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Luo X, Han S, Wang Y, Du P, Li X, Thai PK. Significant differences in usage of antibiotics in three Chinese cities measured by wastewater-based epidemiology. WATER RESEARCH 2024; 254:121335. [PMID: 38417269 DOI: 10.1016/j.watres.2024.121335] [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: 11/02/2023] [Revised: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 03/01/2024]
Abstract
Antibiotic use, particularly inappropriate use by irrational prescribing or over-the-counter purchases, is of great concern for China as it facilitates the spread of antibiotic resistances. In this study, we applied wastewater-based epidemiology (WBE) to monitor the total consumption of eight common antibiotics in three cities in northern, eastern and southern China. Wastewater samples were successively collected from 17 wastewater treatment plants including weekdays and weekends spanning four seasons between 2019 and 2021. The concentration of antibiotics and their corresponding metabolites showed a significant correlation, confirming the measured antibiotics were actually consumed. Different seasonal trends in antibiotic use were found among the cities. It was more prevalent in the winter in the northern city Beijing, with the high antibiotic consumption attributed to peak influenza occurrence in the city. This is clear evidence of irrational prescription of antibiotics since it's known that antibiotics do little to treat influenza. In terms of overall consumption, Foshan is significantly lower, thanks to warmer climate and higher use of herbal tea as a prevention measure. WBE estimates of antibiotic consumption were relatively comparable with other data sources, with azithromycin as the top antibiotic measured here. The studied cities had higher WBE estimated antibiotics consumption than results of previous studies in the literature. Monitoring antibiotic use in different areas and periods through WBE in combination with complementary information, can better inform appropriate antibiotic guideline policies in various regions and nations.
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Affiliation(s)
- Xiaozhe Luo
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, PR China
| | - Sheng Han
- Fujian Water Resource Investment and Development Group Co., Ltd., 350001, Fuzhou, China
| | - Yue Wang
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, PR China
| | - Peng Du
- Beijing Key Laboratory of Urban Hydrological Cycle and Sponge City Technology, College of Water Sciences, Beijing Normal University, Beijing 100875, PR China.
| | - Xiqing Li
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, PR China
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Queensland 4102, Australia
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Otieku E, Kurtzhals JAL, Fenny AP, Ofori AO, Labi AK, Enemark U. Healthcare provider cost of antimicrobial resistance in two teaching hospitals in Ghana. Health Policy Plan 2024; 39:178-187. [PMID: 38048336 PMCID: PMC11020270 DOI: 10.1093/heapol/czad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023] Open
Abstract
Understanding the healthcare provider costs of antimicrobial resistance (AMR) in lower-middle-income countries would motivate healthcare facilities to prioritize reducing the AMR burden. This study evaluates the extra length of stay and the associated healthcare provider costs due to AMR to estimate the potential economic benefits of AMR prevention strategies. We combined data from a parallel cohort study with administrative data from the participating hospitals. The parallel cohort study prospectively matched a cohort of patients with bloodstream infections caused by third-generation cephalosporin-resistant enterobacteria and methicillin-resistant Staphylococcus aureus (AMR cohort) with two control arms: patients infected with similar susceptible bacteria and a cohort of uninfected controls. Data collection took place from June to December 2021. We calculated the cost using aggregated micro-costing and step-down costing approaches and converted costs into purchasing power parity in international US dollars, adjusting for surviving patients, bacterial species and cost centres. We found that the AMR cohort spent a mean of 4.2 extra days (95% CI: 3.7-4.7) at Hospital 1 and 5.5 extra days (95% CI: 5.1-5.9) at Hospital 2 compared with the susceptible cohort. This corresponds to an estimated mean extra cost of $823 (95% CI: 812-863) and $946 (95% CI: US$929-US$964) per admission, respectively. For both hospitals, the estimated mean annual extra cost attributable to AMR was approximately US$650 000. The cost varies by organism and type of resistance expressed. The result calls for prioritization of interventions to mitigate the spread of AMR in Ghana.
