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Wang NC. Claiming or abdicating medical authority: Treatment recommendation actions, doctor-patient relationship, and antibiotic overprescription in Chinese paediatrics. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:722-743. [PMID: 38063484 DOI: 10.1111/1467-9566.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/12/2023] [Indexed: 05/22/2024]
Abstract
Antibiotic overprescription in China has long been considered a problem on the supply side, linked to the financial incentives of physicians. Based on the conversation analysis of 187 video-recorded naturally occurring medical consultations in Chinese paediatric primary care settings, this study finds that the driving force behind the problem of antibiotic overprescription in China has changed. Physicians use a low-authority communication style to recommend treatment, displaying a low level of medical authority and a willingness to accommodate caregivers' preferences in antibiotic prescribing decisions. The problem is now attributed to physician-caregiver interaction, doctor-patient relationship and the antibiotic-saturated prescribing culture. Practice implications involve deepening the understanding of the evolving nature of the antibiotic overprescription problem in China, building trust between physicians and patients/caregivers in order to facilitate the physicians' role as the gatekeeper of antibiotics and providing training programmes to help physicians develop effective communication skills.
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Affiliation(s)
- Nan Christine Wang
- School of Public Administration, Hunan University, Changsha, Hunan Province, China
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Alrasheed M, Hamdy Mansy W, Naser Al-Arifi M. Community pharmacist intervention in doxycycline self-medication for acne among pregnant women in Saudi Arabia. Saudi Pharm J 2024; 32:102027. [PMID: 38525265 PMCID: PMC10960118 DOI: 10.1016/j.jsps.2024.102027] [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: 12/17/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Self-medication during pregnancy remains a prevalent global phenomenon, with pregnant women often relying on their own judgment to manage symptoms. Objective: This study aimed to assess community pharmacist practice regarding self-medication requests for acne treatment in pregnant women within Saudi Arabia. Methods A descriptive, observational cross-sectional study was conducted in Riyadh, Saudi Arabia. Community pharmacists completed a questionnaire after interacting with a simulated customer (SC) seeking doxycycline for a pregnant woman. Data were analyzed using SPSS software. Results One hundred community pharmacists participated in the study. The majority were between 25 and 35 years old (56 %) and worked in chain pharmacies (81 %). Notably, 71 % requested a prescription before dispensing any medication. While 66 % advised the SC to consult a physician or dermatologist, only 15 % inquired about the pregnancy and related information of the SC's sister. Conclusion This study suggests a positive trend in community pharmacy practice regarding self-medication requests during pregnancy. However, further improvement is needed, particularly in terms of in-depth inquiry about pregnancy status and potential risks associated with specific medications. Collaborative efforts between the Ministry of Health (MOH), Saudi Food and Drug Administration (SFDA), and pharmacy education programs are crucial to minimize inappropriate dispensing practices and ensure optimal patient safety.
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Affiliation(s)
- Marwan Alrasheed
- Department of Clinical Pharmacy, College of Pharmacy King Saud University, Riyadh 12372, Saudi Arabia
| | - Wael Hamdy Mansy
- Department of Clinical Pharmacy, College of Pharmacy King Saud University, Riyadh 12372, Saudi Arabia
| | - Mohamed Naser Al-Arifi
- Department of Clinical Pharmacy, College of Pharmacy King Saud University, Riyadh 12372, Saudi Arabia
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Elhaddadi H, Hamami A, Sara A, Elouali A, Babakhouya A, Rkain M. Prevalence and Determinants of the Use of Antibiotics by Self-Medication in the Pediatric Population in Oujda, Morocco. Cureus 2024; 16:e60126. [PMID: 38864035 PMCID: PMC11165378 DOI: 10.7759/cureus.60126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVE Antibiotic resistance driven by antibiotic self-medication and inappropriate use of antibiotics is a growing global health threat. Our study aimed to describe parents' self-medication practices with antibiotics, determine the factors favoring their use in the pediatric population, and assess parents' knowledge of the role of antibiotics and antimicrobial resistance. MATERIALS AND METHODS We conducted a cross-sectional study over two months (September and October 2023). Data collection was performed using a questionnaire-guided interview. We included 460 parents of children consulting or hospitalized in the Pediatric Department of the University Hospital Mohammed VI in Oujda, Morocco. RESULTS A total of 62% of parents questioned were mothers. Self-medication with antibiotics was noted in 313 families (68%). Parents used antibiotics mainly to treat cough (43%) and fever (24%). Betalactams were the antibiotic class most used by parents (72%). Information on dosage and methods of antibiotic administration was provided by pharmacy staff but was not respected by most parents (78%). Efficacy of treatment (58%), saving consultation costs and time (47%), and the ease of obtaining treatment without a prescription (42%) were reported in the majority of cases as reasons for using antibiotics by self-medication. In our context, the probability of self-medicating with antibiotics in the pediatric population is increased by female gender (OR=1.04), low level of education (OR=1.02), low socio-economic status (OR=1.09), and buying antibiotics without a prescription (OR=1.22). CONCLUSION Although antibiotic self-medication in children is a worldwide phenomenon, influenced by several geographical, cultural, and economic factors, there is an urgent need to promote a global health strategy.
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Affiliation(s)
- Hasnae Elhaddadi
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Amal Hamami
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Anane Sara
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Aziza Elouali
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Abdeladim Babakhouya
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Maria Rkain
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
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Shi HX, Tan X, Shu JQ, Zhou J, Dan SY, Yang L, Chen ZL. Knowledge, attitude, and practice of medication and its influencing factors among residents in western China: a large-scale cross-sectional study. Front Med (Lausanne) 2024; 11:1303672. [PMID: 38439902 PMCID: PMC10909907 DOI: 10.3389/fmed.2024.1303672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Background This study aimed to understand the knowledge, attitude, and practice (KAP) of drug use among residents in western China and its influencing factors for accurately designing the knowledge, contents, and methods of popular science activities for safe drug use among residents to provide a reference for conducting rational drug use educational activities and improving residents' level of safe drug use. Methods A cross-sectional questionnaire survey was conducted to investigate the KAP of medication among western China residents and its influencing factors from March to April 2023. Each question option was assigned a score according to logic, and the risk factors for resident medication safety KAP were explored through univariate and logistic regression analyses. Results A total of 7,557 valid questionnaires were collected, with an effective recovery rate of 96.7%. The average scores of KAP were 72.77 ± 22.91, 32.89 ± 10.64, and 71.27 ± 19.09, respectively. In the evaluation criteria of the questionnaire, the score of medication knowledge reached "good," and the score of attitude and practice was "average." Multiple linear regression analysis indicated that male sex and low education level were significant factors affecting the lack of drug knowledge among residents. Old age and low education level were the factors of poor attitude toward medication. The low condition of medical security was a factor in residents' irregular drug use behavior. Conclusion The overall level of rational drug use among residents in western China is good, but there are still some inconsistencies. Rational drug use education should be conducted according to the risk points of residents in drug safety KAP to further improve the level of rational drug use of residents.
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Affiliation(s)
- Hong-xia Shi
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xue Tan
- Department of Pharmacy, People’s Hospital of Karamay, Karamay Xinjiang, China
| | - Jian-qin Shu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jun Zhou
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Si-yuan Dan
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lin Yang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ze-lian Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Al-Tarawneh A, Ali T, Al-Taani GM. Public Patterns and Determinants of Antibiotic Self-Medication and Antibiotic Knowledge in Southern Jordan. Antibiotics (Basel) 2024; 13:98. [PMID: 38275327 PMCID: PMC10812463 DOI: 10.3390/antibiotics13010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Antibiotic self-medication, which refers to acquisition and using antibiotics to treat infections based on personal experience and/or without a doctor's advice or prescription, is a significant public health issue jeopardizing patient health outcomes. The purpose of the present cross-sectional online survey was to assess the frequency of self-medication among the general public in various geographical locations in southern Jordan, as well as to examine the determinants to self-medication. The survey was distributed through several social media networks over the period November-December 2022, and included demographic information as well as items related to the use and abuse of antibiotics, information sources about antibiotics, the duration of use of antibiotics, and assessment of the public knowledge about appropriate antibiotic use. Inferential analysis, such as the Chi-Square test and logistic regression, were adopted to assess the associations between the different variables with self-medication. A total of 984 respondents were enrolled in the study. Of these, 752 had been using antibiotics during the last year. However, the self-medicating cases were 413 of the 752. The main source of information about the utilization of antibiotics among participants in the survey was pharmacists. The participants commonly (36.0%) tended to use antibiotics until the symptoms disappeared. Nearly half of the respondents reported usually taking antibiotics for treating a runny nose (rhinorrhea). The logistic regression analysis indicated that self-medication with antibiotics was significantly associated with female gender (p-value < 0.001), low educational level (p-value = 0.014), rural living location (p-value 0.003), no health insurance (p-value = 0.001) and occupation (p-value = 0.005). Meanwhile age had no significant relationship to self-medication. Finally, the results revealed poor understanding of key appropriate antibiotic usage, which inevitably influences self-medication practice. It is crucial to come up with several programs and governmental policies to suppress widespread antibiotic self-medication as it will affect the health of future generations of Jordanian citizens.
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Affiliation(s)
- Alaa Al-Tarawneh
- Department of Allied Medical Sciences, Karak University College, Al-Balqa Applied University, Karak 19117, Jordan; (A.A.-T.); (T.A.)
| | - Tasneem Ali
- Department of Allied Medical Sciences, Karak University College, Al-Balqa Applied University, Karak 19117, Jordan; (A.A.-T.); (T.A.)
| | - Ghaith M Al-Taani
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid 21163, Jordan
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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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Lin R, Duan L, Liu C, Wang D, Zhang X, Wang X, Zhang X, Wang Q, Zheng S, Liu C. The public's antibiotic use behavioural patterns and their determinants for upper respiratory tract infections: a latent class analysis based on consumer behaviour model in China. Front Public Health 2023; 11:1231370. [PMID: 38162628 PMCID: PMC10754980 DOI: 10.3389/fpubh.2023.1231370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Background The irrational use of antibiotics among the public is a major contributor to antimicrobial resistance (AMR), which is a serious global threat. Prior studies have demonstrated that there are different behavioural patterns regarding antibiotic use among the public, and targeted interventions for subgroups with different behavioural patterns may be more effective. Thus, this study aimed to identify the public's behavioural patterns of antibiotic use for upper respiratory tract infections (URTIs) and their influencing factors. Methods A cross-sectional survey was conducted among the general population in Chongqing, China. Consumer decision-making (Consumer Behaviour Model, CBM) was used to assess the public's behaviours regarding antibiotic use, including need recognition, information searching, alternative evaluation, obtaining antibiotics, antibiotic consumption, and postuse evaluation. Furthermore, a latent class analysis was used to identify the underlying behavioural patterns among the public. The identified behavioural patterns of antibiotic use were further linked with individuals' capacity, opportunity, and motivation factors of antibiotic use based on a multinominal logistic regression to explore possible determinants. Results A total of 815 respondents were enrolled in the study. The public's irrational use of antibiotics was prevalent, including antibiotic self-medication (39.63%), nonprescription antibiotic purchasing (59.02%), and early stopping of antibiotic prescriptions (76.56%). Participants had inadequate knowledge of antibiotics (Mean = 2.33, SD = 1.71), reported high availability to antibiotics (Mean = 7.13, SD = 2.41), held strong belief in antibiotic effectiveness (Mean = 10.29, SD = 2.71), and demonstrated a high perceived threat of AMR (Mean = 12.30, SD = 3.20). Four behavioural patterns regarding antibiotic use for URTIs were identified, namely, "antibiotic self-medicators" (n = 165, 20.25%), "formal health care seekers" (n = 216, 26.50%), "various treatment users" (n = 198, 24.20%), and "self-medication without antibiotics" (n = 236, 28.96%). Individuals' self-efficacy of antibiotic use, belief in antibiotic effectiveness, awareness of antibiotic side effects, perceived antibiotic availability, social influence, and demographics (age, education, medical insurance, and having a medical background) were significantly associated with the public's different behavioural patterns of antibiotic use for URTIs. Conclusion This study calls for collaborative efforts among the public, physicians, policy makers, and the implementation of precise and multifaceted interventions to effectively reduce irrational use of antibiotics in the public. Such interventions include identifying subgroups within the public to provide more targeted education about antibiotics and the management of URTIs, reinforcing the regulation of antibiotic dispensing, and improving physicians' rational antibiotic prescriptions.
