27 public hospitals participated, with a response rate of 84.4%. Adherence to core elements ranged from (53%) in the leadership commitment domain to (72%) for AMS procedure application (actions). Based on the mean score, there was no significant difference between hospitals according to location, size, and specialty. The most neglected core elements that emerged as top priority areas were the provision of financial support, collaboration, access, as well as monitoring and evaluation.

Conclusion

The current results revealed significant shortcomings in the AMS program in public hospitals despite 4 years of implementation and policy support. Most of the core elements of the AMS program were below average, which requires hospital leadership commitment, and multifaceted collaborative actions from the concerned stakeholders in Jordan.

Information sources, attitudes, and practices of Self-Medication by Jordanian patients: A cross-sectional study

Background and Objective

Self-medication (SM) has significantly increased worldwide in the past decades, which may have detrimental health consequences including antimicrobial resistance, adverse drug reactions, drug-drug interaction, and dependency. Although several studies have evaluated the extent of SM, such studies are still limited in Jordan. The aim of this study was to explore sources of SM information, attitudes toward SM and the practice of SM and its associated factors.

Methods

The data of this cross-sectional study was collected between February and July 2022. A validated questionnaire was distributed to patients attending pharmacies from different locations in Jordan. The survey evaluated sources of information and attitudes toward SM, extent of SM practice, and attitudes towards SM, symptoms that the participants treat with SM and those that usually requires medical doctor consolation, followed by questions about the classes of medications mostly used for SM and the reasons for SM.

Results and Discussion

The study enrolled 695 Jordanian adults. The most reported indications for SM included headache (86.9 %), flu (76.4 %), and fever (69.6 %). The most common causes for SM included previous knowledge about the diseases and its treatments (84.2 %), and full knowledge of the medicine to be purchased (55.2 %). Results of the ordinal regression showed that physician counseling frequency was positively and significantly associated with "not being on chronic medication" (p-value = 0.001), and having a positive SM attitude level (p-value = 0.019), while negatively correlated with being in medical field (p-value < 0.001), having no children (p-value = 0.009), and relaying on non-scientific sources to obtain information for SM (p-value = 0.014). The frequency of SM practice was positively associated with being in medical field (p-value < 0.001, having no insurance (p-value < 0.001), and relaying on nonscientific sources (p-value = 0.017). Lastly, having a positive SM attitude level (p-value < 0.001) and not being on chronic medications (p-value = 0.007) were associated with decreased SM practice.

Conclusion

The study participants demonstrated increased SM practice due to the wrong perceptions toward SM and the reliance on non-scientific source of information about SM practice.

Healthcare Professionals’ Perceptions, Barriers, and Facilitators towards Adopting Computerised Clinical Decision Support Systems in Antimicrobial Stewardship in Jordanian Hospitals

Understanding healthcare professionals’ perceptions towards a computerised decision support system (CDSS) may provide a platform for the determinants of the successful adoption and implementation of CDSS. This cross-sectional study examined healthcare professionals’ perceptions, barriers, and facilitators to adopting a CDSS for antibiotic prescribing in Jordanian hospitals. This study was conducted among healthcare professionals in Jordan’s two tertiary and teaching hospitals over four weeks (June–July 2021). Data were collected in a paper-based format from senior and junior prescribers and non-prescribers (n = 254) who agreed to complete a questionnaire. The majority (n = 184, 72.4%) were aware that electronic prescribing and electronic health record systems could be used specifically to facilitate antibiotic use and prescribing. The essential facilitator made CDSS available in a portable format (n = 224, 88.2%). While insufficient training to use CDSS was the most significant barrier (n = 175, 68.9%). The female providers showed significantly lower awareness (p = 0.006), and the nurses showed significantly higher awareness (p = 0.041) about using electronic prescribing and electronic health record systems. This study examined healthcare professionals’ perceptions of adopting CDSS in antimicrobial stewardship (AMS) and shed light on the perceived barriers and facilitators to adopting CDSS in AMS, reducing antibiotic resistance, and improving patient safety. Furthermore, results would provide a framework for other hospital settings concerned with implementing CDSS in AMS and inform policy decision-makers to react by implementing the CDSS system in Jordan and globally. Future studies should concentrate on establishing policies and guidelines and a framework to examine the adoption of the CDSS for AMS.

