Assessment of Knowledge, Attitude, and Practice toward Antibiotic Use among Harar City and Its Surrounding Community, Eastern Ethiopia

Effects of instructional video and community radio broadcasting interventions to improve knowledge and behavior of antibiotic use in the COVID-19 era

BACKGROUND

Antibiotic overuse is a serious health issue. It has been demonstrated that improper antibiotic use is linked to a lack of knowledge in the public. To encourage judicious antibiotic use in the COVID-19 ERA, it is critical to provide accessible and secure therapies.

OBJECTIVES

This study aimed to assess the effects of instructional video and community radio broadcasting interventions on knowledge and behavior of antibiotic use.

METHODS

Adults over the age of 20 were enrolled in a quasi-experimental study. A total of 369 representatives were divided into two groups: 185 participants in the control group and 184 participants in the intervention group. Data were collected twice, before and after the educational program by community health workers. Both descriptive and inferential statistics were used to analyze the data.

RESULTS

The participants' average age was 56.4 ± 0.6 years. Most of the respondents were female (264, 71.5%) and had only received an elementary education (186, 50.4%). A mean difference score was produced for the control and intervention groups. Both groups experienced a statistically significant gain in mean difference score of knowledge following the educational program (3.42 ± 4.18, [95% CI 2.81-4.02] vs 5.42 ± 4.97, [95% CI 4.69-6.14]) (P < 0.001). A mean difference score was produced with behavior (1.78 ± 3.45, [95% CI 1.28-2.28] vs 2.77 ± 3.06, [95% CI 2.28-3.27]) (P < 0.001). A mean difference in knowledge score between the groups was greater, with the intervention group scoring higher; all significant variables were controlled by multivariable regression analysis (1.31 [95% CI 0.53-2.09]) (P = 0.001). Similarly, a mean difference behavior score (1.34 [95% CI 0.82-1.86]) (P < 0.001).

CONCLUSION

The integration of an educational poster, instructional video, and community radio broadcasting interventions about antibiotic use through CHWs in local communities is beneficial. This program should be implemented at the national level to promote rational drug use. Future studies should investigate how the educational program affects antibiotic use rates in the long term.

Prevalence and Antimicrobial Susceptibility Profile of Salmonella and Shigella among Diarrheic Patients Attending Selected Health Facilities in Addis Ababa, Ethiopia

Diarrhea is one of the important public health problems in developing countries. Salmonella and Shigella species are the major bacterial causal agents of diarrhea. The increasing burden of antimicrobial resistance is posing difficulty in the treatment of these pathogens. This study aimed to assess the occurrence of Salmonella and Shigella in the feces of diarrheic patients receiving health services in Addis Ababa, Ethiopia, and to determine their antimicrobial susceptibility profile. A cross-sectional study involving 13 health centers was conducted where 428 diarrheic patients were recruited. Standard microbiology techniques were used to isolate Salmonella and Shigella from stool samples. In addition, Salmonella isolates were confirmed by polymerase chain reaction (PCR). The Kirby-Bauer disc diffusion method was employed to assess susceptibility to 11 antimicrobials for each of the Salmonella and Shigella isolates. The prevalence of Salmonella and Shigella spp. among diarrheic patients was 8.4%; n = 36 and 5.6%; n = 24, respectively. Thirty (83.3%) of Salmonella isolates were susceptible to all antimicrobials tested, whereas 4 (10.8%) of isolates were resistant to 2 or more antimicrobials and 2 (5.6%) were multidrug resistant. Resistance to ampicillin was recorded in only one (2.7%) of Salmonella isolates; however, resistance to ampicillin was recorded in 12 (50%) of the Shigella isolates. Half of the Shigella isolates (n = 12) were resistant to 2 or more antimicrobials while 5 (20.8%) of them were resistant to 3 or more antimicrobials. The overall rate of resistance to antimicrobials was more common in Shigella compared to Salmonella isolates. In conclusion, Salmonella and Shigella were isolated from the feces of diarrheic patients, with a higher rate of antimicrobial resistance in Shigella isolates, which could make the treatment of shigellosis challenging. Therefore, increasing hygienic practices during food preparation to reduce the burden of Salmonella and Shigella infection and prudent use of antimicrobials are recommended to limit the spread of antimicrobial resistant strains.

Knowledge, Attitude, and Practices (KAP) on Antibiotic Use and Disposal Ways in Sidama Region, Ethiopia: A Community-Based Cross-Sectional Survey