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Affiliation(s)
- Rujiao Lin
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lixia Duan
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xi Wang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinyi Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qianning Wang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuangjiang Zheng
- Department of Medical Affairs, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Wahab A, Alam MM, Hasan S, Halder S, Ullah MO, Hossain A. Exploring the knowledge, practices & determinants of antibiotic self-medication among bangladeshi university students in the era of COVID-19: A cross-sectional study. Heliyon 2023; 9:e19923. [PMID: 37809972 PMCID: PMC10559346 DOI: 10.1016/j.heliyon.2023.e19923] [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: 03/16/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Self-medication with antibiotics is a growing public health concern. Antibiotics are easily accessible on requested from pharmacies throughout the majority of developing countries. The present study aimed to determine the prevalence of self-medication with antibiotics among university students in Bangladesh, as well as to evaluate their knowledge and practices related to antibiotics and its resistance. A structured questionnaire was administered to 1000 students over a month in January 2022 at three universities of Bangladesh. The results showed that 61.0% of the participants had self-medicated with antibiotics in the last six months. In regards to the participants' level of knowledge and practice, a significant proportion, 60.0% exhibited a substandard understanding of antibiotic resistance and appropriate antibiotic usage. Male students (61.7%) were found to self-medicate more often than female students (38.3%). The highest prevalence of self-medication was observed in the age group of 22-25 years (32.2%). The most common reasons for self-medication were previous experience with the illness (40.9%) and the belief that the illness was not serious (36.2%). The most common illnesses for which self-medication was practiced were fever (40.9%) and cough and cold (29.3%). During multivariate logistic regression analyses age, gender, maintaining diet chart, and habit of exercising regularly were found to be associated with the increased risk of self-medication with antibiotics. The study highlighted the critical need for targeted interventions to promote responsible antibiotic use, enhance knowledge about antibiotic resistance, and discourage self-medication among university students in Bangladesh. Addressing these factors would enable the government to mitigate risks associated with self-medication, prevent antibiotic resistance, and alleviate the burden on health and the economy at large.
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Affiliation(s)
- Abrar Wahab
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Mohammad Morshad Alam
- Department of Public Health, North South University, Dhaka, Bangladesh
- Health Nutrition and Population Global Practice, The World Bank, Dhaka, Bangladesh
| | - Shahriar Hasan
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Sangeeta Halder
- Department of Public Health, North South University, Dhaka, Bangladesh
- Army Medical Core Centre and School, Tangail, Bangladesh
| | - Md Obayed Ullah
- Department of Microbiology, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Ahmed Hossain
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Al-Qerem W, Bargooth A, Jarab A, Akour A, Abu Heshmeh S. Knowledge, attitudes, and practices of Jordanian patients toward Self-Medication. Saudi Pharm J 2023; 31:482-491. [PMID: 37063441 PMCID: PMC10102443 DOI: 10.1016/j.jsps.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
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.
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Jayawardhana Y, Premaratne A, Kalpani S, Jayasundara S, Jayawardhane G, Jayawarna C, Gamage S, Jayawardhana K, Johnsan R, Jayasundara C, Liyanapathirana V. Investigating the drivers for antibiotic use and misuse amongst medical undergraduates-perspectives from a Sri Lankan medical school. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001740. [PMID: 36963066 PMCID: PMC10027203 DOI: 10.1371/journal.pgph.0001740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/23/2023] [Indexed: 03/22/2023]
Abstract
Medical undergraduates are a unique group who gain the theoretical knowledge on prescribing antibiotics but are not authorized to prescribe till full licensure. This unique situation may result in self-medication and unauthorized prescription of antibiotics. This cross-sectional study was conducted among medical students of the Faculty of Medicine, University of Peradeniya, Sri Lanka in 2021 to identify patterns and drivers for antibiotic use and misuse among medical undergraduates. A validated, self-administered Google forms-based online questionnaire was used to gather information on antibiotic use, misuse, and associated factors: demographics, knowledge and perceptions. Two scores; a practice score and a knowledge score were calculated to compare with the associated factors. The study population consisted of 347 medical students with a mean age of 24 (SD1.7) years and 142/347 (40.9%) were male participants. The patterns of misuses identified included; use of antibiotics without a prescription (161/347, 46.4%), keeping left-over antibiotics for future use (111/347, 32.0%), not completing the course of antibiotics (81/347, 23.3%), use of left-over antibiotics (74/347, 21.3%), prescribing to animals (61/347, 17.6%), prescribing antibiotics to family members or friends (51/347, 14.7%), antibiotic self-medication (25/347, 7.2%) and not following the dosage regime prescribed (24/347, 6.9%). The practice score ranged from 33% to 100% (median 87%, IQR 80.0-93.3) and did not differ significantly with either the gender or the year of study. The knowledge score ranged from 4% to 100% (median 87%, IQR: 71.5-95.4) differing significantly according to the year of study. Antibiotic prescription by medical undergraduates was perceived as unacceptable (329/347, 94.8%) by the majority. Individual misuse patterns were associated favourably or unfavourably with gender, year of study, having a health care worker at home and knowledge score. The knowledge score increased with the advancement in training at the medical school while the practice score remained indifferent, highlighting the need to identify the additional drivers of antibiotic misuse among medical undergraduates.
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Affiliation(s)
| | - Avanthi Premaratne
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Sri Lanka, Sri Lanka
| | - Sudeepa Kalpani
- Faculty of Medicine, University of Peradeniya, Sri Lanka, Sri Lanka
| | | | | | | | - Sarala Gamage
- Faculty of Medicine, University of Peradeniya, Sri Lanka, Sri Lanka
| | | | - Radshana Johnsan
- Faculty of Medicine, University of Peradeniya, Sri Lanka, Sri Lanka
| | | | - Veranja Liyanapathirana
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Sri Lanka, Sri Lanka
- * E-mail:
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Pre-Visit Use of Non-Prescribed Antibiotics among Child Patients in China: Prevalence, Predictors, and Association with Physicians’ Prescribing of Antibiotics at Medical Visits. Antibiotics (Basel) 2022; 11:antibiotics11111553. [DOI: 10.3390/antibiotics11111553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Antibiotic resistance is one of the most serious global public health crises. Inappropriate use of antibiotics is an important contributor. Using a cross-sectional survey, we recruited 3056 caregivers from 21 provinces in China to complete a questionnaire pertaining to their most recent medical visits for children’s acute respiratory tract infection (ARTI) symptoms in October 2013. The findings show that the prevalence of caregivers giving children non-prescribed antibiotics before their medical visit was as high as 38%. Caring for an older child and having lower educational attainment increased the likelihood of self-medication with antibiotics; among Chinese residential areas, caregivers living in tier 2 urban districts were most likely to administer non-prescribed antibiotics before their visit. Physicians’ prescribing of antibiotics was significantly associated with caregivers’ self-reported pre-visit use of non-prescribed antibiotics. Misuse should be addressed by regulating the sale of antibiotics and improving communication at medical consultations.
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Min S, Zhou Y, Sun Y, Ye J, Dong Y, Wang X, Zhou Z, Zhou H, Li H. Knowledge, attitude, and practice associated with antimicrobial resistance among medical students between 2017 and 2022: A survey in East China. Front Public Health 2022; 10:1010582. [PMID: 36353280 PMCID: PMC9637849 DOI: 10.3389/fpubh.2022.1010582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/07/2022] [Indexed: 01/27/2023] Open
Abstract
This study described the knowledge, attitude, practice regarding antimicrobial resistance (AMR) among medical students between 2017 and 2022 in East China. A questionnaire-based survey was conducted with a total of 1,066 respondents. We highlighted that the undergraduates had a significant increase in the knowledge of antimicrobial resistance during the 5 years from 2017 to 2022 (p < 0.001). The majority of the assertions about the AMR were correctly identified by respondents. However, gaps were still observed in the issues of antimicrobial targets and bacterial transmission. In addition, overconfident attitudes and inappropriate behaviors of antimicrobial overuse and misuse were observed in the respondents. A number of 30.2% to 45.2% of the respondents asserted that there is no risk of AMR as long as the antimicrobials are taken correctly, and a proportion of the students (25.3% in 2022; 69.3% in 2017, p < 0.001) declared to buy antimicrobials from friends or family members to treat the same illness. Finally, spearman correlation coefficient was enrolled to compare the correlation of the student's KAP. Results showed that the students' knowledge of antimicrobials had a correlation with attitude (p = 0.0126) and practice (p < 0.001), suggesting that public education on knowledge could influence the behaviors among the medical students. Taken all together, our findings show a need to strengthen the medical students' cogitation on antimicrobial attitude and practice of appropriate usage as an essential strategy to reduce intractable public health problems. Additional curriculum reforms will be needed to add more specific AMR-related lectures to raise awareness amongst medical students in China.
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Affiliation(s)
- Shengyi Min
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yuxuan Zhou
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yuxuan Sun
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Jiaquan Ye
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yongfei Dong
- Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Xichao Wang
- Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Zhemin Zhou
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Hanyu Zhou
- Central Laboratory, The First Affiliated Hospital of Wannan Medical College, Wuhu, China,*Correspondence: Heng Li
| | - Heng Li
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China,Hanyu Zhou
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Yin X, Gong Y, Sun N, Li D, Wu J, Wang J, Qiu L, Li H. Prevalence of inappropriate use behaviors of antibiotics and related factors among chinese antibiotic users: an online cross-sectional survey. BMC Infect Dis 2022; 22:689. [PMID: 35964018 PMCID: PMC9375431 DOI: 10.1186/s12879-022-07671-1] [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: 11/15/2021] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Inappropriate use of antibiotics could have a profound negative impact on individual and community. This study aimed to assess the prevalence of inappropriate use behaviors of antibiotics in Chinese antibiotic users and explored their related factors. Methods A cross-sectional survey was conducted from July 1, 2018 to September 30, 2018. A structured questionnaire was widely distributed on the online survey platform (Questionnaire Star, https://www.wjx.cn) and was used to collect data from respondents in China on demographic and sociological characteristics, antibiotic use and related knowledge. Main outcomes included self-medication with antibiotics (SMA), self-storage with antibiotics (SSA), and non-adherence to antibiotic treatment (NAAT). Logistic regression was used to identify the related factors of above inappropriate use behaviors of antibiotics. Results Of the 15,526 participants, 37.1% reported SMA in the past 6 months, 67.9% reported SSA in the past 6 months, and 48.3%, 15.2%, 25.5% and 78.0% of respondents said that they had missed antibiotics, increased antibiotic dosage, decreased antibiotic dosage, and discontinued antibiotics once symptoms disappear, respectively. Overall, 53.3% reported NAAT during this period. After adjusting for other variables, multivariate logistic regression analyses showed that those aged 30–44 years old, with higher levels of education, poorer status of self-perceived health, or lower levels of antibiotic knowledge were more likely to have these inappropriate use behaviors of SMA, SSA, and NAAT (P < 0.05). Conclusions The prevalence of SMA, SSA, and NAAT is high in China. Developing a nationwide action plan for the rational use of antibiotics among publics, including national media publicity, online and offline health education, and medication guidance from general practitioners, is urgently needed. Self-medication with antibiotics, self-storage with antibiotics, and non-adherence to antibiotic treatment are important performances of inappropriate use behaviors of antibiotics. The results of this study showed that the prevalence of inappropriate use behaviors of antibiotics among Chinese antibiotic users were between 37.1% and 67.9%. A nationwide action plan for rational use of antibiotics is urgently needed in China.