Determinants of antibiotic self-medication: A systematic review and meta-analysis

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.

Self-medication practice in Kathmandu Metropolitan City: A cross-sectional study

Objectives

Self-medication is increasingly popular among people in developing nations like Nepal where the expense of healthcare is relatively high and over-the-counter) medications are widely and easily accessible. Although this method has certain advantages, it is also clear that it has some drawbacks, including the potential for adverse drug reactions, drug resistance, medication interactions, and increased morbidity and mortality. This study aimed to evaluate the use of self-medication in nine wards of Kathmandu Metropolitan City (ward no. 4, 5, 13, 15, 16, 17, 23, 31, and 32).

Methods

This cross-sectional descriptive survey was conducted in the chosen wards of Kathmandu Metropolitan city for 3 months from August to October 2021. A semi-structured questionnaire was used to collect data from 372 patients who were seeking self-medication. The participants were chosen randomly.

Results

Self-medication was common among people (78%). The most frequent ailments for which participants self-medicated were the common cold (17.1%), headache (14.7%), fever (14.5%), and cough (7.6%). Anticold medications (18.2%), non-steroidal anti-inflammatory drugs (17.4%), antipyretics (15.2%), and analgesics (9.1%) were the most popular drug classes used in self-medication. The two most frequent justifications for self-medication were the absence of any major ailment (35%) and self-experience (22.7%). When symptoms started, the majority of patients started taking medication for themselves, and 47.7% of them got their prescriptions directly from the pharmacist by explaining their symptoms. When the symptoms were not relieved by the medication used for self-medication, it was found that the majority of participants (79.7%) stopped using the medication and visit the doctor.

Conclusion

The prevalence of self-medication in Kathmandu city was ascertained by assessing the practice among residents of the Kathmandu Metropolitan city. The study showed self-medication is common among people and therefore, proper education about drug use and self-medication is needed.

A Comparative Piloting of Determinants of Self-Medication Among University Students in the MENA Region; UAE and Jordan as an Example

PURPOSE

Unsupervised self-medication (SM) is a global public health concern. University students are particularly vulnerable due to misperceptions of improved academic performance and thus are at risk of dependence, addiction, and drug overdose. Past studies have shown an alarming prevalence of SM among university students in the Middle East and North Africa (MENA) region. However, there is a scarcity of reports from the region dissecting determinants of SM. Therefore, this study aimed to determine the prevalence and epidemiological correlates of SM among university students and its perceived impact on their academic performance.

METHODS

Two countries in the MENA region were surveyed in a cross-sectional design; UAE and Jordan. Through a stratified sampling technique, undergraduate students in both healthcare and non-healthcare majors of study were recruited to participate. A structured, self-administered questionnaire developed for the purpose of this study was distributed to consented participants via the university's official email. Statistical analyses were performed using SPSS. Descriptive and inferential statistics were used to analyze data. A p-value <0.05 was considered statistically significant.

RESULTS

A total of 362 students participated in the study (74% were females, 60% were from the UAE, and 59% were in healthcare majors). Significantly higher prevalence rates and adjusted odds of SM were found among females, students from Jordan, and those in healthcare majors, particularly for paracetamol (90.2% of females [p=0.001], 88.3% from Jordan [p=0.03], 92.5% in healthcare majors [p=0.001]) and antibacterial drugs (48.9% of females [p=0.01], 60.7% from Jordan [p=0.001], 53.3% in healthcare majors [p=0.001]). Majoring in healthcare fields was the most consistent determinant of such practice, while social influences of family and friends represented the chief source of recommendation. Only 21% of respondents assumed SM boosts their academic performance.