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Affiliation(s)
- Evans Otieku
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. Box LG 74, Accra 233, Ghana
- Department of Public Health, Aarhus University, Batholins Alle 1, Building No. 1261, Aarhus 8000, Denmark
| | - Joergen Anders Lindholm Kurtzhals
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen 1165, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 1165, Denmark
| | - Ama Pokuaa Fenny
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. Box LG 74, Accra 233, Ghana
| | - Alex Owusu Ofori
- Laboratory Services Directorate, Komfo Anokye Teaching Hospital, Kumasi 233, Ghana
- Department of Clinical Microbiology, Korle-Bu Teaching Hospital, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi 233, Ghana
| | - Appiah-Korang Labi
- Department of Medical Microbiology, Korle-Bu Teaching Hospita, University of Ghana Medical School, Accra 233, Ghana
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Batholins Alle 1, Building No. 1261, Aarhus 8000, Denmark
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Zhang T, Lin H, Zhao X, Wang W, Yan F, Lambert H. Influences on treatment-seeking and antibiotic use for common illnesses in eastern China. BMC Public Health 2023; 23:1849. [PMID: 37740203 PMCID: PMC10517519 DOI: 10.1186/s12889-023-16700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Antibiotic resistance rates remain high in China where antibiotics are widely used for common illnesses. This study aimed to investigate the influences on people's decisions on treatment and antibiotic use for common illnesses in eastern China. METHODS Semi-structured interviews were conducted with 29 patients recruited through convenience sampling between July 2020 and January 2021 in one hospital in County A in Zhejiang Province, and one hospital and one village clinic in County B in Jiangsu Province, respectively. All interviews were audio-recorded, transcribed verbatim and thematically analysed. This study is nested in a larger interdisciplinary mixed method project and we also compared our qualitative findings with quantitative results from a household survey conducted as part of this wider project. RESULTS Participants' decisions about treatment-seeking and antibiotic use for common illnesses were found to be influenced by four interactive domains. (i) Self-evaluation of illness severity: Participants tend to self-treat minor conditions with ordinary medicines first and do not resort to antibiotics unless the condition worsens or is considered inflammation- related. Visiting healthcare facilities is seen as the final option. (ii) Access to and trust in care: These treatment-seeking practices are also associated with the perception, in contrast with retail pharmacies, hospitals provide professional and trustworthy care but are difficult to access, and hence require visiting only for severe illness. (iii) Prior experience: previous medical treatment and experiences of self-medication also influence participants' treatment decisions including the use of antibiotics. (iv) Medication characteristics: Participants view antibiotics as powerful medicines with harms and risks, requiring consumers to carefully trade off benefits and harms before use. CONCLUSIONS People's treatment decisions in relation to antibiotic use in eastern China are influenced by an interplay of lay conceptual models of illnesses and antibiotics and broader organisational, social, and contextual factors. Interventions focusing on individual education to incorporate biomedical knowledge into lay understandings, and reducing situational and social incentives for self-medicating with antibiotics by strengthening access to quality professional care, would be helpful in promoting antibiotic stewardship.
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Affiliation(s)
- Tingting Zhang
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hanyi Lin
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Xinping Zhao
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Fei Yan
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China.
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China.
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Wang Q, Wu Y, Wang D, Lai X, Tan L, Zhou Q, Duan L, Lin R, Wang X, Zheng F, Yu T, Wang L, Fan S, Wang Y, Zhang X, Liu C. The impacts of knowledge and attitude on behavior of antibiotic use for the common cold among the public and identifying the critical behavioral stage: based on an expanding KAP model. BMC Public Health 2023; 23:1683. [PMID: 37653367 PMCID: PMC10472573 DOI: 10.1186/s12889-023-16595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND This study aims to explore the impacts of knowledge and attitude on the behavior of antibiotic use during the treatment of the common cold based on the expanding KAP model, and then identify the critical behavioral stage. METHODS A cross-sectional study was conducted on 815 public from 21 community health centers (CHCs) in Chongqing, China. Based on the expanding KAP model, a self-administered questionnaire was designed to measure knowledge, attitude, multi-stage behavior, and perceived threat, in which multi-stage behavior was divided into pre-use antibiotic behavior, during-use antibiotic behavior, and post-use antibiotic behavior. A structural equation model was used to examine the model fit and the direct, indirect, mediating effects, and moderating effect of the variables. RESULTS The expanding KAP showed good model fit indices with χ²/df = 0.537, RMSEA = 0.033, CFI = 0.973, GFI = 0.971, NFI = 0.934, TLI = 0.979. Knowledge had a positive effect on attitude (β = 0.503, p < 0.05), pre-use antibiotic behavior (β = 0.348, p < 0.05), during-use antibiotic behavior (β = 0.461, p < 0.001), and post-use antibiotic behavior (β = 0.547, p < 0.001). Attitude had a positive effect on during-use antibiotic behavior (β = 0.296, p < 0.001), and post-use antibiotic behavior (β = 0.747, p < 0.001). The mediating effect of attitude was positive among knowledge, during-use antibiotic behavior (β = 0.149, p < 0.05), and post-use antibiotic behavior (β = 0.376, p < 0.001). Perceived threat also had a positive moderating effect between knowledge and post-use antibiotic behavior (β = 0.021, p < 0.001). CONCLUSIONS Knowledge, attitude and perceived threat had different effects on different stages of antibiotic behavior. The critical behavioral stage prioritized the post-use antibiotic behavior and during-use antibiotic behavior over pre-use antibiotic behavior.