Antibiotic resistance has been among the top public health threats elsewhere. Scientific information on knowledge, attitudes, and practices (KAP) at the community level towards antibiotic use and disposal ways is a vital step for effective intervention. This study aimed at determining the levels of KAP and associated risk factors for antibiotics in and around Hawassa City, southern Ethiopia. A community-based cross-sectional study was conducted, and data were collected using a structured questionnaire. Descriptive statistics, chi-square test, and logistic regression were used to analyze and interpret the results. A total of 504 participants with a mean age of 35.32 ± 9.03 years were included in the study. Most of the participants were urban dwellers (59.5%); more than half (55.6%) of the participants were male; most of the participants (62.7%) were at least college graduates; about half were employed (52.4%); about 41.7% of the participants had a large family size (≥7) with a mean family size of 5.7 ± 2.7; the average family monthly income was ETB 7213.71 ± 3673, and over three-fourth (74.8%) of the study participants were married. In addition, about 83.13% of the study participants heard about antibiotics; almost all of them (99.8%) had ever used antibiotics at some point in their life (75% of which used antibiotics within 6 months), and all of them could name at least one common type of antibiotic. Moreover, most of the participants (86.5%) did not receive any training related to antibiotics, and 29.4% of them obtained antibiotics without a prescription. Most participants had poor knowledge (64%), negative attitudes (60.4%), and poor practices (55%) towards antibiotic use, resistance, and disposal methods. Significant and positive linear correlations between knowledge and attitude (r = 0.539, P ≤ 0.001), knowledge-practice (r = 0.532, P ≤ 0.001), and attitude-practice (r = 0.786, P < 0.001) were also observed. Most of the sociodemographic variables were significantly associated with the mean KAP scores of the study participants. Living in a rural area, having a large family size, and being female, married, illiterate, and farmer resulted in a very low level of knowledge. Similarly, living in a rural area, having a small family size, and being older and married resulted in a negative attitude. Furthermore, having a smaller family size, having a low family monthly income, and being married, illiterate, and self-employed resulted in poor practice. A very low level of KAP towards antibiotics among people living in and around Hawassa City calls for urgent and effective intervention strategies.

Knowledge, Attitudes, and Practices Regarding Antibiotic Use and Resistance: A Cross-Sectional Study among Students in Israel

Antibiotic resistance is one of the biggest threats to human health, food security, and development. This study aimed to examine the level of knowledge and awareness regarding antibiotic resistance while comparing students from health sciences to students in other disciplines. A cross-sectional study was conducted based on the "antibiotic resistance" questionnaire developed by the World Health Organization. A total of 371 students participated in the study. All respondents had taken antibiotics in the past. A tenth had taken them on their own without a prescription, and 14% had not received an explanation regarding the use of antibiotics. The average for the knowledge questions was 15.49 ± 5.35 (out of 27). Many students mistakenly associated antibiotics with viral diseases. Despite these misconceptions, there was a high level of awareness and understanding regarding the ways to treat antibiotic resistance. Still, the awareness of the severity of antibiotic resistance was not high. Differences were found between the disciplines in general knowledge and the level of awareness and understanding about the ways to treat antibiotic resistance, where health science students had the highest scores, followed by social science students and finally, computer and management students. No differences were found in the perception of the severity of the phenomenon. This information is essential to developing educational interventions to improve knowledge, attitudes, and practices regarding antibiotic use among students, especially those unrelated to the health sciences.

Determinants of Knowledge, Attitude, and Practices of Veterinary Drug Dispensers toward Antimicrobial Use and Resistance in Main Cities of Malawi: A Concern on Antibiotic Stewardship

Antimicrobial resistance (AMR) is an emerging challenge to global public health. The use of antibiotics in the veterinary field is one of the contributing factors to AMR mostly due to poor knowledge, attitudes, and practices (KAP) of dispensers. Veterinary drug dispensers are expected to guide clients on indications, contraindications, and withdrawal periods of veterinary drugs. This study assessed veterinary drug dispensers' KAP toward AMR and associated potential contributing factors. A cross-sectional study, using a structured questionnaire, was conducted in three main cities of Malawi, namely Mzuzu, Lilongwe, and Blantyre. A total of 68 agrovet shops were selected using a simple random sampling technique. The KAP level was presented descriptively. Bivariate and multivariable analyses were run to investigate the relationships between the independent and outcome variable. Overall, the KAP score for knowledge, attitude, and practices was 46.7%, 49.2%, and 41.6%, respectively. The significant determinants of the knowledge were the practice of asking for a written prescription (OR: 16.291, 95% CI: 11.6-24.2) (p = 0.024), female (OR: 0.609, 95% CI: 0.3-0.9) (p = 0.001), and old age (≥35) (OR: 0.227, 95% CI: 0.1-0.5) (p = 0.04). Poor knowledge, negative attitude, and poor practices were observed among most of the participants. Sensitization and training on AMR and antimicrobial stewardship are recommended to address the KAP score gaps and the observed determinants among veterinary drug dispensers.

Knowledge, attitudes, and practices related to COVID-19 infection, related behavior, antibiotics usage, and resistance among Syrian population: A cross-sectional study

BACKGROUND AND AIMS

Antibiotic resistance is seen as a worldwide health risk as a result of the overuse of antibiotics. Many countries noted that antibiotic usage was high during the COVID-19 pandemic. The purpose of this study is to evaluate Syrians' knowledge, attitudes, and practice about the use of antibiotics and antibiotic resistance during the COVID-19 epidemic.

METHODS

A cross-sectional study was conducted using an online questionnaire to collect the data from the Syrian population from February 5 to March 4, 2022. Syrians 18 years or older all over the world were able to participate in this study. A convenience snowball sampling method was used. SPSS version 20.0 was used to analyze the data. To examine the results, binominal logistic regression was used. Statistical significance was defined as a p < 0.05.

RESULTS

Out of 2406 respondents, 60.2% knew that transmission of COVID-19 could occur even if the patient has not developed any symptoms, and 91.6% were able to recognize the main clinical symptoms of COVID-19. There was a statistically significant difference between male and female knowledge of COVID-19 (p = 0.002), with males having 3.78 ± 2.1 (2.7-3.87) and females scoring 3.93 ± 2.3 (3.7-4.1). Newly graduated students have more knowledge of COVID-19 than other subtypes of Job (p = 0.0001), and those with medical practice are more knowledgeable than those without (p = 0.0001). Only 16.6% answered that taking antibiotics would not speed up the recovery from all the infections. 65.3% answered correctly that misuse of antibiotics could cause antibiotic resistance.