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Affiliation(s)
- Xiaoxv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yanhong Gong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Na Sun
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Dandan Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jianxiong Wu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jing Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Lei Qiu
- International School of Public Health and One Health, Hainan Medical University, Haikou, 570100, People's Republic of China.
| | - Hui Li
- School of Health Services Management, Anhui Medical University, Hefei, 230032, People's Republic of China.
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Horvat O, Petrović AT, Paut Kusturica M, Bukumirić D, Jovančević B, Kovačević Z. Survey of the Knowledge, Attitudes and Practice towards Antibiotic Use among Prospective Antibiotic Prescribers in Serbia. Antibiotics (Basel) 2022; 11:antibiotics11081084. [PMID: 36009952 PMCID: PMC9405044 DOI: 10.3390/antibiotics11081084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
The complex issue of antibacterial resistance (ABR) requires actions taken with the One Health approach, involving both human and veterinarian medicine. It can spread from animals to humans through the food chain or through direct contact. Health profession students, as the future antibiotic providers, can greatly impact antibiotic-related issues in the future. The study was conducted to evaluate knowledge, attitudes and practice of future antibiotic prescribers in relation to judicious use of antibiotics. This cross-sectional, questionnaire-based study was performed on 400 students of health professions who were allowed to prescribe antibiotics of the University of Novi Sad, Serbia. Students of medicine and students of dentistry showed a significantly higher knowledge score compared to students of veterinary medicine (p = 0.001). Multivariate regression identified predictors of adequate antibiotic knowledge: being a female student (B = 0.571; p = 0.020), higher grade average (B = 1.204; p = 0.001), students of medicine (B = 0.802; p = 0.006) and dentistry (B = 0.769; p = 0.026), and students who used a complete package of antibiotics during the last infection (B = 0.974; p = 0.001) or for the period recommended by the doctor (B = 1.964; p = 0.001). Out of the total sample, self-medication was reported among 42.8% of students. The identified predictors of self-medication were: more frequent (B = 0.587; p = 0.001) and irregular (B = 0.719; p = 0.007) antibiotic use, taking antibiotics until symptoms disappeared (B = 2.142; p = 0.001) or until the bottle was finished (B = 1.010; p = 0.001) during the last infection. It seems prudent to reevaluate the educational curricula regarding antibiotic use and ABR of prospective prescribers in Serbia.
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Affiliation(s)
- Olga Horvat
- Faculty of Medicine, Department of Pharmacology Toxicology and Clinical Pharmacology, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Ana Tomas Petrović
- Faculty of Medicine, Department of Pharmacology Toxicology and Clinical Pharmacology, University of Novi Sad, 21000 Novi Sad, Serbia
- Correspondence:
| | - Milica Paut Kusturica
- Faculty of Medicine, Department of Pharmacology Toxicology and Clinical Pharmacology, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Dragica Bukumirić
- Institute of Public Health “Dr Milan Jovanovic Batut”, 11000 Belgrade, Serbia
| | - Bojana Jovančević
- Faculty of Medicine, Department of Pharmacology Toxicology and Clinical Pharmacology, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Zorana Kovačević
- Faculty of Agriculture, Department of Veterinary Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
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Mallah N, Orsini N, Figueiras A, Takkouche B. Income level and antibiotic misuse: a systematic review and dose-response meta-analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1015-1035. [PMID: 34845563 PMCID: PMC9304051 DOI: 10.1007/s10198-021-01416-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/15/2021] [Indexed: 05/04/2023]
Abstract
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.
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Affiliation(s)
- Narmeen Mallah
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Adolfo Figueiras
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Bahi Takkouche
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain.
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
- Department of Preventive Medicine, Faculty of Medicine, University of Santiago de Compostela, 15782, Santiago de Compostela, Spain.
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Wang L, Liang C, Yu H, Zhang H, Yan X. Reliability and validity evaluation of the appropriate antibiotic use self-efficacy scale for Chinese adults. BMC Public Health 2022; 22:1344. [PMID: 35836244 PMCID: PMC9284704 DOI: 10.1186/s12889-022-13729-1] [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: 02/01/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Liying Wang
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, China
| | - Chunguang Liang
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, China.
| | - Haitao Yu
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, China
| | - Hui Zhang
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, China
| | - Xiangru Yan
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, China
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Mahmoudi H. Assessment of knowledge, attitudes, and practice regarding antibiotic self-treatment use among COVID-19 patients. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc12. [PMID: 35909654 PMCID: PMC9284720 DOI: 10.3205/dgkh000415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Self-medication with antibiotics is a common practice across different age groups and different cultures that can cause problems such as drug resistance, side effects, and rising costs for the healthcare system community. During the coronavirus pandemic (COVID-19), people with mild symptoms have avoided seeing a doctor, preferring to self-medicate. The impact of self-medication in COVID-19 patients is an important public health issue. The aim of this study was to evaluate the knowledge of, attitudes toward, and performance of self-medication with antibiotics in COVID-19 patients. Methods: This cross-sectional study was conducted among patients with COVID-19. Participants were selected by random sampling. A survey of knowledge, attitude and practice of taking antibiotics in patients with COVID-19 was conducted. Data were analyzed using SPSS version 22 software. Results: The prevalence of self-medication with antibiotics in patients with COVID-19 was 56.1%. Most COVID-19 patients have the overall knowledge, attitude and practice score of self-medication with antibiotics. There was a significant difference between the knowledge and attitudes of educated and uneducated patients (p<0.01). Of the demographic variables, there was no significant difference between sexes in terms of attitude and practice of antibiotic self-medication in COVID-19 patients (p>0.05). Conclusion: Considering the high prevalence of antibiotic self-medication in COVID-19 patients, it is recommended to provide the necessary education and practical means of reducing the amount of antibiotic self-medication.
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Affiliation(s)
- Hassan Mahmoudi
- Department of Microbiology, Hamadan University of Medical Sciences, Hamadan, Iran,Assistant Professor of Medical Bacteriology, Nahavand School of Allied Medical Sciences, Hamadan, Iran,*To whom correspondence should be addressed: Hassan Mahmoudi, Department of Microbiology, Hamadan University of Medical Sciences, Hamadan 65961-46354 , Iran, Phone: +989189539458, E-mail:
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Coope C, Schneider A, Zhang T, Kadetz P, Feng R, Lambert H, Wang D, Oliver I, Michie S, Cabral C. Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis. BMJ Open 2022; 12:e056348. [PMID: 35338063 PMCID: PMC8961142 DOI: 10.1136/bmjopen-2021-056348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. METHODS Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). RESULTS Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. CONCLUSIONS Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.
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Affiliation(s)
- Caroline Coope
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Annegret Schneider
- Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Behaviour Change, University College London, London, UK
| | - Tingting Zhang
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Paul Kadetz
- Queen Margaret University, Institute for Global Health and Development, Edinburgh, UK
| | - Rui Feng
- Library, Anhui Medical University, Hefei, Anhui, China
| | - Helen Lambert
- Population Health Sciences, University of Bristol, Bristol, UK
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Isabel Oliver
- Field Service, National Infection Service, Public Health England National Infection Service, Salisbury, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Christie Cabral
- Population Health Sciences, University of Bristol, Bristol, UK
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Perception and practice of self-medication with antibiotics among medical students in Sudanese universities: A cross-sectional study. PLoS One 2022; 17:e0263067. [PMID: 35081149 PMCID: PMC8791537 DOI: 10.1371/journal.pone.0263067] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/11/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction The benefits of antibiotics are under threat by self-medication, which culminated in economic burdening of developing countries, treatment failures, the emergence of antibiotic-resistant strains of bacteria and an increased probability of exposure and infection of the general population by antibiotic-resistant bacterial strains. Objectives This study aimed to evaluate the knowledge and attitude of medical students in Sudan towards the use of antibiotics, the prevalence of self-medication with antibiotics among medical students in Sudan and to identify risk factors which promote self-medication with antibiotics. Materials and methods This was a cross-sectional, descriptive and institution-based study, between November 2020 and May 2021. 1,110 medical students were selected by multistage cluster sampling. Logistic regression was used to identify risk factors of self-medication with antibiotics among the study participants. Results The median knowledge score was 7 out of a maximum of 10 (IQR: 5–8). A moderately positive attitude was observed among the participants (Median: 7/10; IQR: 6–8). Knowledge and attitude scores were significantly associated with academic year and monthly allowance (p < 0.05). 675 (60.8%) self-medicated with antibiotics within the previous 12 months, mostly from community pharmacies (321/675; 47.5%). Antibiotics were most commonly used to treat respiratory tract infections (38.1%) and cough (30.4%). Chi-square analysis demonstrated that self-medication with antibiotics was significantly associated with gender, year of study and monthly income. Conclusions Undergraduate medical students had moderate knowledge and attitude towards antibiotic use and antibiotic resistance, and an alarmingly high prevalence of self-medication with antibiotics. This highlights the urgent need for tighter legislation regarding the sales of antibiotics in community pharmacies by the state and federal health ministries.
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Assessing Knowledge, Beliefs, and Behaviors around Antibiotic Usage and Antibiotic Resistance among UK Veterinary Students: A Multi-Site, Cross-Sectional Survey. Antibiotics (Basel) 2022; 11:antibiotics11020256. [PMID: 35203857 PMCID: PMC8868437 DOI: 10.3390/antibiotics11020256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/06/2022] [Accepted: 02/09/2022] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance (AMR) is a profound threat to human and animal health. Antimicrobial prescribing behaviours are influenced by psychological factors such as knowledge, beliefs, and emotions. As future antimicrobial prescribers, it is important to understand beliefs about AMR and stewardship among veterinary (vet) students. This cross-sectional online survey assessed vet students’ self-reported behavior, knowledge, and beliefs in specific relation to antibiotic resistance (ABR) and antibiotic usage. Participants were early years (first- and second-year; n = 460) and later-years (third- and fourth-year; n = 113) undergraduate vet students from three UK universities. Self-reported antibiotic-related behaviors were responsible among most students. Knowledge about ABR and stewardship was moderate among early years students and good among later years students. Vet students typically believed that vets had less responsibility for both causing and preventing ABR than other groups (animal owners, human medics, and the public). This study offers evidence that vet students (along with other groups) tend to lay greater responsibility for ABR/AMR outside of their own profession, which may impact their future prescribing behaviors. It is vital that AMR and antimicrobial stewardship are embedded across veterinary curricula, and that the One Health nature of the challenge posed by AMR is emphasized to encourage shared responsibility across all stakeholder groups, thereby helping to reduce ‘other-blaming’ for AMR.