CONCLUSION

Our pilot study underlines the predominant determinants of SM among university students in the MENA region, namely female gender, students from Jordan, and those in healthcare majors. Informed data-driven awareness campaigns to mitigate such practice should be designed to focus on these susceptible populations.

Factors Influencing Public Willingness to Reuse the Unused Stored Medications in Jordan: A Cross-Sectional Study

The reissuing, redispensing, redistributing, or even recycling of the returned unused stored medicines is referred to as medicine reuse. A few studies have examined people's willingness to reuse unused stored medicines. This study aims primarily to explore the public's willingness to reuse unused stored medicines in the future and the factors affecting their decisions, and to assess the pharmacological types and formulations of the unused stored medicines by the public. A cross-sectional study was conducted using a convenient sampling technique over three weeks (February-March 2022) among Jordanian populations. Data were collected from 681 participants who agreed to fill out a questionnaire, which was distributed online. Participants showed a positive perception of reusing any of the unused stored medicines in the future; of those, 79.6% (n = 400) believed that reusing "unused medicines" has economic benefits and 50% (n = 251) believe there are environmental benefits. Moreover, more than half of the participants believed that reusing "unused medicines" is safe (n = 256, 51%), but provided that a pharmacist or a doctor evaluates their quality or that the unused medicines are stored well. Results from this study show that the public positively endorses the idea of reusing unused stored medicines if the quality and safety are assured. However, future studies are needed to evaluate the Jordanian healthcare professionals' perceptions towards medicine reuse and pharmaceutical companies' willingness to be a part or facilitator of medicine reuse.

Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis

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 .

Income level and antibiotic misuse: a systematic review and dose-response meta-analysis

OBJECTIVES

To quantify the association between income and antibiotic misuse including unprescribed use, storage of antibiotics and non-adherence.

METHODS

We identified pertinent studies through database search, and manual examination of reference lists of selected articles and review reports. We performed a dose-response meta-analysis of income, both continuous and categorical, in relation to antibiotic misuse. Summary odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated under a random-effects random effects model.

RESULTS

Fifty-seven studies from 22 countries of different economic class were included. Overall, the data are in agreement with a flat linear association between income standardized to socio-economic indicators and antibiotic misuse (OR per 1 unit increment = 1.00, p-value = 0.954, p-value non-linearity = 0.429). Data were compatible with no association between medium and high income with general antibiotic misuse (OR 1.04; 95% CI 0.89, 1.20 and OR 1.03; 95% CI 0.82, 1.29). Medium income was associated with 19% higher odds of antibiotic storage (OR 1.19; 95% CI 1.07, 1.32) and 18% higher odds of any aspect of antibiotic misuse in African studies (OR 1.18; 95% CI 1.00, 1.39). High income was associated with 51% lower odds of non-adherence to antibiotic treatment (OR 0.49; 95% CI 0.34, 0.60). High income was also associated with 11% higher odds of any antibiotic misuse in upper-middle wealth countries (OR 1.11; 95% CI 1.00, 1.22).

CONCLUSIONS

The association between income and antibiotic misuse varies by type of misuse and country wellness. Understanding the socioeconomic properties of antibiotic misuse should prove useful in developing related intervention programs and health policies.

Reliability and validity evaluation of the appropriate antibiotic use self-efficacy scale for Chinese adults

BACKGROUND

Antibiotic resistance is one of the greatest threats to global public health. Inappropriate use of antibiotics can lead to an increase in antibiotic resistance. Individual self-efficacy in the appropriate use of antibiotics plays a key role, especially in China where the population has easy access to antibiotics. However, there are no tools available to assess the self-efficacy of appropriate antibiotic use for Chinese adults. We aimed to translate and develop a Chinese version of the Appropriate Antibiotic Use Self-Efficacy Scale (AAUSES), and validate its reliability and validity.