CONCLUSION

Our study concluded that the Syrian population demonstrated good knowledge of COVID-19 and moderate acceptance of the new norm. Knowledge regarding antibiotic use and resistance and practice of preventive measures was poor, which can encourage the health authorities to develop community education programs to increase public awareness of the usage of antibiotics and safety protocols during the COVID-19 pandemic.

Antibiotic Use among Patients Visiting Primary Hospitals in Northwest Ethiopia: A Multicenter Cross-Sectional Survey

Background. Antimicrobial medications are becoming ineffective because of the surge in antimicrobial resistance. Poor knowledge and inappropriate beliefs combined with the misuse of antibiotics may be common in the community and public health institutions. This study assessed the knowledge, belief, and antibiotic use practice among patients visiting rural hospitals in Northwest Ethiopia. Methods. A facility-based multicenter cross-sectional survey was conducted in Northwest Ethiopian primary hospitals from August to September 2020. The data are presented as frequencies and means (±SD) of our findings. The independent samples T test and One-Way Analysis of Variance (ANOVA) were used to explore the mean knowledge differences of antibiotic use among respondents. A $p$ value of <0.05 with 95% CI was considered significant. Results. More than half of the participants (57.2%) were males, and the mean age was 34.8 ± 13.4 years. The mean (±SD) knowledge score of the respondents was 3.69 (±1.7) (range: 0 to 10), and the majority (69.7%) had poor knowledge. The mean (±SD) belief score (acceptance towards antibiotic use) of the respondents was 20.08 ± 4 (range: 7 to 35) and most (70.1%) of the respondents had moderate levels of perception regarding antibiotic use. The majority (69.5%) of respondents took antibiotics over the past year. Participants practiced inappropriate uses of antibiotics such as medication discontinuation (49.5%), keeping unused antibiotics for future use (35.5%), and sharing medications with/from others (30.1%). Diploma holder participants had significantly higher mean knowledge scores on antibiotic use than those who were unable to read and write ( $p=0.047$ ). Similarly, students had higher mean knowledge scores compared with farmers ( $p=0.024$ ), merchants ( $p=0.031$ ), and housewives ( $p=0.047$ ). Conclusion. Our study showed a widespread misuse of antibiotics in Northwest Ethiopia. Malpractice such as dose interrupting, sharing of antibiotics for/from the others, and keeping leftover drugs for future use were common among the respondents. These findings suggest that a greater effort is required in public education related to proper and safe uses of antibiotics and that greater efforts are needed to enforce the control of antibiotic use to overcome the emergence of antibiotic resistance.

Drivers of irrational use of antibiotics among children: a mixed-method study among prescribers and dispensers in Tanzania

Background

Misuse of antibiotics has been associated with poor knowledge, attitude and practice (KAP). Therefore, this study aimed to assess if KAP of prescribers and dispensers could drive irrational use of antibiotics among children in Tanzania.

Methods

A convergent parallel mixed-methods study design that employed quantitative and qualitative approaches was conducted in 14 regional referral hospitals (RRHs). A total of 108 participants, prescribers [54] and dispensers [54] working with the pediatric population in the respective regions participated in a quantitative survey, by filling the standard questionnaire while 28 key informant interviews were conducted with in-charges of units from the pharmacy and pediatric departments. Two key informants (prescriber and dispenser) were selected from each RRH.

Results

Overall, among prescribers and dispensers, there was adequate knowledge; 81.5% and 79.6%, p = 0.53, those with positive attitudes were 31.5% and 81.5%, p < 0.001 and poor practices were among 70.4% and 48% p = 0.0312 respectively. Among prescribers, 14.8% agreed and strongly agreed that prescribing antibiotics that a patient did not need does not contribute to resistance. Moreover 19% disagreed to prescribe antibiotics according to local guidelines. Among dispensers, a-quarter of the dispensers thought individual efforts to implement antibiotic stewardship would not make a difference, 17% agreed and strongly agreed that antibiotics can treat viral infection and 7% agreed and strongly agreed antibiotics can be stopped upon resolution of symptoms. From qualitative interviews, both participants displayed an adequate understanding of multi-contributors of antibiotic resistance (AR) including polypharmacy, community self-medication, among others. Regardless, both professions declared to prescribed and dispensed antibiotics according to the antibiotics available in stock at the facility. Furthermore, prescribers perceived laboratory investigation took a long time, hence wasting their time. On the other hand, Dispensers reported not to provide adequate instruction to the patients, after dispensing antibiotics.

Conclusions

Both prescribers and dispensers had adequate knowledge, few prescribers had positive attitudes and the majority had poor practices. Few dispensers had poor attitude and practice. These findings highlight the need to provide adequate training on antimicrobial stewardship and enforce regulation that foster appropriate medical practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08359-7.

Knowledge, attitude and practices of residents toward antimicrobial usage and resistance in Gondar, Northwest Ethiopia

BACKGROUND

Antimicrobials are essential for human and animal health. Drug resistance to an antimicrobial agent follows the introduction of a new antimicrobial agent. Evidence suggests that the public plays an important role in the risk, increase, and spread of antimicrobial resistance. This study aimed to assess the knowledge, attitudes, and practices of the Gondar City residents regarding antimicrobial use and resistance.