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Sun N, Gong Y, Liu J, Wu J, An R, Dong Y, Zhu Y, Mu K, Zhang G, Yin X. Prevalence of Antibiotic Purchase Online and Associated Factors Among Chinese Residents: A Nationwide Community Survey of 2019. Front Pharmacol 2021; 12:761086. [PMID: 34803704 PMCID: PMC8595837 DOI: 10.3389/fphar.2021.761086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Online sales of antibiotics have increased public access to these medicines. This study aimed to analyze the online antibiotic purchase behavior of the Chinese residents and identify its associated factors. Methods: We conducted a nationwide cross-sectional online survey among Chinese community residents from January 20 to February 28, 2019. A structured questionnaire was used to collect data on their sociodemographic characteristics, health-related variables, and the online antibiotic purchase behavior in the past 3 months. Descriptive statistics and logistic regression analyses were used. The statistical analyses were performed using SAS version 9.4 (SAS Institute Inc.). Results: A total of 101,120 respondents were included in the analysis. The weighted prevalence of antibiotic purchase online was 3.71% (95% CI, 3.53–3.88%). Residents who purchased antibiotics online were more likely to be older (age≥65 years), be a male, live in rural areas, have a higher education level, report an excellent economic status, suffer from chronic diseases, and search for health information on the internet. Conclusion: Numerous residents had purchased antibiotics online in the past 3 months throughout China. We should pay more attention to this behavior. There is a need to strengthen regulation of antibiotic sales online and improve public education on antibiotic purchase online. More comprehensive information on antibiotic purchase online as well as the advantages and disadvantages of online sales of antibiotics should be investigated in the future studies.
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Affiliation(s)
- Na Sun
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaming Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianxiong Wu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongrong An
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Dong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Zhu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ketao Mu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guopeng Zhang
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Sun R, Yao T, Zhou X, Harbarth S, Lin L. Non-biomedical factors affecting antibiotic use in the community: a mixed-methods systematic review and meta-analysis. Clin Microbiol Infect 2021; 28:345-354. [PMID: 34768017 DOI: 10.1016/j.cmi.2021.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the past two decades, human antibiotic consumption has increased globally, contributing to the emergence and spread of antimicrobial resistance and calling for urgent effective actions. OBJECTIVES To systematically identify and collate studies exploring non-biomedical factors influencing healthcare consumers' antibiotic use globally, in order to inform future interventions to improve antibiotic use practices. METHODS Data sources: PubMed, EMBASE, PsycINFO, and Cochrane. STUDY ELIGIBILITY CRITERIA Original and empirical studies that identified factors for healthcare consumers' antibiotic use. PARTICIPANTS Healthcare consumers. Assessment of risk of bias: Adapted BMJ survey appraisal tools, the Critical Appraisal Skills Programme checklist, and the Mixed Methods Appraisal Tool were utilised for quality assessment. Methods of data synthesis: The Social Ecological Framework and Health Belief Model were employed for data synthesis. We did random-effects meta-analyses to pool the odds ratios of risk factors for antibiotic use. RESULTS We included 71 articles for systematic review and analysis: 54 quantitative, nine qualitative, and eight mixed-methods studies. Prevalent non-prescription antibiotic uses and irresponsible prescriptions were reported globally, especially in low-to-middle income countries. Barriers to healthcare - wait time, transportation, stigmatization - influenced people's antibiotic use practices. Further, lack of oversight and regulation in the drug manufacturing and weak supply chain have led to the use of substandard or falsified antibiotics. Knowledge had mixed effects on antibiotic use behaviours. Meta-analyses identified pro-attitudes towards self-medication with antibiotics, relatives having medical backgrounds, older age, living in rural areas, and storing antibiotics at home to be risk factors for self-medication with antibiotics. CONCLUSIONS Non-prescription antibiotic use and irresponsible prescriptions in the community are prevalent in all WHO regions and largely driven by a mixed collection of non-biomedical factors specific to the respective setting. Future AMR strategies should incorporate implementation science approach for community-based complex interventions that addresses drivers of the target behaviours tailored to local contexts.
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Affiliation(s)
- Ruyu Sun
- Zhejiang University, Hangzhou, Zhejiang, P.R.China
| | - Tingting Yao
- Zhejiang University, Hangzhou, Zhejiang, P.R.China
| | - Xudong Zhou
- Zhejiang University, Hangzhou, Zhejiang, P.R.China
| | - Stephan Harbarth
- University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Leesa Lin
- London School of Hygiene & Tropical Medicine, London, United Kingdom; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, P. R. China.
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23
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Dillard LK, Wu CZ, Saunders JE, McMahon CM. A scoping review of global aminoglycoside antibiotic overuse: A potential opportunity for primary ototoxicity prevention. Res Social Adm Pharm 2021; 18:3220-3229. [PMID: 34711521 DOI: 10.1016/j.sapharm.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Aminoglycosides are widely used, broad-spectrum antibiotics with significant potential for ototoxicity. Global efforts to prevent ototoxicity must account for aminoglycoside overuse and non-prescription use. OBJECTIVES The goals of this study were to a) estimate the prevalence of aminoglycoside overuse by synthesizing evidence on self-medication, over the counter (OTC) availability, and household antibiotic storage for later use, and to report the specific aminoglycosides used and the predictors of overuse, and b) leverage this information to comment on potential risk of ototoxicity. METHODS Two systematic search strings were conducted to extract peer-reviewed articles published from 2005 to 2020. The first focused on overuse of aminoglycoside antibiotics. The second focused on potentially ototoxic effects of aminoglycosides related to drug overuse. RESULTS A total of 26 articles were included (first search string: n = 21; second search string: n = 5). The prevalence of aminoglycoside self-medication was high and household storage and OTC availability of aminoglycosides was common. Gentamicin was the most commonly overused aminoglycoside. No studies provided information on antibiotic dosing or resultant toxicities, including ototoxicity. CONCLUSIONS The limited available evidence indicates that antibiotic overuse (self-medication, home storage, and non-prescription availability) is relatively common, especially in low resource settings, and that aminoglycoside antibiotics comprise a variable, but concerning, proportion of non-prescribed antibiotics. Additional evidence is needed to evaluate the relationship between these dispensing patterns and ototoxicity.
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Affiliation(s)
- Lauren K Dillard
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
| | - Cecilia Z Wu
- Mass General Brigham Home Care, Department of Staff Education, Waltham, MA, USA
| | - James E Saunders
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Catherine M McMahon
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
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Lin L, Sun R, Yao T, Zhou X, Harbarth S. Factors influencing inappropriate use of antibiotics in outpatient and community settings in China: a mixed-methods systematic review. BMJ Glob Health 2021; 5:bmjgh-2020-003599. [PMID: 33184066 PMCID: PMC7662435 DOI: 10.1136/bmjgh-2020-003599] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND For decades, antibiotics have been excessively consumed around the world, contributing to increased antimicrobial resistance (AMR) and negatively impacting health outcomes and expenditures. Antibiotic use in China accounts for half of worldwide antibiotic consumption, which mainly takes place in outpatient and community settings, and often unnecessarily for self-limiting community-acquired infections. This study aimed to identify and assess factors of inappropriate use of antibiotics in the Chinese context to inform the development of interventions to mitigate inappropriate consumption in the absence of clinical indications. METHODS We conducted a mixed-methods systematic review and included empirical studies with original data conducted in mainland China, Hong Kong and Taiwan that investigated factors of antibiotic use in the community including outpatient care among patients, caregivers and prescribers. We searched MEDLINE, EMBASE, the Cochrane Library, PsycINFO, Google Scholar and one Chinese database CNKI (China Knowledge Resource Integrated Database), using a combination of the key terms 'antibiotic', 'antimicrobial', 'use', 'consumption', 'behaviour', 'prescribe' and related syntax for all peer-reviewed publications published before June 2020. Health Belief Model was employed for data synthesis. FINDINGS Fifty-four studies were included in the full-text review: 44 quantitative, 5 qualitative and 5 mixed-methods studies. Despite a high AMR awareness, public perception/misconception of antibiotic efficacy and easy access to antibiotics for self-limiting conditions drive inappropriate demand and use in the community including primary care setting. Providers' prescribing behaviours are influenced by financial incentives, lack of diagnostic capacity and concerns over complications. CONCLUSIONS Inappropriate outpatient and community antibiotic use is influenced by non-biomedical factors at the individual, community, health system and societal levels in mainland China, contributing to a high antibiotic use rate. This study calls for context-tailored One Health interventions, restrictive antibiotic drug policy and multifaceted antibiotic stewardship programmes that simultaneously address drivers of inappropriate use from both the supply-side and demand-side within and beyond clinical settings. PROSPERO REGISTRATION NUMBER CRD42019139591.
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Affiliation(s)
- Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruyu Sun
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tingting Yao
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xudong Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Infectious Diseases Division, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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25
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Yin X, Mu K, Yang H, Wang J, Chen Z, Jiang N, Yang F, Zhang G, Wu J. Prevalence of self-medication with antibiotics and its related factors among Chinese residents: a cross-sectional study. Antimicrob Resist Infect Control 2021; 10:89. [PMID: 34090536 PMCID: PMC8180170 DOI: 10.1186/s13756-021-00954-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/17/2021] [Indexed: 01/20/2023] Open
Abstract
Background Self-medication is one of the most common forms of inappropriate use of antibiotics. This study aimed to assess the prevalence of self-medication with antibiotics (SMA) in China and evaluate the related factors. Methods A cross-sectional survey was conducted in Wuhan, Hubei, China from July 1, 2019 to July 31, 2019. Participants were recruited in public places to answer a structured questionnaire. The information of participants’ social demographic characteristics, antibiotic knowledge and health beliefs were collected. Binary Logistics regression analysis was used to examine the associated factors of SMA. Results Of the 3206 participants, 10.32% reported SMA in the past 6 months. Participants who with middle or high perceived barriers to seek health care services showed a higher likelihood of SMA (P < 0.05). Participants who with middle or high perceived threats of self-medication, and who with middle or high self-efficacy to overcome obstacles showed a lower likelihood of SMA (P < 0.05). Conclusions Compared with developed countries, the prevalence of SMA in China is still higher. Measures to conduct public health education and improve the accessibility of health services are crucial to decrease the overall self-medication rate in China. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00954-3.
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Affiliation(s)
- Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Ketao Mu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Heping Yang
- Wuchang University of Technology, Wuhan, Hubei, People's Republic of China
| | - Jing Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Zhenyuan Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Nan Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Fengjie Yang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Guopeng Zhang
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| | - Jianxiong Wu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China.