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Affiliation(s)
- Qianning Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yuanyang Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei China
| | - Xiaoquan Lai
- Department of Nosocomial Infection, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Li Tan
- Department of Nosocomial Infection, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Qian Zhou
- Department of Hospital Infection Management, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Lixia Duan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Rujiao Lin
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Feiyang Zheng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Tiantian Yu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Lu Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Si Fan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yanting Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
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5
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Hill EM. An examination of health locus of control in relation to antibiotic resistance perceptions and antibiotic use behaviors among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-9. [PMID: 37167584 DOI: 10.1080/07448481.2023.2208227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Objective: The aim of the present study was to examine the role of health locus of control (HLOC; internal, chance, powerful others) in antibiotic resistance perceptions and antibiotic use behaviors among college students. Participants: Participants were 366 students recruited from the introductory psychology pool at a university in the northeastern United States. Methods: Participants completed the study via Qualtrics in 2015 (October-December). They completed the Multidimensional Health Locus of Control Scale (measuring internal, chance, powerful others HLOC) and questions about their antibiotic use and antibiotic resistance perceptions. Results: Linear regression analyses were employed to examine the role of the HLOC in antibiotic use behaviors and antibiotic resistance perceptions. With the exception of the regression with antibiotic resistance concern as an outcome, powerful others HLOC was the strongest predictor across all models. Conclusions: Antibiotic misuse was prevalent in our sample and powerful others HLOC was associated with problematic antibiotic use.
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Affiliation(s)
- Erin M Hill
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
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Ji W, Gillani AH, Ye D, Zhao H, Du J, McIver DJ, Tian Y. Perceptions and preparedness of senior medical students about antimicrobial stewardship programs: are we providing adequate training to future prescribers? Expert Rev Anti Infect Ther 2023; 21:309-315. [PMID: 36756806 DOI: 10.1080/14787210.2023.2179034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Senior medical students will become one of the key partners in antimicrobial stewardship efforts in the future, yet the level of education and their perceptions toward this topic are not well documented in China. RESEARCH DESIGN AND METHODS We conducted a cross-sectional, anonymous, online survey between December 2021 and February 2022. The students came from six universities of all five provinces/autonomous regions in northwest China. Students completed the survey by using WeChat. RESULTS More than half of students agreed/strongly agreed that antimicrobials are overused (53.1%) and that antimicrobial resistance is a significant problem nationally (50.2%). Most of the respondents (70%) were interested in learning more about antimicrobials. Around 60% of the respondents thought they were well prepared for future use of antimicrobials. Only 30% of the respondents were familiar with the term 'Antimicrobial Stewardship,' but 80.7% were interested in taking part in an antimicrobial stewardship program training. More than half of the senior medical students thought that courses in antibacterial is suitable for second and third academic years. CONCLUSIONS It is therefore suggested to provide specific curriculum and strengthen training of antimicrobial use for medical students in the future, as well as more rotation practice in infectious diseases related departments.
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Affiliation(s)
- Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dan Ye
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Department of Pharmacy, Xi'an No. 3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
| | - Hang Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiaxi Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - David J McIver
- Institute for Global Health Sciences, University of California, San Francisco, SF, USA
| | - Yun Tian
- Department of Clinical Pharmacy, Shaanxi Provincial Cancer Hospital, Xi'an, Shaanxi, China
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Xue T, Liu C, Li Z, Liu J, Tang Y. Weighing patient attributes in antibiotic prescribing for upper respiratory tract infections: A discrete choice experiment on primary care physicians in Hubei Province, China. Front Public Health 2022; 10:1008217. [PMID: 36605239 PMCID: PMC9807867 DOI: 10.3389/fpubh.2022.1008217] [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: 07/31/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to determine how primary care physicians weigh intervenable patient attributes in their decisions of antibiotic prescribing for upper respiratory tract infections (URTIs). Methods A discrete choice experiment (DCE) was conducted on 386 primary care physicians selected through a stratified cluster sampling strategy in Hubei province, China. The patient attributes tested in the DCE were identified through semi-structured interviews with 13 primary care physicians, while the choice scenarios were determined by a D-efficient design with a zero prior parameter value. Conditional logit models (CL) and mixed logit models (MXL) were established to determine the preference of the study participants in antibiotic prescribing for URTI patients with various attributes. Relative importance (RI) was calculated to reflect the influence of each attribute. Results In addition to age and duration of symptoms, the interventionable patient attributes were also considered by the primary care physicians in their antibiotic prescribing decisions. They preferred to prescribe antibiotics for URTI patients with difficulties to schedule a follow-up appointment (p < 0.001) and for those without a clear indication of refusal to antibiotics (p < 0.001). Patient request for antibiotics had an RI ranging from 15.2 to 16.3%, compared with 5.1-5.4% for easiness of follow-up appointment. The influence of these two interventionable patient attributes was most profound in the antibiotic prescribing decisions for patients aged between 60 and 75 years as indicated by their interaction effects with age (β = 0.69 for request for antibiotics, p < 0.01; β = -1.2 for easiness of follow-up, p < 0.001). Conclusion Reducing patient pressure and improving accessibility and continuity of care may help primary care physicians make rational antibiotic prescribing decisions for URTIs.