METHODS

A cross-sectional study was conducted from April to July 2021 on 400 randomly selected Gondar city residents using a pretested semi-structured questionnaire. The descriptive and chi-square tests were used to analyse the data.

RESULTS

The response rate was one hundred percent. Approximately 75% of respondents were men, with 32% having completed secondary school. Nearly 74% and 35% of participants were married and worked in various government jobs. Furthermore, 48%, 54%, and 50% of respondents, respectively, had moderate knowledge, a positive attitude, and good practice concerning antimicrobial use and resistance. The chi-square analysis revealed a significant (p < 0.05) disparity between knowledge and educational level, marital status, and position in the house. The respondents' attitude levels were also significantly associated (p < 0.05) with their educational level, marital status, occupation, and position in the house. Respondents' practice levels were also significantly associated (p < 0.05) with their educational level and occupation. The study also found a significant relationship between respondents' knowledge and attitude (χ2 = 215.23, p ≤ 0.01), knowledge and practice (χ2 = 147.2, p ≤ 0.01), and attitude and practice (χ2 = 116.03, p ≤ 0.01).

CONCLUSION

This study found that study participants had some misconceptions about antimicrobial use and resistance. As a result, both enforcing antimicrobial regulation and educating people about antimicrobial use are advised.

Knowledge, awareness, and attitudes toward antibiotic resistance and practice of self-medication among university students in Bangladesh: A cross-sectional study

BACKGROUND

The prevalence of self-medication is high in Bangladesh due to easy access and poor regulatory controls over these drugs. Our study aimed to assess the attitude of university students in Bangladesh toward antibiotic usage, especially their knowledge and awareness about antibiotics and their resistance. We also evaluated the determinants behind their attempts at drug intake without prescription.

MATERIALS AND METHODS

A cross-sectional study was conducted in Mawlana Bhashani Science and Technology University that included information from randomly selected 200 students from 15 departments using a structured questionnaire. The statistical analyses were performed by using SPSS software (version 21) and R programming.

RESULTS

The study revealed that 61.0% of the students use self-medication at different times or always; 32.5% of the respondents keep antibiotics for future use, and 38% of the students think it is right to stop antibiotics when symptoms are improving. Half of the participants (47.5%) use antibiotics based on their previous experience. The criteria of antibiotic selection have a significant relationship with knowledge about antibiotic resistance (P = 0.017) and altered prescribed medicine without doctor's advice (P < 0.001). The multivariate analysis indicates that respondents who know about antibiotic resistance select antibiotics from the community pharmacists with respect to their own experience 5.102 times higher than those who do not know about antibiotic resistance.

CONCLUSIONS

The study mainly explored the knowledge gaps of the students on the options that are responsible for antibiotic resistance in the community and found that students have mid-level knowledge (66%) about antibiotic resistance.

Antibiotics non-adherence and its associated factors among households in southern Ethiopia

Objectives:

This study aimed at assessing the prevalence of antibiotics non-adherence and its associated factor among households in southern Ethiopia.

Methods:

A community-based cross-sectional study was conducted among 323 randomly selected households in Wenago town. To collect the data, structured questionnaire was used. Categorical variables were represented by frequency and percentage. For continuous variables, the mean value and standard deviation were used. Bivariate and multivariate logistic regression analyses were used to identify factors related to antibiotic non-adherence. Finally, for significant factors with p-values less than 0.05, the adjusted odds ratio with 95% confidence interval was calculated and evaluated.

Results:

The prevalence of antibiotic non-adherence in the household was 194 (60.1%) (95% confidence interval = 55.1–65.6). Remission of symptoms (63%) is one of the top reasons for antibiotic non-adherence in the home. Male sex (adjusted odds ratio = 1.77, 95% confidence interval = 1.03–3.08), lower educational status (adjusted odds ratio = 3.42, 95% confidence interval = 1.51–7.75; adjusted odds ratio = 2.37, confidence interval = 1.12–5.02), poor attitude toward antibiotics use (adjusted odds ratio = 1.89; 95% confidence interval = 1.23–3.04), poor knowledge about antibiotics use (adjusted odds ratio = 1.34; 95% confidence interval = 1.11–2.39), and no-prescription information from pharmacy (adjusted odds ratio = 2.02, 95% confidence interval = 1.09–3.72) were all associated with non-adherence. While no medication discomfort (adjusted odds ratio = 0.31, 95% confidence interval = 0.178–0.56) had a negative effect on non-adherence.

Conclusion:

In this study, antibiotic non-adherence was considerably high among the participants. Being male, lower educational status, poor attitude, poor knowledge, no-prescription information from pharmacy/druggist, and medication discomfort were related with antibiotic non-adherence. As a result, community service providers must provide relevant prescription information as well as appropriate counseling to antibiotic non-adherent patients.

The Predictors Influencing the Rational Use of Antibiotics Among Public Sector: A Community-Based Survey in Thailand

Background

The spread and emergence of antimicrobial resistance is the significant public health concerns over past decades. The major leading cause comes from irrational use of antibiotics.

Aim

To explore the characteristics of rational use of antibiotics and identify its predictive factors among public sector living in Nakhon Nayok Province, Thailand.

Methods

This project was conducted by using the data-source from Rational Use of Antibiotics (RUA) Survey Project at Nakhon Nayok Province. A cross-sectional community-based study method and face to face interviews were conducted. Two hundred fifty-four participants were selected by using Quota sampling method. Descriptive statistics were used to describe the sociodemographic and antibiotics use characteristics. Chi-square test were utilized to determine the association between explanatory variables and major outcome while multiple logistic regression was analysed to identify the predictors of antibiotics use behavior.