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The General Population's Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10050497. [PMID: 33925971 PMCID: PMC8146421 DOI: 10.3390/antibiotics10050497] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/27/2022] Open
Abstract
The general population has increasingly become the key contributor to irrational antibiotic use in China, which fuels the emergence of antibiotic resistance. This study aimed to estimate the prevalence of the general population’s irrational use behaviors of antibiotics and identify the potential reasons behind them. A systematic review and meta-analysis were performed concerning four main behaviors relevant to easy access and irrational use of antibiotics and common misunderstandings among the population about antibiotics. Four databases were searched, and studies published before 28 February 2021 were retrieved. Medium and high-level quality studies were included. Random effects meta-analysis was performed to calculate the prevalence of the general population’s irrational behaviors and misunderstandings relevant to antibiotic use. A total of 8468 studies were retrieved and 78 met the criteria and were included. The synthesis showed the public can easily obtain unnecessary antibiotics, with an estimated 37% (95% CI: 29–46) of the population demanding antibiotics from physicians and 47% (95% CI: 38–57) purchasing non-prescription antibiotics from pharmacies. This situation is severe in the western area of China. People also commonly inappropriately use antibiotics by not following antibiotic prescriptions (pooled estimate: 48%, 95% CI: 41–55) and preventatively use antibiotics for non-indicated diseases (pooled estimate: 35%, 95% CI: 29–42). Misunderstanding of antibiotic use was also popular among people, including incorrect antibiotic recognition, wrong antibiotic use indication, inappropriate usage, and ignorance of potential adverse outcomes. Over-and inappropriate use of antibiotics is evident in China and a multifaceted antibiotic strategy targeted at the general population is urgently required.
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27
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Anaba EL, Cole-Adeife MO, Oaku RI. Prevalence, pattern, source of drug information, and reasons for self-medication among dermatology patients. Dermatol Ther 2021; 34:e14756. [PMID: 33404171 DOI: 10.1111/dth.14756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/13/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022]
Abstract
Self-medication is common with dermatology patients. Yet, studies on this phenomenon are few. The pattern and reasons for self-medication are not clear. The objective of this study was to document the prevalence, pattern, source of drug information, and reasons for self-medication among dermatology patients. This was a prospective cross-sectional study of 468 adult dermatology patients over a 9-month period. A self-administered questionnaire was administered to all new patients to the dermatology outpatient clinic. The questionnaire had questions on sociodemographic data, self-medication, what specifically was used by the patients, source of information, and reasons for self-medication. Data were analyzed using the SPSS 22.0. Statistics such as means, medians, and frequencies. t test and chi-square test are presented. The mean age of the patients was 37.9 ± 16.3. The prevalence of self-medication was 63.7%. The pattern of self-medication was herbal only in 11.7%, western medication only in 45.6%, and western and herbal in 42.6%. Reason for self-medication was easy accessibility in 54%, difficulty seeing a doctor in 16.8%, and difficulty accessing medical care in 13.8%. Source of drug information was Pharmacist in 46.3% and friend in 26.5%. Self-medication was significant in males and in those with inflammatory diseases. Self-medication was common and this was due to ready accessibility of drugs and poor access to doctors. Self-medication was common in males and in those who have inflammatory diseases. The pattern of self-medication was dependent on age and the level of education. Source of information on drugs was pharmacists, friends, and family.
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Affiliation(s)
- Ehiaghe L Anaba
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | | | - Ruth Itohan Oaku
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
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28
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Blaser MJ, Melby MK, Lock M, Nichter M. Accounting for variation in and overuse of antibiotics among humans. Bioessays 2021; 43:e2000163. [PMID: 33410142 DOI: 10.1002/bies.202000163] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 01/10/2023]
Abstract
Worldwide, antibiotic use is increasing, but many infections against which antibiotics are applied are not even caused by bacteria. Over-the-counter and internet sales preclude physician oversight. Regional differences, between and within countries highlight many potential factors influencing antibiotic use. Taking a systems perspective that considers pharmaceutical commodity chains, we examine antibiotic overuse from the vantage point of both sides of the therapeutic relationship. We examine patterns and expectations of practitioners and patients, institutional policies and pressures, the business strategies of pharmaceutical companies and distributors, and cultural drivers of variation. Solutions to improve antibiotic stewardship include practitioners taking greater responsibility for their antibiotic prescribing, increasing the role of caregivers as diagnosticians rather than medicine providers, improving their communication to patients about antibiotic treatment consequences, lessening the economic influences on prescribing, and identifying antibiotic alternatives.
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Affiliation(s)
- Martin J Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, New Jersey, USA
| | - Melissa K Melby
- Department of Anthropology, University of Delaware, Newark, Delaware, USA
| | - Margaret Lock
- Department of Social Studies of Medicine and Department of Anthropology, McGill University, Montreal, Quebec, Canada
| | - Mark Nichter
- School of Anthropology, Mel and Enid Zuckerman College of Public Health, Department of Family Medicine, University of Arizona, Tucson, Arizona, USA
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29
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Mandrea L, Frentiu A, Frentiu D. Self-Medication Practice and the Attitude Towards Medical and Pharmaceutical Care. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/vgofkjenhn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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30
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Xu R, Mu T, Jian W, Xu C, Shi J. Knowledge, Attitude, and Prescription Practice on Antimicrobials Use Among Physicians: A Cross-Sectional Study in Eastern China. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211059984. [PMID: 34873939 PMCID: PMC8661115 DOI: 10.1177/00469580211059984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over-prescription of antimicrobials for patients is a major driver of bacterial resistance. The aim of the present study was to assess the knowledge, attitude, and prescription practices regarding antimicrobials among physicians in the Zhejiang province in China, and identify the determining factors. A total of 600 physicians in public county hospitals and township health institutions were surveyed cross-sectionally using a structured electronic questionnaire. The questionnaire was completed by 580 physicians and the response rate was 96.67%. The mean score of 11 terms related to antimicrobial knowledge was 6.81, and an average of 32.1% of patients with upper respiratory tract infections (URTIs) were prescribed antimicrobials. Multivariate analysis indicated that young general practitioners with less training are more likely to contribute to more frequent antimicrobial prescriptions ( P < .05). In contrast, older physicians with more training are more willing to provide patients with the correct knowledge regarding antimicrobials and less likely to prescribe antimicrobials for URTIs. Correlation analysis showed that the level of physician's knowledge, attitude, and prescription practice is related ( P < .05). In conclusion, proper prescription of antimicrobials depends on adequate knowledge and regular training programs for physicians.
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Affiliation(s)
- Rixiang Xu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou China
- School of Pharmacy, Hangzhou Medical Collage, Hangzhou, China
- Zhejiang Drug Policy Research Center, Hangzhou, China
| | - Tingyu Mu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wang Jian
- School of Pharmacy, Hangzhou Medical Collage, Hangzhou, China
| | - Caiming Xu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou China
| | - Jing Shi
- School of Pharmacy, Hangzhou Medical Collage, Hangzhou, China
- Zhejiang Drug Policy Research Center, Hangzhou, China
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Li D, Yang H, Gong Y, Zhao Y, Qiu L, Sun N, Yin X. Development and nationwide application of an antibiotic knowledge scale. Prev Med 2020; 141:106262. [PMID: 33022320 DOI: 10.1016/j.ypmed.2020.106262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022]
Abstract
Misconceptions about antibiotics among the public can potentially lead to their inappropriate use. Currently, there is no antibiotic knowledge assessment tool to address this issue. This study aimed to develop and validate an antibiotic knowledge scale (AKS) and apply this scale to assess public knowledge about antibiotics in China. An initial 18-item AKS was designed and validated among 1180 people recruited in June 2017. After removing redundant items, the reliability and validity of the AKS were examined. Subsequently, a nationwide survey was conducted, and 12,772 people were recruited using multistage sampling and surveyed using the developed AKS. A logistic regression model was used to identify the factors associated with poor knowledge about antibiotics. The final AKS included two screening items and fifteen knowledge evaluation items. Cronbach's alpha, test-retest reliability, and split-half reliability were 0.91, 0.88, and 0.89, respectively. These knowledge evaluation items were loaded in four distinct factors that explained 70.72% of cumulative variance among respondents. Using the developed AKS to assess public knowledge about antibiotics among 12,772 participants, the mean score on the AKS was 7.25 and 67% of participants had poor antibiotic knowledge, which was associated with male gender, rural residence, lower educational level, poor economic status, living in western China, and lacking education on antibiotics. The AKS demonstrated satisfactory reliability and validity in identifying the population with poor antibiotic knowledge. Importantly, the majority of participants had inadequate knowledge about antibiotics. Thus, it is necessary to conduct interventions focusing on improving public knowledge about antibiotics.
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Affiliation(s)
- Dandan Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Heping Yang
- Wuchang University of Technology, Wuhan, Hubei, PR China
| | - Yanhong Gong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yuxin Zhao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Lei Qiu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Na Sun
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xiaoxv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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Fletcher-Miles H, Gammon J. A scoping review on the influential cognitive constructs informing public AMR behavior compliance and the attribution of personal responsibility. Am J Infect Control 2020; 48:1381-1386. [PMID: 32067811 DOI: 10.1016/j.ajic.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Antibiotic resistance is a growing threat to public health. Despite various attempts at educating the public on antimicrobial resistance (AMR) and judicial antibiotic use, fallacies and misconceptions remain. To successfully promote behavior change, various cognitive constructs pertaining to antibiotic behavior need to be identified and targeted. METHODS Using the Arksey and O'Malley (2005) methodological framework, a credible reflexive examination of literature was conducted, permitting identification of a breadth of literature that pertained to the influence of cognitive constructs on public antimicrobial behavior. RESULTS From 393 abstracts identified, 67 full articles were screened, and 43 papers were chosen for review. Three themes were identified (1) sociodemographic influences; (2) knowledge, misconceptions, and fallacies; and (3) public attitudes and the social influence of friends and family. Geographical location, education level, cognitive dissonance, and social norms were found to influence AMR cognition, resulting in disproportionate risk assessments that are facilitated by social information brokering. CONCLUSIONS Public AMR resilience, responsibility, and behavior compliance are influenced by cognitive constructs, which are liable to the appropriation of misconceptions, fallacies, and social behavior models obtained via information brokering. A cohesive multidisciplinary participatory approach to AMR management and interventional design that applies the influence of cognitive constructs to inform public AMR behavior compliance is recommended.
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Affiliation(s)
- Hayley Fletcher-Miles
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom.
| | - John Gammon
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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Wang NC. Understanding antibiotic overprescribing in China: A conversation analysis approach. Soc Sci Med 2020; 262:113251. [DOI: 10.1016/j.socscimed.2020.113251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 01/03/2023]
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Tiong TW, Chua SS. Knowledge and Attitude of University Students on Antibiotics: A Cross-sectional Study in Malaysia. DRUG HEALTHCARE AND PATIENT SAFETY 2020; 12:135-144. [PMID: 32884359 PMCID: PMC7443416 DOI: 10.2147/dhps.s253301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/29/2020] [Indexed: 11/23/2022]
Abstract
Background Antibiotic resistance has become one of the major global health threats. The lack of knowledge on antibiotics contributes to the indiscriminate use of these medications and subsequent antibiotic resistance. Objective To evaluate the knowledge and attitude of university students regarding antibiotics. Methods A cross-sectional study was conducted on university students at a private university in Malaysia in 2018, using a self-administered validated questionnaire. Results Of the 424 respondents included in this study, 25.7% had taken antibiotics in the previous month while 22.6% had good knowledge about antibiotics. The faculty to which the respondents were attached was the only determinant associated with the respondents’ knowledge level on antibiotics. The odds of respondents from other faculties having poor knowledge level on antibiotics were significantly higher than those from the Faculty of Health and Medical Sciences (P<0.001). The study found that 77.8% of the respondents knew the roles of antibiotics in treating bacterial infections, but only 27.4% knew that antibiotics were not for viral infections. However, 46.5% of the respondents recognized that penicillin is an antibiotic, but only 35.4% and 9.2% knew that aspirin and diphenhydramine, respectively, are not antibiotics. More than 70% of the respondents were aware that antibiotics have side effects and that overuse of antibiotics could lead to resistance. However, 35.6% expected antibiotics to be prescribed for common colds and 33% would not complete their course of antibiotics. Conclusion The study shows that university students do not have adequate knowledge and about one-third have misconceptions about antibiotics. This calls for health education interventions at university level as this target population will be the future leaders of the country.