METHODS

A total of 659 adults were recruited to participate in the questionnaire. The original version scale was first translated into Chinese using the backward and forward translation procedures. The internal consistency reliability of the scale was measured by the Cronbach alpha coefficient, the test-retest reliability, and the corrected item-total correlation. The validity of the scale was assessed by the content validity index, exploratory factor analysis, and confirmatory factor analysis.

RESULTS

The content validity index of the scale was 0.96. Exploratory factor analysis (EFA) supported a 4-factor structure of the translated questionnaire, and the discriminant validity of the scale was good. Confirmatory factor analysis (CFA) showed in the model fitness index, the chi-square degree of freedom was 2.940, the goodness-of-fit index(GFI) was 0.929, the incremental fit index (IFI) was 0.908, the comparative fit index(CFI) was 0.906, root mean square error of approximation(RMSEA) was 0.077, and standardized root mean residual (SRMR) was 0.0689, and the model fitting indexes were all in the acceptable range. Cronbach alpha coefficient for the scale was 0.910. The test-retest reliability was 0.947, and the corrected item-total correlations for the items ranged from 0.488 to 0.736. Self-efficacy for appropriate antibiotic use in adults varied by education, occupation, income, place of residence, and whether or not they had heard of antibiotic resistance.

CONCLUSIONS

The results indicated that the Chinese version of the AAUSES had good reliability and validity. Therefore, it can be considered a tool to evaluate the appropriate antibiotic use self-efficacy of adults in China.

Self-Medication as an Important Risk Factor for Antibiotic Resistance: A Multi-Institutional Survey among Students

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.

Risk factors associated with self-medication among the indigenous communities of Chittagong Hill Tracts, Bangladesh

Background

In developing countries like Bangladesh, self-medication has become a predicament associated with health risks and clinical complications. To date, no studies have been conducted on the practice of self-medication among the indigenous population living in Chittagong Hill Tract (CHT).

Objectives

This study was aimed to determine the prevalence of self-medication and analyzing the factors associated with it among the indigenous population in CHT.

Methods

This cross-sectional study was conducted from late October to early December 2020; among different indigenous group populations residing in the three districts of CHT aged 18 or more. A pre-tested and semi-structured questionnaire was developed to collect data on socio-demographic characteristics, health status, frequency of self-medication, reasons for self-medication in last one year, as well as other variables. Multivariate logistic regression was performed to assess associated factors with self-medication.

Results

A total of 1350 people from different indigenous populations were interviewed, among whom 49.9% practiced self-medication. The rate of self-prescribed antibiotics usage (80.9%) was significantly higher compared to other drugs. Self-prescribed medications were mostly used for diarrhea and food poisoning (60.6%), cough, cold and fever (51.4%), and headache (51.4%). A common source of self-prescribed medicines was community or retail pharmacy and the most reported reason for self-prescribed medication was the long-distance of healthcare facilities from home.

Conclusion

The prevalence of self-medication is substantially high among indigenous people and the effect is alarming. Particular concern is the misuse of antibiotics and analgesic drugs. Increasing awareness among the population of the negative effect of self-medication and implementation of proper policies and actions are urgently needed to prevent self-medication among indigenous population in Bangladesh.

Evaluation of Self-Medication with Antibiotics in Primary Care Clinics in Palestine

BACKGROUND

Antibiotics are highly effective medications and essential in curing infectious diseases; however, their inappropriate use, such as self-medication, is a significant factor in developing antimicrobial resistance.

OBJECTIVE

This study aimed to evaluate the level of antibiotic self-medication among patients who visited primary care clinics in Palestine.

METHODS

Data were collected via a self-administered questionnaire, either printed or electronically, using google forms (Google Inc., USA). The sample size needed to provide a 95% confidence level and 5% margin error and assuming a prevalence of 50% of SM with antibiotics was 377 patients. A total of 700 questionnaires were randomly distributed to patients aged 18 years or older. However, 87 were excluded due to duplication, incomplete responses, or participants under 18 years old. Finally, 423 patients were included in this study, with 254 patients completing the electronic Google Forms and 181 completing the written survey. The questionnaire consists of patients' demographics, antibiotics knowledge, and self-medication behavior. In addition, descriptive statistics and knowledge scales were performed using SPSS 22 IBM to measure and assess the scope of the problem and find the association between self-medication demographics, education, and socioeconomic status.