Results

The mean age of the participants was 42 years, those with aged between 35 and 56 had more rational use of antibiotics behavior than those with 13–34 years while older adults (57–78 years) were significantly associated with irrational use of antibiotics [AOR = 0.38; 95% CI (0.17–0.85)] than those with less than 34 years of age. Less than half (45.7%) and about one third of them (31.1%) showed adequate knowledge and appropriate attitude towards antibiotics use. An adequate knowledge [AOR = 3.37; 95% CI (1.92–5.90)], appropriate attitude [AOR = 2.90; 95% CI (1.54–5.43)], not using antibiotics within last 3 months [AOR = 1.89; 95% CI (1.04–3.43)], and not visiting drugstore when having three main diseases [AOR = 2.04; 95% CI (1.06–3.92)] were the significant predictors of rational antibiotics use (p-value <0.05).

Conclusion

Strategies development in terms of knowledge and attitude enhancement about antibiotics use particularly at the different ages together with RDU pharmacy encouragement and policy restriction of community drugstores antibiotics sales are the most effective method to promote rational antibiotics use behavior in the public sector.

Antibiotics Self-Medication Practice and Associated Factors Among Residents in Dessie City, Northeast Ethiopia: Community-Based Cross-Sectional Study

BACKGROUND

Taking antibiotics without prescription would result in the emergency of antibiotics resistance. The aim of this study was to assess antibiotics self-medication practice and associated factors among residents in Dessie City, Ethiopia.

METHODS

A community-based cross-sectional was employed from June to July 2021. A total of 407 participants have been selected from each Kebele by stratified and systematic random sampling techniques. The collected data were checked, translated and exported into SPSS version 26. Results were organized using frequency and percentage tables. Bi-variate and multi-variable logistic regressions were used to test the association of independent variables with antibiotics self-medication practice.

RESULTS

Four hundred and seven participants enrolled with a response of 96.7%. One hundred and fifty-two (37.3%) were females, and 115 (28.3%) respondents have taken antibiotics in the last 6 months. The prevalence of antibiotics self-medication practice was 55.3% (95% CI: 50.6-60.2). Amoxicillin (45%), Ciprofloxacin (36%), and Amoxicillin with clavulanic acid (24%) were commonly used antibiotics. Cough (34.4), fever (30.7), cold and flu (29.0), diarrhea (21.9) and headache (18.7) were the most reported conditions that necessitate antibiotics self-medication. Educational level (8-10 grade) (AOR = 4.10, 95% CI: 1.28, 13.12), using mass media as a source of information (AOR = 2.23, 95% CI: 1.24, 4.27), relying on previous experience for source of information (AOR = 2.02, 95% CI: 1.23, 3.31), having awareness of antibiotics resistance (AOR = 2.45, 95% CI: 1.34, 4.50) and good knowledge of antimicrobial resistance (AOR = 1.81, 95% CI: 1.11, 2.97) were significantly associated with antibiotics self-medication practice.

CONCLUSION

Antibiotics self-medication practice among residents was high. Educational status, using mass media and previous experiences as sources of information on antibiotics, having awareness of antibiotics resistance, and knowledge of antimicrobial resistance were significantly associated with self medication of antibiotics. Attention should be given by the stakeholders to reduce self medication practice with antibiotics.

Prevalence and Determinants of Antibiotic Self-Administration Among Adult Antibiotic Users: A Cross-Sectional Study

INTRODUCTION

Each year, antibiotics save hundreds of thousands of lives; nonetheless, antibiotic self-administration is a major concern all over the world. This study aimed to investigate the prevalence of antibiotic self-administration among two-month adult antibiotic users as well as the factors contributing to this prevalence.

METHOD AND PARTICIPANTS

This cross-sectional study was conducted among 295 Bangladeshi adults between May 22nd and June 15th, 2021, during the COVID-19 pandemic. Descriptive statistics included frequency distribution, while inferential statistics included the Pearson chi-square test. For data analysis, the statistical software STATA-16 was used.

RESULTS

In this study, the prevalence of antibiotic self-administration was 17.97%. Antibiotic self-administration was found to be significantly more prevalent among those who were unable to take antibiotic on time, incomplete doses, did not know over prescriptions may cause antibiotic resistance, and could not correctly recognize amoxicillin and azithromycin are antibiotics.

CONCLUSION

Due to the increased rate of antibiotic self-administration among adults in Bangladesh, the responsible authority should give more attention towards the factors responsible for antibiotic self-administration and revise their current policy to ensure the safe and effective use of antibiotics.

Knowledge, Attitudes and Practices of Patients on Antibiotic Resistance and Use in Public Hospitals of Amhara Regional State, Northwestern Ethiopia: A Cross-Sectional Study

Background

Although inappropriate antibiotic use could contribute to the spread of antimicrobial resistance, data on the knowledge, attitude and  practice of antibiotic use and resistance among patients in north-western Ethiopia are scarce. This study assessed patients’ knowledge, attitudes and practices regarding antibiotic use and resistance in selected public hospitals of Amhara regional state, Ethiopia.

Methods

A cross-sectional study was conducted in selected public hospitals of Amhara regional state from November to December 2020 to assess the knowledge, attitude, and practice of patients on antibiotic resistance and use. Data were collected from 233 participants using a structured questionnaire and analyzed using SPSS version 23.