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Affiliation(s)
- Ting Wei Tiong
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Siew Siang Chua
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
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Lin L, Fearon E, Harbarth S, Wang X, Lu C, Zhou X, Hargreaves JR. Decisions to use antibiotics for upper respiratory tract infections across China: a large-scale cross-sectional survey among university students. BMJ Open 2020; 10:e039332. [PMID: 32843519 PMCID: PMC7449317 DOI: 10.1136/bmjopen-2020-039332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To investigate the decision-making process of Chinese university students with respect to antibiotic use for upper respiratory tract infections (URTIs). DESIGN A cross-sectional questionnaire study. SETTING The participants recruited from six universities across all Chinese regions from September to November 2015. PARTICIPANTS A total of 2834 university students sampled across six Chinese regions who self-reported experiencing symptoms of URTI within the past month completed the survey. OUTCOME MEASURES The prevalence of decisions for treatment and antibiotic use for URTIs as well as knowledge about antibiotic use were measured by a self-administrated questionnaire. Using regular and multinomial logistic regression a nd adapted health belief model, we identified and measured a number of variables as potential risk factors for antibiotic misuse behaviours in order to explain and predict people's treatment decisions and antibiotic use including knowledge, perceptions, access to antibiotics and cues to action. RESULTS Of the 2834 university students who self-diagnosed a URTI, 947 (33.4%) self-reported having taken antibiotics; among them, 462 (48.8%) used non-prescription antibiotics, which came principally from left-over prescriptions (29.0%) and over-the-counter purchases at retail pharmacies (67.3%). One in four who sought care pressured their doctors for antibiotics; all received them. Those who perceived greater severity of the disease, had access to antibiotics, perceived benefits of using antibiotics (for the common cold: adjusted OR (aOR)=2.55, 95% CI 1.93 to 3.38 or as anti-inflammatory drugs: aOR=1.35, 95% CI 1.12 to 1.63), and were cued to action (eg, seeing presence of fever: aOR=2.05, 95% CI 1.62 to 2.60 or self-diagnosing their current infection as severe: aOR=1.86, 95% CI 1.41 to 2.45), keeping antibiotics at home (aOR=2.27, 95% CI 1.83 to 2.81) and access to over-the-counter antibiotics (aOR=2.00, 95% CI 1.63 to 2.45), were more likely to misuse antibiotics. CONCLUSIONS Misconceptions of antibiotic efficacy and easy access to antibiotics-with or without a prescription-were associated with antibiotic misuse among Chinese university students, which calls for context-appropriate multifaceted interventions in order to effectively reduce antibiotic misuse.
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Affiliation(s)
- Leesa Lin
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Fearon
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephan Harbarth
- Infection Prevention and Control Division, University Hospitals Geneva, Geneve, Switzerland
| | - Xiaomin Wang
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Xudong Zhou
- School of Medicine, Zhejiang University, Hangzhou, China
| | - James R Hargreaves
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Jimah T, Fenny AP, Ogunseitan OA. Antibiotics stewardship in Ghana: a cross-sectional study of public knowledge, attitudes, and practices among communities. ONE HEALTH OUTLOOK 2020; 2:12. [PMID: 33829133 PMCID: PMC7993532 DOI: 10.1186/s42522-020-00021-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Antibiotic resistance is a major contributing factor to global morbidity and mortality and is associated with inappropriate medication use. However, the level of antibiotic consumption and knowledge about antibiotic resistance in Ghana is inadequately quantified. Our study identifies strategies for improved stewardship of antibiotics to prevent the proliferation of resistant pathogens by assessing the level of antibiotic knowledge, attitudes, and consumption behaviors by region, gender, age, and education in rural and urban Ghana. METHODS A cross-sectional study was conducted in 12 communities in the urban Greater Accra and rural Upper West regions of Ghana. A questionnaire survey was administered to 400 individuals aged 18 years and older in selected locations during September-October 2018 to collect data on individual knowledge, attitudes, and practices concerning antibiotics and antibiotic resistance. Multivariate analysis was used to investigate the association between demographic characteristics and knowledge, attitudes, and related behaviors. RESULTS Over 30% (125/400) had not received a doctor's prescription during their last illness. Seventy percent (278/400) had taken at least one antibiotic in the year prior to the survey. The top five frequently used antibiotics were Amoxicillin, Amoxicillin-clavulanic acid, Ampicillin, Ciprofloxacin, and Metronidazole. Women and older adults had higher knowledge compared to their respective counterparts (p < 0.01). Furthermore, prudent antibiotic use was significantly more prevalent in women than men (p < 0.05). Although no regional differences were found in overall knowledge, compared to urban residents, individuals residing in rural settings exhibited higher knowledge about the ineffectiveness of antibiotics for viruses like the cold and HIV/AIDS (p < 0.001). Two hundred and fifty-two (63%) respondents were unaware of antibiotic resistance. There was generally a low level of self-efficacy among participants regarding their role in preserving the effectiveness of antibiotics. CONCLUSION Antibiotic knowledge, attitudes, and use varied significantly across demographics, suggesting a context-specific approach to developing effective community interventions.
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Affiliation(s)
- Tamara Jimah
- Department of Population Health & Disease Prevention, Anteater Instruction and Research Building, University of California, 653 E Peltason Drive, Irvine, CA 92697 USA
| | - Ama P. Fenny
- Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Accra, Ghana
| | - Oladele A. Ogunseitan
- Department of Population Health & Disease Prevention, Anteater Instruction and Research Building, University of California, 653 E Peltason Drive, Irvine, CA 92697 USA
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Knowledge, attitudes and practices in relation to antimicrobial resistance amongst Chinese public health undergraduates. J Glob Antimicrob Resist 2020; 23:9-15. [PMID: 32814152 DOI: 10.1016/j.jgar.2020.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/18/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess knowledge, attitudes and practices amongst public health undergraduates in relation to antimicrobial resistance (AMR) in China. METHODS A cross-sectional survey was conducted amongst all final-year public health undergraduates from 18 universities across China. A structured questionnaire was used to collect information on AMR-related knowledge, attitudes and practices, whilst multivariable linear and logistic regressions were employed to detect associations among these three aspects. RESULTS A total of 1115 participants were included in this study. The mean ± standard deviation AMR knowledge score was 7.68 ± 2.56. Moreover, 75.2% of students had performed incorrect antimicrobial practice. Studying in a key university [slope = 1.49, 95% confidence interval (CI) 0.71-2.27], being male (slope = 0.36, 95% CI 0.02-0.70), having clinical experience (slope = 1.71, 95% CI 1.13-2.30) and having an affirmative attitude towards AMR were positively associated with knowledge score. Knowledge score was also positively associated with AMR practice (odds ratio = 1.07, 95% CI 1.00-1.13). CONCLUSIONS A knowledge gap in relation to AMR was determined among Chinese public health students. This gap is associated with attitudes towards AMR and in turn influences antimicrobial use. It is clear that additional measures are needed in the curriculum, including additional AMR-specific clinical practices.
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Serbian students' knowledge, attitudes and behaviour towards antibiotic use: is there room for improvement? Int J Public Health 2020; 65:1257-1267. [PMID: 32737562 DOI: 10.1007/s00038-020-01448-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES This study has been aimed at evaluating knowledge, attitudes and behaviour of university students regarding the usage of antibiotics focusing on differences between medical and nonmedical students. METHODS This cross-sectional questionnaire-based study was performed on 800 students of the University of Novi Sad, Serbia. RESULTS The identified predictors of adequate antibiotic knowledge were enrolled in medical program, higher grade average and appropriate use of antibiotics during last infection. Multivariate regression identified following predictors of self-medication: being medical student (B = 0.715; p < 0.001), more frequent (B = 0.628; p < 0.001) and irregular (B = 0.584; p = 0.001) antibiotic use, a family member engaged in medical profession (B = 0.789; p < 0.001), living in dormitory (B = 0.679; p = 0.007) or rented apartment (B = 0.621; p = 0.002), using antibiotics until symptoms resolved (B = 1.616; p < 0.001) or until the bottle was finished (B = 0.628; p < 0.001) during the last infection. CONCLUSIONS Although a high number of students showed adequate knowledge about antibiotics, numerous misconceptions were recorded, including self-medication. Further educational interventions are necessary to improve their understanding, perceptions as well as their behaviour towards antibiotic use.
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Antwi AN, Stewart A, Crosbie M. Fighting antibiotic resistance: a narrative review of public knowledge, attitudes, and perceptions of antibiotics use. Perspect Public Health 2020; 140:338-350. [PMID: 32515278 DOI: 10.1177/1757913920921209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS The aims of this study were to ascertain the comprehensive knowledge, perceptions, and attitudes of people from varying socioeconomic regions towards antibiotic use; identify the misperceptions and malpractices; and inform health policy and practice. METHOD EBSCO host databases, PubMed, and Google Scholar were searched to obtain relevant primary research papers within the years 2010-2018. Search phrases included the following: 'antibiotics use', 'community perceptions', 'public opinion, knowledge, behaviour, practices, perceptions'. Initially, selected papers were screened using the Preview, Question, Read, Summarize (PQRS) model. RESULTS Review of the 20 articles selected was based on six identified themes. It was found that insufficient knowledge and awareness of antibiotics use; self-medication and the use of leftover antibiotics; treating viral diseases with antibiotics or used as painkillers; expecting antibiotic prescription as a culmination of consultation; and the credibility of information obtained are issues that cut across different countries. CONCLUSION Evidence from this review suggests that misconceptions of antibiotic use are similar in different countries. Therefore, the need for the development and implementation of transferable policies as well as educating the public is necessary for the fight against ABR.