RESULTS

Approximately 50% of participants reported self-medication with antibiotics, with a very high use among participants with medical knowledge. Most people have adequate awareness of antibiotics, whereas out of 423 respondents, (40.2%, n = 170) had GKL, (50.4%, n= 213) had AKL, and only (9.5%, n=40) presented PKL. The primary source for self-treatment with antibiotics was community pharmacies (87.1%, n=223), whereas (14.1%, n=36) got antibiotics from family and friends. Convenience, easy access, and experience with community pharmacists contributed to self-medications. The most commonly used antibiotic for self-medication was amoxicillin/clavulanic acid.

CONCLUSION

Self-medication with antibiotics is a common practice in Palestine, regardless of socioeconomic or educational status. Patients' educations about complications from inappropriate use and the possibility of side effects are essential steps to decrease patients' demands for antibiotics. Furthermore, compliance and adherence of community pharmacists in dispensing antibiotics only with a prescription is necessary.

Self-Medication Practices with Antibiotics and Associated Factors among the Public of Malaysia: A Cross-Sectional Study

Background

Self-medication with antibiotics (SMA) is an important public health issue, which can result in the facilitated development of antibiotic resistance, and may increase the risk of inappropriate utilization of antibiotics. So, the objective of the present study was to estimate the prevalence rate of SMA and to also explore SMA practices among the lay population of Kuala Lumpur (Malaysia).

Methods

The current study was cross-sectional population-based and used a convenient sampling technique. Moreover, Lorenz’s formula was used to calculate the sample size and the required sample size was 480. Data were collected through face-to-face interviews with a pre-validated questionnaire and the study was conducted in Kuala Lumpur (Malaysia). Descriptive statistics, cross-tabulation, and logistic regression were executed by using SPSS version 24.

Results

Out of 480 participants, 45.8% were polled male and the prevalence of SMA in this study was found to be 15.1%. The majority of participants 23.1% indicated that they practiced antibiotics at least once in the last six months. The commonly self-medicated antibiotics were amoxicillin-clavulanate 20.6%, ampicillin/cloxacillin 14.2%, and levofloxacin 8.3%. Moreover, 64.8% of participants indicated that they bought their antibiotics from pharmacies. Whereas, most of the participants practice antibiotics to save money 19.2% and time 23.1%. Findings from multivariate logistic regressions showed that predictors of SMA were male gender, (95% CI: 0.300–0.877) occupation (95% CI: 0.122–10.797), health insurance (95% CI: 0.025–0.472), and education (95% CI: 0.084–0.800).

Conclusion

The results of this study indicate that SMA persists among the community and education level has a significant impact on this behavior. Thus, concerning health management authorities should step in with developing legislation to stop this practice, and by implementing such interventions and policies to educate and to raise awareness about the risk of SMA for the future.

Community Use of Antibiotics in Turkey: The Role of Knowledge, Beliefs, Attitudes, and Health Anxiety

Turkey has been among the leading countries in antibiotic consumption. As a result of the 4-year National Action Plan for Rational Drug Use, antibiotic prescriptions had declined from 34.9% in 2011 to 24.6% in 2018. However, self-medication with antibiotics without prescription is common, which is not reflected in official statistics. The present study aims at investigating antibiotic use in the community and the factors related to it. A web-based survey was conducted among 945 Turkish-speaking respondents (61.3% female). The questionnaire included questions about antibiotic use for different illnesses, ways to obtain and handle leftover antibiotics, knowledge, beliefs of the antibiotic effectiveness, attitudes, health anxiety, and background factors. According to the results, 34.2% of the sample had self-medicated themselves with antibiotics without a valid prescription. The most common way to self-medicate was to use leftover antibiotics. While 80.4% knew that antibiotics are used to treat bacterial infections, 51.4% thought that antibiotics are effective for viral diseases. The most important predictor of antibiotic use frequency was the belief in their efficiency for various illnesses and symptoms, followed by negative attitudes to antibiotics, health anxiety, knowledge level, positive attitudes, and health status. The results underline the importance of targeting misbeliefs about antibiotics in future campaigns.