Results

According to the findings, 60.3% of the participants obtained their antibiotics without a prescription from private pharmacies, and the most commonly used antibiotic to treat human diseases was ampicillin (70.7%). Even though 69.8% of the patients heard about antibiotics and antibiotic resistance from several sources, 68.1–87.9% of them were unaware on the factors that contribute to the transmission of resistant bacteria to humans and the impact of antibiotic resistance on human and animal health. Using the mean score of 3.15 ± 0.08 as the cut-off, 37.5% of patients know about antimicrobial resistance and use. With a mean score of 27.6 ± 0.3, 45.3% of patients had positive attitudes toward prudent antibiotic use and resistance. About 44% of participants had a good practice, with a mean practice score of 4.95 ± 0.17. A higher level of education was associated with better knowledge, positive attitudes, and better practices regarding antibiotic use and resistance. Although 57.3% of respondents viewed poor handwashing practices in hospitals as a major factor contributing to increased antibiotic resistance, 59.9% of respondents viewed implementing hygiene, infection prevention, and control practices as a major strategy contributing to reducing antibiotic use and resistance.

Conclusion

According to the present study, there is a low level of awareness among patients about the proper antibiotics use and resistance. It is essential to raise awareness, develop, and implement interventions to reduce antimicrobial use and antibiotic resistance in the study area.

Knowledge of use of antibiotics among consumers in Tanzania

Background

Studies assessing consumers' knowledge of the rational use of antibiotics are essential to understand the knowledge gap before intervention strategies are instituted.

Objectives

To assess the knowledge of rational use of antibiotics among consumers in Dar es Salaam, Tanzania.

Methods

A cross-sectional study assessing knowledge of rational use of antibiotics among 960 consumers was conducted in Dar es salaam in March 2021. Participants were consecutively enrolled from outpatient pharmacies in selected public and private hospitals and marketplaces in Ilala Municipality. Data were collected using the WHO-validated questions on knowledge of consumers of antibiotic uses.

Results

Overall, 196 (20.4%) and 503 (52.4%) participants demonstrated good knowledge of rational antibiotic use and conditions that can be treated with antibiotics, respectively. However, 678 (70.6%) responded that they stopped using antibiotics after dose completion, 515 (53.6%) would request the same antibiotic if it had helped to treat a similar condition in the past and 406 (42.3%) are willing to use the same antibiotic if a friend or family member used the medication previously to treat similar signs and symptoms. Besides, the following conditions were mentioned as being treatable with antibiotics: influenza (50.7%), sore throat (61.4%) and urinary tract infection (60.5%).

Conclusions

The majority of the consumers had poor knowledge of the rational uses of antibiotics and a moderate proportion had good knowledge of the conditions that are treatable with antibiotics. Those with a high level of education and with health insurance had good knowledge of rational uses of antibiotics.

Knowledge and Expectations on Antibiotic Use Among the General Public in Malaysia: A Nationwide Cross-Sectional Survey

BACKGROUND

Identifying knowledge gaps regarding antibiotic use and resistance is important for future interventional strategies. There is limited information on Malaysia's general public's knowledge and expectations on antibiotic use.

PURPOSE

To assess the knowledge of antibiotic use and resistance, expectations from antibiotic prescription, and identify inappropriate practices related to antibiotic use among Malaysia's general public.

MATERIALS AND METHODS

A nationwide cross-sectional survey was conducted among Malaysians aged 18 years and above from each state, from May to November 2019. Participants were recruited via quota sampling, followed by convenient sampling. A validated self-administered questionnaire was used to collect data.

RESULTS

Of the 1971 respondents recruited, 56.6% had engaged in at least one inappropriate practice; particularly, not completing the antibiotic course (48.8%). The mean total knowledge score was 8.57±4.24 (total 20). The majority incorrectly believed that antibiotics work on viral infections (79.1%) and colds and coughs (77.0%). Less than half of them believed that antibiotics could be stopped when symptoms improved (42.8%). Most respondents incorrectly perceived that antibiotic resistance occurs when the body becomes resistant to antibiotics (90.2%) and antibiotic resistance is not an issue in the country (62.9%). More than half the participants expected antibiotics to be prescribed for self-limiting symptoms (fever: 62.9%, sore throat: 57.2%, cold or flu: 50.9%). Respondents with better knowledge were less likely to engage in inappropriate antibiotic use (never engaged: 9.26±4.40 versus had engaged: 8.11±4.00, p<0.001), and expect doctors to discuss with them the need for antibiotics (agree/strongly agree: 9.03±4.25 versus neutral: 6.62±3.91 versus disagree/strongly disagree: 8.29±4.00, p<0.001).

CONCLUSION

Knowledge gaps in the role of antibiotics and understanding of antibiotic resistance should be considered whtpen designing future educational strategies for the general public.