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Affiliation(s)
- A N Antwi
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK.,Parasitology Department, Noguchi Memorial Institute for Medical Research, P.O. Box LG 581, Legon, Accra, Ghana
| | - A Stewart
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Michelle Crosbie
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK
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Subashini N, Udayanga L. Demographic, socio-economic and other associated risk factors for self-medication behaviour among university students of Sri Lanka: a cross sectional study. BMC Public Health 2020; 20:613. [PMID: 32366238 PMCID: PMC7197154 DOI: 10.1186/s12889-020-08622-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/31/2020] [Indexed: 12/17/2022] Open
Abstract
Background Self-prescribing practices are considered as a significant issue in the health sector due to mal-practices. This has become a more worsen issue in developing countries with easy access to medication. Current study was undertaken to estimate the prevalence of self-medication and to evaluate the driving factors behind this behavior, among university students of Sri Lanka. Method A total of 700 randomly selected undergraduates of three state universities in Sri Lanka, were recruited as the study population for the cross-sectional study. Information on socio-demographic, Knowledge, Attitudes and Practices relevant to Self-Medication (SM) were gathered using an interviewer administered questionnaire. Binary logistic regression was used to calculate the Odds Ratios (OR) and the 95% confidence intervals of the OR for socio-demographic risk factors on SM. Results Around 78% of the studied population denoted a SM behaviour. Only, 37.7% of respondents were familiar with the classification of “Over the Counter” (OTC) drugs, while majority were well aware of the risks of SM (> 50%). Fever (61.3%) and cough (56.7%) were the major health issues for SM, while antipyretics and drugs for cough and runny nose (73.6%) were the mostly used medication. Previous experience (76%) and trivial nature of health issues (73%) were recognized as the major reasons for SM. Majority of respondents declared that community pharmacies (86.9%) and left over medication from previous prescriptions (51%) were the sources for SM. Based on the binary logistic regression, age, residence locality, field of study and academic year were recognized as significant risk factors (P < 0.05) for SM within the studied undergraduate population. Conclusion Based on the high prevalence rate of SM, the health authorities of Sri Lanka should pay more attention towards the wellbeing and responsible medication usage of undergraduates. Designing of effective tools and regulations to monitor the selling of medication and improving the health education are recommended to ensure responsible SM within the country.
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Affiliation(s)
- Nirma Subashini
- Department of Horticulture & Landscape Gardening, Faculty of Agriculture & Plantation Management, Makadura, Wayamba University of Sri Lanka, Gonawila, Sri Lanka
| | - Lahiru Udayanga
- Department of Biosystems Engineering, Faculty of Agriculture & Plantation Management, Makadura, Wayamba University of Sri Lanka, Gonawila, Sri Lanka.
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Shi L, Chang J, Liu X, Zhai P, Hu S, Li P, Hayat K, Kabba JA, Feng Z, Yang C, Jiang M, Zhao M, Hu H, Fang Y. Dispensing Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang, Northeastern China: A Cross-Sectional Study. Antibiotics (Basel) 2020; 9:E163. [PMID: 32268530 PMCID: PMC7235837 DOI: 10.3390/antibiotics9040163] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 01/21/2023] Open
Abstract
: The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional study was performed from March to May 2018 using the standardized client method. Two different simulated scenarios were presented at pharmacies, namely, pediatric and adult acute cough associated with a common cold. Of 150 pharmacy visits, 147 visits were completed (pediatric case: 73, adult case: 74). A total of 130 (88.4%) community pharmacies dispensed antibiotics without a prescription, with a significant difference between pediatric and adult cases (pediatric case, 79.5% versus adult case, 97.3%, p = 0.005). Symptoms were asked in most visits (pediatric case: 82.2%, adult case 82.4%). Patients' previous treatment and history of allergies were both inquired more frequently in the pediatric cases than in the adult cases. Medication advice was provided more often in the adult cases than in pediatric cases. Antibiotics were easily obtained without a prescription in Shenyang, especially for adult patients. Adequate inquiries and counseling had not occurred in most pharmacies.
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Affiliation(s)
- Li Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Xiaoxi Liu
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang 110016 China;
| | - Panpan Zhai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Zhitong Feng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa 999078, Macao, China;
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
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Dyar OJ, Zhang T, Peng Y, Sun M, Sun C, Yin J, Ding L, Sun C, Wang Y, Sun Q, Greko C, Stålsby Lundborg C. Knowledge, attitudes and practices relating to antibiotic use and antibiotic resistance among backyard pig farmers in rural Shandong province, China. Prev Vet Med 2020; 175:104858. [PMID: 31835205 DOI: 10.1016/j.prevetmed.2019.104858] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022]
Abstract
China is among the world's largest consumers of antibiotics for livestock, and the demand for meat protein continues to rise. Pig production takes place at a range of facilities, including backyard pig farms. The aim of this study was to describe the knowledge, attitudes and practices of backyard pig farmers concerning antibiotic use and resistance, and to observe household storage of antibiotics for use in pigs. We conducted a cross-sectional questionnaire survey among 271 rural residents with backyard pig farms in 12 villages in one town in Shandong province. The median number of pigs per backyard farm was 14, and 82 % (222/271) of participants reported not having had any training about raising pigs. Eighteen percent of participants (48/271) reported always or often adding antibiotics to feed to keep pigs healthy and prevent diseases, and a third (88/271) of participants believed that pigs should be given antibiotics when they stop eating. Thirty percent (82/271) reported having bought antibiotics in the previous year without having first spoken with a veterinarian. Antibiotics accounted for over half of all medicines stored (55 %, 197/358), and were observed in 31 % of all households (83/271). Less than half of participants (45 %, 37/83) from households in which antibiotics for pig use were found knew that they were storing antibiotics. The most common class of antibiotics stored for use in pigs was (Q)J01C beta-lactam antibiotics, penicillins (19 %, 37/197), followed by (Q)J01F macrolides, lincosamides and streptogramins (14 %, 28/197), and (Q)J01M quinolones (12 %, 25/197). These results provide important insights into how backyard pig farmers are using antibiotics in rural China and suggest potential targets for interventions to reduce unnecessary and inappropriate use.
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Affiliation(s)
- Oliver J Dyar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tianyang Zhang
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Yang Peng
- Zhucheng Center for Disease Prevention and Control, Zhucheng City, Shandong, China
| | - Mingli Sun
- Zhucheng Center for Disease Prevention and Control, Zhucheng City, Shandong, China
| | - Chengyun Sun
- Zhucheng Center for Disease Prevention and Control, Zhucheng City, Shandong, China
| | - Jia Yin
- School of Health Care Management, Shandong University, Jinan, Shandong, China; Key Laboratory of Health Economics and Policy Research, NHC, Shandong University, Jinan, Shandong, China; Center for Health Management and Policy Research, Shandong University, Jinan, Shandong, China
| | - Lilu Ding
- School of Health Care Management, Shandong University, Jinan, Shandong, China; Key Laboratory of Health Economics and Policy Research, NHC, Shandong University, Jinan, Shandong, China; Center for Health Management and Policy Research, Shandong University, Jinan, Shandong, China; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Chengtao Sun
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Yang Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Qiang Sun
- School of Health Care Management, Shandong University, Jinan, Shandong, China; Key Laboratory of Health Economics and Policy Research, NHC, Shandong University, Jinan, Shandong, China; Center for Health Management and Policy Research, Shandong University, Jinan, Shandong, China.
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Resman F. Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program. Ther Adv Infect Dis 2020; 7:2049936120933187. [PMID: 32612826 PMCID: PMC7307277 DOI: 10.1177/2049936120933187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022] Open
Abstract
Regardless of one's opinion of antimicrobial stewardship programs (ASPs), it is hardly possible to work in hospital care and not be exposed to the term or its practical effects. Despite the term being relatively new, the number of publications in the field is vast, including several excellent reviews of general and specific aspects. Work in antimicrobial stewardship is complex, and includes not only aspects of infectious disease and microbiology, but also of epidemiology, genetics, behavioural psychology, systems science, economics and ethics, to name a few. This review aims to take several of these aspects and the scientific evidence of antimicrobial stewardship studies and merge them into two questions: How should we design ASPs based on what we know today? And which are the most essential unanswered questions regarding antimicrobial stewardship on a broader scale? This narrative review is written in two separate parts aiming to provide answers to the two questions. This first part is written as a step-wise approach to designing a stewardship intervention based on the pillars of unmet need, feasibility, scientific evidence and necessary core elements. It is written mainly as a guide to someone new to the field. It is sorted into five distinct steps: (a) focusing on designing aims; (b) assessing performance and local barriers to rational antimicrobial use; (c) deciding on intervention technique; (d) practical, tailored design including core element inclusion; and (e) evaluation and sustainability. The second part, published separately, formulates ten critical questions on controversies in the field of antimicrobial stewardship. It is aimed at clinicians and researchers with stewardship experience and strives to promote discussion, not to provide answers.
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Affiliation(s)
- Fredrik Resman
- Department of Translational Medicine, Clinical
Infection Medicine, Lund University, Rut Lundskogs Gata 3, Plan 6, Malmö, 20502,
Sweden
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Sun C, Hu YJ, Wang X, Lu J, Lin L, Zhou X. Influence of leftover antibiotics on self-medication with antibiotics for children: a cross-sectional study from three Chinese provinces. BMJ Open 2019; 9:e033679. [PMID: 31843850 PMCID: PMC6924767 DOI: 10.1136/bmjopen-2019-033679] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To investigate leftover antibiotics and their influence on self-medication with antibiotics (SMA) for Chinese children, and further explore the different influences of leftovers from two main sources: previous prescriptions and pharmaceutical purchases. DESIGN A cross-sectional questionnaire study. SETTING The participants were approached through kindergartens and primary schools as well as in vaccination clinics. PARTICIPANTS A total of 9526 parents from three Chinese provinces whose children were aged 0-13 years completed the survey. OUTCOME MEASURES The prevalence of keeping antibiotics at home for children and the proportion of leftover antibiotics from two main sources were measured by a self-administrated questionnaire. Logistic regression models were established to examine the association between keeping antibiotics at home and SMA for children, specifically the risks of leftovers from two main sources. RESULTS Overall, 4580 (48.1%) reported keeping antibiotics at home for children. Among those who had leftovers, 2891 (63.1%) reported that their leftovers came from previous prescriptions and 1619 (35.3%) reported that their leftovers came from pharmaceutical purchases. Mothers, older age of child, higher household income, higher education level and medical background were significantly associated with keeping antibiotics at home. Keeping antibiotics at home was significantly associated with SMA for children (adjusted OR=4.91, 95% CI 3.84 to 6.28). Particularly, compared with parents who did not keep antibiotics at home, parents who kept leftover antibiotics from previous prescriptions and those whose leftovers came from pharmaceutical purchases were 3.80 (95% CI 2.89 to 5.00) and 6.45 (95% CI 4.89 to 8.51) times more likely to engage in SMA for children, respectively. CONCLUSIONS Keeping antibiotics at home for children was pervasive in China. Most leftovers came from previous prescriptions, while those from pharmacies had a higher risk of SMA for children.