Public Health Literacy, Knowledge, and Awareness Regarding Antibiotic Use and Antimicrobial Resistance during the COVID-19 Pandemic: A Cross-Sectional Study

Multi-drug-resistant (MDR) organisms pose a global threat to modern medicine, which has grown as a result of irrational antibiotic use and misuse. This study aimed to assess general public knowledge in Jordan and awareness of antibiotics and antibiotic resistance during the COVID-19 pandemic. A cross-sectional study was carried out utilizing the WHO multicountry public awareness survey. The study population was composed mainly of social media users, and a total of 1213 participants completed the online survey. According to the findings, more than half of the participants were well versed in antibiotic use and resistance. Those with adequate health literacy were found to better understand antibiotics (OR = 1.37, p = 0.017) and antibiotic resistance (OR = 1.46, p = 0.003). The vast majority (88.5%) recognized at least one antibiotic resistance term; however, 53.2% believed that antibiotic resistance is a problem in other nations. The participants in this study reported using antibiotics incorrectly, believing that they were treating sore throats, colds, and flu. The participants were well aware of antibiotic resistance solutions and their consequences on health. Age, education, health literacy, and antibiotic knowledge were found to be substantially (p < 0.05) associated with greater awareness of antibiotic resistance. The findings highlight the need for antimicrobial resistance education campaigns, health literacy, and antibiotic stewardship initiatives.

Exploring Information Available to and Used by Physicians on Antibiotic Use and Antibiotic Resistance in Jordan

Evidence based information sources for physicians are needed for informed antibiotic prescribing practices. The aim of this study was to explore physicians' preferred sources of information and evaluate physicians' awareness of available information and initiatives on prudent antibiotic prescribing in Jordan. A cross-sectional study was conducted utilizing an online questionnaire and included physicians (n = 409) from all sectors and specialties in Jordan. Published guidelines (31.8%), the workplace (25.7%), colleagues or peers (20.0%), group or conference training (18.3%), and the medical professional body (18.1%) were the main sources of information about avoiding unnecessary antibiotic prescribing, with the influence of these sources on changing prescribers' views being 34.7%, 17.1%, 11%, 13.4%, and 7.6%, respectively. One-third of physicians (33.7%) reported no knowledge of any initiatives on antibiotic awareness and resistance. Regarding awareness of national action plans on antimicrobial resistance, 10.5%, 34%, and 55.5% of physicians were aware, unaware, and unsure of the presence of any national action plans, respectively. Physicians showed interest in receiving more information on resistance to antibiotics (58.9%), how to use antibiotics (42.2%), medical conditions for which antibiotics are used (41.3%), prescribing of antibiotics (35.2%), and links between the health of humans, animals, and the environment (19.8%). The findings can inform interventions needed to design effective antimicrobial stewardship, enabling physicians to prescribe antibiotics appropriately.

Al‐Azzam S, Nusair MB, Alnahar SA, Obeidat NA. Self-medication among pregnant women attending outpatients' clinics in northern Jordan-a cross-sectional study