Assessing the Syrian Population's Knowledge, Attitudes, and Practices Regarding Antibiotic Usage

Background Antibiotic resistance is a serious public health threat that results mainly secondary to antibiotics misuse. The present study aimed to determine the knowledge, attitude, and practice toward antibiotic use among the Syrian population. Methods This cross-sectional study was conducted at the outpatient clinics of two major hospitals in Damascus, Syria. Applying a random convenience sampling, data were collected in a 1-week period by interviewing participants using a structured questionnaire, which targeted demographics, practice, knowledge, and attitude. Data were used to assess the relationship between the knowledge level and attitudes and demographics. Results Most respondents had a moderate level of knowledge (187, 74.8%) and a moderate attitude score (148, 59.2%). In addition, most respondents (149, 59.6%) stated that they take antibiotics based on pharmacist advice only and do not complete the full antibiotic course (200, 80%). A significant association was found between the knowledge level and financial status ( p -value = 0.003), education level ( p -value = 0.001), and having relatives working in the health care sector ( p -value = 0.021). In addition, a significant association was found between the attitude and having health insurance. Conclusion This study provides baseline evidence about the knowledge, attitudes, and practices regarding antibiotics among the Syrian population, that will help in designing targeted interventions to solve the inappropriate use of antibiotics.

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

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

Knowledge, attitude and practice of antibiotics and their determinants in Eritrea: an urban population-based survey

OBJECTIVE

To measure knowledge, attitude and practice of antibiotics and antibiotic resistance (ABR) and their determinants in the Eritrean urban population.

DESIGN

A population-based, nation-wide, cross-sectional study.

SETTING

Urban settings of Eritrea.

PARTICIPANTS

Members of the general public aged ≥18 years and living in 13 urban places of Eritrea. Three-stage stratified cluster sampling was used to select the study participants.

DATA COLLECTION AND ANALYSIS

Date were collected from July 2019 to September 2019 in a face-to-face interview using a structured questionnaire. The collected data were double entered and analysed using Census and Survey Processing system (V.7.0) and SPSS (V.23), respectively. Descriptive statistics, χ² test, t-tests, analysis of variance, factorial analysis and multivariable logistic regression were performed. All analyses were weighted and p<0.05 was considered significant.

PRIMARY AND SECONDARY OUTCOME MEASURES

Main outcome variables were knowledge, attitude and practice of antibiotics and ABR. Secondary outcome measure was the determinants of knowledge, attitude and practice.

RESULTS

A total of 2477 adults were interviewed. The mean score of knowledge and attitude of antibiotics and ABR was 10.36/20 (SD=3.51, minimum=0 and maximum=20) and 22.34/30 (SD=3.59, minimum=6 and maximum=30), respectively. Of those who used antibiotics, the proportion of at least one inappropriate practice (use of antibiotics without prescription and/or discontinuation of prescribed antibiotics before completing the full course) was 23.8%. Young age <24 years (adjusted odds ratio (AOR)=1.61, 95% CI: 1.08 to 2.41), male sex (AOR=1.48, 95% CI: 1.14 to 1.91), higher level of education (AOR=1.76, 95% CI: 1.08 to 2.88), and negative attitude towards appropriate use of antibiotics (AOR=0.95, 95% CI: 0.92 to 0.97) were found to be the significant determinants of inappropriate practice of antibiotics.

CONCLUSION

The gap in knowledge and inappropriate practice of antibiotics in the Eritrean urban population was widespread; requiring immediate attention from policy-makers and healthcare professionals.

Antibiotic Practices, Perceptions and Self-Medication Among Patients at a National Referral Hospital in Uganda

Background

Antimicrobial resistance (AMR) is a major global health concern with increasing reports of microorganisms resistant to most of the available antibiotics. There are limited data on antibiotic practices, perceptions and self-medication among Ugandans, necessitating this study.

Methods

A cross-sectional study was conducted among patients at Kiruddu National Referral Hospital, Kampala, Uganda. A pre-tested interviewer administered a questionnaire that was used to collect data after an informed consent. Chi-square tests and logistic regression were used to assess associations between outcome and exposure variables. A P<0.05 was statistically significant.

Results

A total of 279 patients (response rate=71%) with a median age of 32 years participated in the study. The majority were females (55.6%, n=155) and from the outpatient department (74.9%, n=209). Overall, 212 (76%) participants had taken an antibiotic in the past 6 months, and some 22.2% (n=47) of the participants had practiced self-medication. Male participants (adjusted odds ratio (aOR)=2.13, 95% confidence intervals (CI): 1.01 to 4.50, P=0.046) and Muslims (aOR=4.37, 96% CI:1.54 to 12.44, P=0.006) were more likely to self-medicate. Employees (aOR=0.06, 95% CI:0.01 to 0.51, P=0.010) and patients with tertiary education (aOR=0.14, 95% CI: 0.02 to 0.81, P=0.028) were less likely to practice self-medication. About 33% (n=70) of the participants had not completed treatment dosage during their last course of antibiotic treatment because of feeling better (60%, n=42), lack of money to purchase the medication (15.7%, n=11) and side effects (10%, n=7). Whereas 169 participants (79.7%) believed that not completing treatment would have an impact on their personal health, only 96 participants (45.3%) believed that this behaviour could affect the health of others.

Conclusion

Antibiotic misuse is significant among patients in Uganda. Continuous health education programs aimed at informing the public on antimicrobial resistance, and its dangers are recommended to curtail this challenge.