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Affiliation(s)
- Chenhui Sun
- Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanhong Jessika Hu
- Murdoch Children's Research Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Xiaomin Wang
- Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jingjing Lu
- Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Leesa Lin
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Xudong Zhou
- Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China
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Nepal A, Hendrie D, Robinson S, Selvey LA. Knowledge, attitudes and practices relating to antibiotic use among community members of the Rupandehi District in Nepal. BMC Public Health 2019; 19:1558. [PMID: 31771595 PMCID: PMC6880381 DOI: 10.1186/s12889-019-7924-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/08/2019] [Indexed: 11/23/2022] Open
Abstract
Background The development of antibiotic resistance is one of the biggest threats to global public health. Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. The aim of this study was to explore the knowledge, attitudes and practices (KAP) towards antibiotic use among adults in Nepal. Methods A quantitative survey was conducted with 220 community members of the Rupandehi district of Nepal, with cluster sampling techniques applied to select households. Interviews were carried out face-to-face using a structured questionnaire. Responses were presented using descriptive analysis, with chi-squared tests and regression analysis applied to identify factors associated with KAP about antibiotic use and the Spearman’s rank order correlation coefficient calculated to examine the relationship between responses to the KAP questions. Results The sample comprised more females (54%) than males, the average age of respondents was 38.5 years and almost 60% of respondents lived in rural areas. Respondents had relatively good knowledge about aspects of antibiotic use other than identifying antibiotics. The concept of antibiotic resistance was well known but imperfectly understood. Half of respondents (50.9%) were unsure whether skipping doses would contribute to the development of antibiotic resistance, 88.2% indicated they would go to another doctor if not prescribed an antibiotic when they thought one was needed and nearly half (47.7%) believed antibiotics helped them get better more quickly if they had a fever. Most respondents reported correct practices accessing and using antibiotics, however, 84.6% at least sometimes preferred an antibiotic when they have a cough and sore throat. Logistic regression showed respondents with higher levels of education tended to have better knowledge, more appropriate attitudes and better practices about antibiotic use. Rural respondents were less likely to have better knowledge about antibiotic use, while females were more likely to report better practices. Conclusion The study provides baseline evidence about the knowledge, attitudes and practices regarding antibiotic use among the population of the Rupandehl district. Its findings will be useful in designing effective and targeted interventions to decrease misconceptions about antibiotic use and to increase awareness about the risks of inappropriate use of antibiotics in the community.
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Affiliation(s)
- Anant Nepal
- School of Public Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102, Australia.
| | - Delia Hendrie
- School of Public Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102, Australia
| | - Suzanne Robinson
- School of Public Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102, Australia
| | - Linda A Selvey
- School of Public Health, The University of Queensland, Herston Rd, Herston, Qld, 4006, Australia
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Wang J, Sheng Y, Ni J, Zhu J, Zhou Z, Liu T, Zhang X, Zhao Q. Shanghai Parents' Perception And Attitude Towards The Use Of Antibiotics On Children: A Cross-Sectional Study. Infect Drug Resist 2019; 12:3259-3267. [PMID: 31802917 PMCID: PMC6802538 DOI: 10.2147/idr.s219287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/28/2019] [Indexed: 12/26/2022] Open
Abstract
Background Parents play an important role in the management of their children’s illnesses, including in decisions concerning how and whether to use antibiotics. This study aims to assess the knowledge and attitude towards antibiotics usage among young parents from different areas in Shanghai and to identify contributing factors of antibiotics usage that are comprehensible for parents. Methods A cross-sectional study was conducted at vaccination clinics of three community health centers from April to June 2017. Primary guardians who took children for vaccination under the national expanded immunization program were invited to participate. Results Of the 1368 young parents interviewed, 78.4% of them have taken their children for medical treatment, and 68.9% of their children have taken antibiotics. Parents with education level of senior high school (OR=1.850, 95% CI: 1.214–2.818), or university/college, or above (OR=3.950, 95% CI: 2.604–5.991), and parents with high-income (OR=1.360, 95% CI: 1.013–1.827) have better comprehension of antibiotics. It is found that parents who deny the existence of antibiotic abuse in China (OR=1.857, 95% CI: 1.100–3.135), who have lower income (OR=1.536, 95% CI: 1.074–2.197) and who have antibiotics prescribed by doctors (OR=1.473, 95% CI: 1.048–2.070) are associated with those incorrect practices. Conclusion Lack of knowledge and poor perception of antibiotics usage are found among young parents in Shanghai. Intervention should be conducted to publicize the rational use of antibiotics, reduce the rate of inappropriate behaviors and limit the sale of antibiotics.
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Affiliation(s)
- Jian Wang
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yuchao Sheng
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, People's Republic of China.,The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, People's Republic of China
| | - Jun Ni
- Vaccination Clinics, Gangyan Community Health Service Center, Shanghai, People's Republic of China
| | - Jianyu Zhu
- Vaccination Clinics, Tangqiao Community Health Service Center, Shanghai, People's Republic of China
| | - Zhigang Zhou
- Vaccination Clinics, Tangqiao Community Health Service Center, Shanghai, People's Republic of China
| | - Tianwei Liu
- Vaccination Clinics, Tangqiao Community Health Service Center, Shanghai, People's Republic of China
| | - Xiaoying Zhang
- Vaccination Clinics, Huacao Community Health Service Center, Shanghai, People's Republic of China
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, People's Republic of China.,The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, People's Republic of China
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Rattanaumpawan P, Chuenchom N, Thamlikitkul V. Perception, attitude, knowledge and learning style preference on challenges of antimicrobial resistance and antimicrobial overuse among first year doctors in training and final year medical students. Antimicrob Resist Infect Control 2019; 8:142. [PMID: 31463045 PMCID: PMC6708150 DOI: 10.1186/s13756-019-0597-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background To promote effective education on challenges of antimicrobial resistance (AMR) and antimicrobial overuse, it is necessary to understand the current perception, attitude, knowledge and learning style preference on these issues among future general practitioners and subspecialists. Methods In 2014, we conducted a questionnaire-based survey in two participant groups: 1) first-year residents and fellows (doctor-in-training, DIT) of Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand and 2) final-year medical students (medical students, MS) of three medical schools in Thailand. Results A total of 225 DIT and 455 MS completed the questionnaire. Both groups had good perception of these problems. However, overall, only half of the participants answered that they can prescribe appropriate antibiotics to their patients (DIT 48.4% vs. MS 52.8%; p = 0.29). The DIT group had significantly higher mean knowledge scores on questions relating to antimicrobial use (64.0% vs. 56.0%; p < 0.001) and infection control (83.0% vs. 80.0%; p = 0.004). For the DIT group, the learning style preference regarding antimicrobial use was conducting an internet search (56.0%), followed by asking infectious disease personnel (50.7%) and/or using the Thai-language antimicrobial guidelines. By contrast, the MS group preferred asking ward personnel (57.4%), followed by using the English-language antimicrobial guidelines (52.1%) and conducting an internet search (27.7%). Conclusion AMR and antimicrobial overuse in Thailand are well recognized challenges. However, final-year MS and first-year DIT have very limited knowledge of these important subjects. Customized education methods should be carefully chosen to ensure that future general practitioners and subspecialists are adequately trained.
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Affiliation(s)
- Pinyo Rattanaumpawan
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Rd., Bangkok Noi, Bangkok, Thailand
| | - Nuttagarn Chuenchom
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Rd., Bangkok Noi, Bangkok, Thailand
| | - Visanu Thamlikitkul
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Rd., Bangkok Noi, Bangkok, Thailand
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Jairoun A, Hassan N, Ali A, Jairoun O, Shahwan M, Hassali M. University students' knowledge, attitudes, and practice regarding antibiotic use and associated factors: a cross-sectional study in the United Arab Emirates. Int J Gen Med 2019; 12:235-246. [PMID: 31388309 PMCID: PMC6607982 DOI: 10.2147/ijgm.s200641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/17/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose: Antibiotic resistance is one of the world’s most fatal health crises. Medical students are the antibiotic prescribers of tomorrow, so better understanding of their knowledge, attitudes, and practice (KAP) pertaining to antibiotic use is crucial. Objectives: This study aimed to assess the KAP of antibiotics and associated factors among university students in the United Arab Emirates (UAE). Methods: This was a descriptive cross-sectional study conducted among a random sample of undergraduate students from Ajman University in the UAE. A self-administered pretested questionnaire was used to collect data on students’ demographics and their KAP regarding antibiotic use. Data were analysed using STATA version 14.2. P<0.05 was considered statistically significant. Results: This study showed that university students have a high rate of antibiotic self-medication. The average KAP score was 56% (95% CI 55%–57%). Statistical modeling showed that major, study year, age, and sex were strong determinants of KAP regarding antibiotic use. Conclusion: There is a need to develop an effective and comprehensive antibiotic-stewardship program as part of undergraduate education. Moreover, reinforcing antibiotic-use policies, involving pharmacies, drug supply, distribution, and sale, are also urgently needed.
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Affiliation(s)
- Ammar Jairoun
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Nageeb Hassan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Abdelazim Ali
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | | | - Moyad Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Mohamed Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Bogale AA, Amhare AF, Chang J, Bogale HA, Betaw ST, Gebrehiwot NT, Fang Y. Knowledge, attitude, and practice of self-medication with antibiotics among community residents in Addis Ababa, Ethiopia. Expert Rev Anti Infect Ther 2019; 17:459-466. [PMID: 31122087 DOI: 10.1080/14787210.2019.1620105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Self-medication with antibiotics, which may cause significant antibiotic resistance, is predominant in developing countries. The aim of this study is to assess the knowledge, attitude, and practice of self-medication with antibiotics among community residents in Ethiopia. Methods: A cross-sectional study design was conducted from June to August 2017. Knowledge-Attitude-Practice questionnaire was developed and distributed to eligible household respondents in Addis Ababa and its surrounding area. Logistic regression analysis was used to identify factors associated with self-medication with antibiotics. Results: Among the 605 invited participants, 595 respondents were participated in this study (response rate = 98.3%) and 67.3% of the respondents had reported self-medication with antibiotics in the past 6 months. The median score of knowledge about antibiotics was 3 (Inter quarter range: 2-4) of a maximum possible score of 6 and the median score of attitude was 19 (Inter quarter range: 16-22) from a maximum of 29. Self-medication with antibiotics was significantly associated with age, educational status, and average monthly income of the communities. Conclusions: Respondents have inadequate knowledge and inappropriate practice toward rational use of antibiotics. Policies such as restricting the purchase of antibiotics without a medical prescription and educating appropriate use of antibiotics are urgently needed.
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Affiliation(s)
- Alemtsehay Adam Bogale
- a Department of Pharmacy Administration and Clinical Pharmacy , School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research , Xi'an Jiaotong University , Xi'an , China
| | - Abebe Feyissa Amhare
- c Department of Epidemiology and Health Statistics , School of Public Health, Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Jie Chang
- a Department of Pharmacy Administration and Clinical Pharmacy , School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research , Xi'an Jiaotong University , Xi'an , China.,d Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | | | - Sintayehu Tsegaye Betaw
- c Department of Epidemiology and Health Statistics , School of Public Health, Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Negatu Tadesse Gebrehiwot
- a Department of Pharmacy Administration and Clinical Pharmacy , School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research , Xi'an Jiaotong University , Xi'an , China
| | - Yu Fang
- a Department of Pharmacy Administration and Clinical Pharmacy , School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research , Xi'an Jiaotong University , Xi'an , China.,d Shaanxi Centre for Health Reform and Development Research , Xi'an , China
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Haque M, Rahman NAA, McKimm J, Binti Abdullah SL, Islam MZ, Zulkifli Z, Saidin NB, Azhar NIK, Binti Lutfi SNN, Binti Othman NSA. A cross-sectional study evaluating the knowledge and beliefs about, and the use of antibiotics amongst Malaysian university students. Expert Rev Anti Infect Ther 2019; 17:275-284. [DOI: 10.1080/14787210.2019.1581607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Nor Azlina A. Rahman
- Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Swansea, UK
| | - Shahidah Leong Binti Abdullah
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | | | - Zainal Zulkifli
- Sultan Haji Ahmad Shah Hospital, Temerloh, Pahang Darul Makmur, Malaysia
| | - Nurfarhana Binti Saidin
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Nadia Iman Khairul Azhar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Siti Nur Najihah Binti Lutfi
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Nur Syamirah Aishah Binti Othman
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
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