Self-medication can facilitate patients' access to medicinal products, save time, and reduce financial and health-care service use burden. On the other hand, irresponsible use of self-medications can result in adverse consequences. Self-medication is common among different demographic groups including pregnant women. In general, medicinal products might have harmful effects on mothers and baby. This study aimed to assess self-medication practices among pregnant women in the northern region of Jordan. A cross-sectional study was conducted on pregnant women attending outpatient clinics in the northern region of Jordan. Self-medication practices among the target population were assessed using a survey questionnaire that was administered through interviewer-assisted mode. Data were collected between December 2019 and September 2020, and descriptive statistics and inferential analysis were applied. A total of 1,313 pregnant women were surveyed (response rate = 95.50%). Self-medication and the use of herbal remedies were practiced by 33.10% and 32.14% of the participant, respectively. Headaches and general pains were the most frequently reported conditions treated by self-medication practice with either conventional medicinal products or herbal remedies. The gravidity (≥4) and the gestational stage (≥28 weeks) were the predictors of self-medication practice. This study showed that self-medication was not widely practiced by pregnant women in the northern region of Jordan. Disease simplicity and previous history were the main motives for self-medicating. Efforts should be made by health-care providers to address pregnant women and educate them to increase their awareness about the unsafe use of medicines and the harmful effects on fetus.

Antimicrobial stewardship in community pharmacies in Jordan: assessing current status

Objectives

The aim of this study was to assess knowledge and perceptions of the Jordanian community pharmacists towards antimicrobial resistance and antimicrobial stewardship programmes (ASPs).

Methods

A descriptive cross-sectional questionnaire-based study was conducted between August and September 2020. The validated questionnaire consisted of sections that measure participants’ demographics, knowledge and perceptions towards ASPs, and assess antibiotic prescribing practice. Questionnaires were distributed via social media to be filled by community pharmacists in Jordan. For knowledge questions, participants gained one point for each correct answer and zero point for each incorrect answer. Then, a knowledge score was calculated out of 10.

Key findings

During the study period, a convenience sample of 200 pharmacists were recruited and were asked to fill out the study questionnaire, with a majority claimed attending ASPs workshops previously (n = 162, 81.0%). The main sources of knowledge about antimicrobial resistance were university courses and books. With a median knowledge score of 6/10, participants knew that antimicrobials are not always safe. Although only less than 25% knew that ASPs does not necessarily increase treatment duration, most of the pharmacists had positive perceptions towards ASPs. Barriers against application of ASPs were mainly lack of training and lack of physicians’ cooperation (89.0% and 87.5%, respectively). It was agreed by 90.0% of the respondents that ASPs would boost public health confidence in community pharmacists, and 86.0% believed that ASPs would enhance their job satisfaction. Multivariate linear regression showed that female gender of pharmacist was significantly associated with higher knowledge score (P-value = 0.045).

Conclusions

This study highlighted that community pharmacists have a good knowledge in antibiotics and a positive perception regarding ASPs. Despite not being highly familiar with ASPs concept, pharmacists showed great support for involvement in ASPs. They also encouraged incorporating ASPs within community pharmacy level which is considered crucial to control antimicrobial resistance throughout the world.

Antimicrobial stewardship programs: perceptions and practices among Jordanian healthcare practitioners

Objective

Antimicrobial stewardship programs are of paramount importance in containing antibiotic resistance and combat the acquisition of multi-drug resistance strains. Healthcare practitioners, specifically physicians and clinical pharmacists are the direct clinical antibiotic prescribing authorities. Therefore, this study aimed to assess Jordanian practitioners' perceptions and practices towards antimicrobial stewardship programs.

Methods

This was a cross-sectional study, in which physicians and clinical pharmacists were approached to fill out a previously validated study instrument. A close-ended structured questionnaire comprising 34 questions covering aspects related to antimicrobial stewardship program perceptions, practices and participants' demographic data were used to collect pertinent information.

Key findings

A total of 286 participants were enrolled in the study. There was an overall positive perception towards antimicrobial stewardship programs, while practices related to this element was still suboptimal. Additional comparison of the overall perception scores among different demographic characteristics showed that long years of practice, postgraduate studies and practice in academic sectors yielded higher perception scores (P = 0.0335, 0.0328 and 0.0007, respectively).

Conclusion

There is an imminent need to enhance Jordanian practitioners' knowledge about antimicrobial stewardship programs. Clear recognition of integral antimicrobial stewardship programs' components must be coupled with highlight changes in current practices related to antimicrobials usage and prescription.