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Affiliation(s)
- Tianqin Xue
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Zhuoxian Li
- Medical Record Management Department, Yueyang Maternal and Child Health-Care Hospital, Yueyang, Hunan, China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China,*Correspondence: Yuqing Tang ✉
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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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9
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Duan L, Liu C, Wang D, Lin R, Qian P, Zhang X, Liu C. The vicious cycle of the public's irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review. Front Public Health 2022; 10:985188. [PMID: 36339167 PMCID: PMC9632431 DOI: 10.3389/fpubh.2022.985188] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/27/2022] [Indexed: 01/25/2023] Open
Abstract
Background The public's irrational use of antibiotics for upper respiratory tract infections (URTIs) is prevalent worldwide. This study aims to synthesize evidence on how people use antibiotics to treat URTIs, its prevalence and determinants. Methods A mixed methods systematic review was conducted using a convergent segregated approach. Relevant studies were searched from PubMed, Cochrane Library, Embase, and Web of Science. A qualitative analysis was initiated, exploring the public's antibiotic use experience for URTIS based on the Consumer Behavior Model (CBM). This was followed by a quantitative synthesis, tapping into the prevalence and predictors of public behavior in antibiotic usage for URTIs. The segregated syntheses complemented each other and were further integrated. Results A total of 86 studies were included: 48 quantitative, 30 qualitative, eight mixed methods studies. The included studies were conducted in Europe (n = 29), Asia (n = 27) and North America (n = 21), assessing the behaviors of patients (n = 46), their parents or caregivers (n = 31), or both (n = 9). Eleven themes emerged covering the six CBM stages: need recognition, information searching, alternative evaluation, antibiotic obtaining, antibiotic consumption, and post-consumption evaluation. The six stages reinforce each other, forming a vicious cycle. The high prevalence of the public's irrational use of antibiotics for URTIs is evident despite the high heterogeneity of the studies (ranging from 0.0 to 92.7%). The perceived seriousness of illness and misbelief in antibiotics were identified consistently across the studies as the major motivation driving the public's irrational use of antibiotics for URTIs. However, individual capacity (e.g., knowledge) and opportunity (e.g., contextual restriction) in reducing antibiotic use have mixed effect. Conclusion Systemic interventions concerning both supply and demand sides are warranted. The public needs to be educated about the appropriate management of URTIs and health care providers need to re-shape public attitudes toward antibiotic use for URTIs through communication and prescribing practices. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier: CRD42021266407.
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Affiliation(s)
- Lixia Duan
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Dan Wang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Rujiao Lin
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Pan Qian
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
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10
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Phueanpinit P, Siriwattanasakul N, Tichakorn P, Klanbut S. Knowledge and perceptions of outpatients regarding upper respiratory tract infections and awareness of an Antibiotics Smart Use campaign in Thailand. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Pacharaporn Phueanpinit
- Department of Clinical Pharmacy Faculty of Pharmacy Srinakharinwirot University Nakhon Nayok Thailand
| | | | - Penpit Tichakorn
- Department of Clinical Pharmacy Faculty of Pharmacy Srinakharinwirot University Nakhon Nayok Thailand
| | - Siranan Klanbut
- Department of Clinical Pharmacy Faculty of Pharmacy Srinakharinwirot University Nakhon Nayok Thailand
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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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13
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Luo Y, Tang X, Ding L, Shao Z, Yu J, Chen Y, Zhou Y, He H, Chen Z. Non-prescriptionxx antibiotic use for people aged 15 years or older for cough in China: a community-based survey. Antimicrob Resist Infect Control 2021; 10:129. [PMID: 34461998 PMCID: PMC8404186 DOI: 10.1186/s13756-021-00998-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Non-prescription antibiotic use at community is a main driver of antimicrobial resistance. Cough is a common condition and prevalent in all townships, including China. This study aims to investigate the non-prescription antibiotic use for cough in China and explore to which extent antibiotic use knowledge was correctly instructed in communities. METHODS A probability-proportionate-to-size sampling method was adopted to survey from all 14 townships in Yiwu city, China. All participants were investigated by face-to-face interview on Portable Android Devices. The continuous variables were presented by mean and standard deviation or medium and inter-quartile range (IQR). The categorical variables were presented using percentage or constituent ratio. Chi-square test for univariate analysis and logistic regression for multivariate analysis were conducted to assess the odds ratios and 95% confidence intervals, respectively. RESULTS A total of 3034 respondents across all the 14 townships and the 50 natural villages/streets completed all key items of the questionnaire. Of 2400 (79.10%) respondents stated that they experienced cough in the past 12 months with the medium age of 36.5 (IQR: 26-49) and 12.21% (293/2400) respondents had the non-prescription antibiotic use behavior. Among those 293 respondents, the proportion of non-prescription antibiotic use for cough peaked at around 16% among people aged 30-39 years old. The major sources of antibiotics were pharmacy (77.70%) and/or family storage (43.92%). CONCLUSIONS Non-prescription antibiotics use for cough is prevalent in the community, especially among people in their thirties. Strengthened drug purchase regulation and well-trained professional pharmacists would be promising alternatives to ameliorate AMR. Moreover, penetrating antibiotics knowledge to common citizens and is an urgent task to alleviate antimicrobial resistance. Therefore, proactive policies and regulations should be made to improve current situations.
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Affiliation(s)
- Yan Luo
- Institute for Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang district, Hangzhou City, 310051, Zhejiang Province, China.,Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xuewen Tang
- Institute for Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang district, Hangzhou City, 310051, Zhejiang Province, China
| | - Linling Ding
- Institute for Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang district, Hangzhou City, 310051, Zhejiang Province, China
| | - Zhujun Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianxing Yu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yangqing Chen
- School of Public Health, Xiamen University, Xiamen, China
| | - Yang Zhou
- Institute for Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang district, Hangzhou City, 310051, Zhejiang Province, China
| | - Hanqing He
- Institute for Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang district, Hangzhou City, 310051, Zhejiang Province, China.
| | - Zhiping Chen
- Institute for Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang district, Hangzhou City, 310051, Zhejiang Province, China.
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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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15
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Large-scale survey of parental antibiotic use for paediatric upper respiratory tract infections in China: implications for stewardship programmes and national policy. Int J Antimicrob Agents 2021; 57:106302. [PMID: 33588014 DOI: 10.1016/j.ijantimicag.2021.106302] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/26/2020] [Accepted: 02/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inappropriate use of antibiotics for upper respiratory tract infections (URTIs) in Chinese children is rampant. Parents' decision-making processes with respect to treatment choices and antibiotic use for paediatric URTIs were investigated to identify key constructs for effective interventions that target the public. METHODS Data were collected between June 2017 and April 2018 from a random cluster sample of 3188 parents of children aged 0-13 years across three Chinese provinces, representing different stages of economic development. Risk factors of parents' treatment choices and antibiotic use for paediatric URTIs were assessed using binary and multinomial logistic regressions, adjusting for socio-demographic characteristics. RESULTS A total of 1465 (46.0%) children of the 3188 parents who self-diagnosed their children with a URTI were given antibiotics, with or without prescription. Among these children, 40.5% were self-medicated with antibiotics by their parents and 56.1% obtained further antibiotic prescriptions at healthcare facilities. About 70% of children (n=2197) with URTI symptoms sought care; of these, 54.8% obtained antibiotic prescriptions and 7.7% asked for antibiotic prescriptions, with 79.4% successfully obtaining them. Those perceiving antibiotics as effective for treating the common cold and fever (adjusted odds ratio [aOR]=1.82[95% confidence interval, 1.51-2.19] and 1.77[1.47-2.13], respectively), who had access to non-prescription antibiotics (aOR=5.08[4.03-6.39]), and with greater perceived severity of infection (aOR=2.01[1.58-2.56]), were more likely to use antibiotics. CONCLUSIONS Multifaceted, context-appropriate interventions are vital to untangle the perpetual problem of self-medication, over-prescription and ill-informed demands for antibiotics. The findings in this study emphasise the need to prioritise interventions that enhance clinical training, neutralise the pressure from patients for antibiotics, educate on appropriate home care, discourage antibiotic self-medication and improve antibiotic dispensing.
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