Cross-Sectional Survey among General Population Regarding Knowledge and Attitude toward Antibiotic Usage in Western Saudi Arabia

Background: Antibiotic resistance is a threatening issue to human wellbeing and an obstacle in the treatment process of many life-threating illnesses. This study aims to assess the knowledge and attitudes toward antibiotic usage among the general population in Jeddah, Saudi Arabia. Methods: A self-administered cross-sectional survey of 460 participants was distributed among the general population in Jeddah in the form of a validated questionnaire. Sample size was calculated to be 460 adults of either gender. Descriptive and inferential statistical analyses were performed using the Statistical Package for Social Sciences. Results: the age of more than half of participants (55.6%) was 18–30 years old, followed by the age group 31–40 years old (26.6%), with the smallest age group >60 years old (1.9%). More than two thirds of participants were male (69.5%), while 131 were female, accounting for 30.5%. Almost one third of participants had poor knowledge about antibiotics (30.5%), 51.0% had used antibiotics without any prescriptions, 54.6% of participants thought antibiotics could be used to treat viral infections, and 55.1% thought it was acceptable to stop taking antibiotics if symptoms start to improve. In addition, 49% believed that taking antibiotics would help them get better more rapidly when suffering from the common cold. Some personal characteristics were significantly associated with the public’s knowledge (e.g., age, education, and monthly income) and their attitudes (e.g., monthly income). Conclusion: Findings revealed a low level of knowledge on the use of antibiotics among the general public in Jeddah. This study signifies the need for improvement in the public’s knowledge and enhancement of their attitudes toward proper utilization of antibiotics.

Current practice and barriers to ICU-acquired weakness assessment: a cross-sectional survey

BACKGROUND

Intensive-care-unit-acquired weakness (ICU-AW) not only leads to difficulty weaning off mechanical ventilation, prolonged hospital stay and increased medical costs, but also reduces the patient's quality of life after discharge and increases the 1-year mortality rate. Early identification and intervention can improve the prognosis of critically ill patients. However, much remains unknown about current clinical practice for ICU-AW assessment by ICU staff in China.

OBJECTIVES

To investigate current practices and barriers to ICU-AW assessment among ICU staff, and provide insights to improve ICU-AW assessment in ICUs in China.

METHODS

Qualitative interviews were used to construct a survey questionnaire (test-retest reliability 0.92, validity 0.96). This survey was subsequently completed by 3206 ICU staff from 31 provinces, municipalities and autonomous regions in China.

RESULTS

In total, 3206 ICU staff responded to the survey (response rate 90%): 616 doctors (19%), 2371 nurses (74%), 129 respiratory therapists (4%), 51 physiotherapists (2%) and 39 dieticians (1%). Only 27% of the respondents had treated/cared for patients with ICU-AW. Reported methods for ICU-AW assessment were clinical experience (53%), ICU-AW assessment tools (12%), and physiotherapy consultation (35%). Forty-three percent of respondents felt that their ICU-AW-related knowledge did not meet clinical needs, only 10% had received ICU-AW-related training, and 19% proactively assessed whether their patients had ICU-AW. In terms of frequency of assessment, 42%, 16% and 11% of respondents considered that ICU-AW should be assessed daily, every 3 days, and on ICU admission and discharge, respectively. The Medical Research Council scale, electrophysiological assessment and the Manual Muscle Testing scale were considered to be optimal tools for ICU-AW diagnosis by 79%, 70%, and 73% of respondents, respectively. The main reported barriers to ICU-AW assessment were lack of knowledge, cognitive impairment among patients, and lack of ICU-AW assessment guidelines and procedures.

CONCLUSION

Current practices for ICU-AW assessment are non-specific, and the main barriers include lack of skills and knowledge.

Assessment of Public Awareness, Attitude, and Practice Regarding Antibiotic Resistance in Kemissie Town, Northeast Ethiopia: Community-Based Cross-Sectional Study

BACKGROUND

Antibiotic resistance is increasing to dangerously high levels globally with subsequent higher medical costs, prolonged hospital stays and increased levels of mortality. Ensuring patients' knowledge, attitude, and proper use of antimicrobials is one of the strategies to control resistance. The aim of this study is to evaluate the public awareness, attitude, and practice regarding antimicrobial use and resistance in Kemissie Town, Northeast Ethiopia.

METHODS

A community-based, cross-sectional study was conducted on 385 adults selected using systematic random sampling in Kemissie town from March 1 to May 1, 2019. A home-to-home visit interview was done using a structured interview guide. The data were coded individually and entered into a computer using Epi-info version 3.5.1 and then exported to SPSS version 23.0 for analysis. Univariate analyses were used to describe the categorical variables.

RESULTS

Of the 345 respondents who took antibiotics, three quarters (74.78%) received antibiotics with a prescription. Of the total respondents, 17.7% of the participants believed unnecessary use of antibiotics enhances resistance to bacteria. Of those who took antibiotics, the majority (72.5 %) finished the full course of treatment. Out of the total 374 respondents, 41.6% had awareness on the fact that antibiotics resistance can affect the development of resistance in the whole community. More than half (51.9%) of the respondents believed that the rational use of antibiotics can reduce the risk of antimicrobial resistance.

CONCLUSION

The majority of the respondents were still unaware of antibiotic resistance and its implications. This requires close attention from policy-makers and healthcare professionals. The community of Kemissie town had a positive attitude towards finishing antibiotic regimens. This study also identified crucial gaps in the practices of the community about the use of antibiotics.

University Students' Antibiotic Use and Knowledge of Antimicrobial Resistance: What Are the Common Myths?

We aimed to assess antibiotic usage and knowledge regarding antibiotics and antimicrobial resistance (AMR) among undergraduate students of the Universiti Brunei Darussalam (UBD), public university located in Brunei Darussalam. A cross-sectional study was performed using a self-administered questionnaire. The questionnaire was adapted from the World Health Organization’s (WHO) “Antibiotic resistance: Multi-country public awareness” survey distributed online. Students at the UBD were invited to participate in the online survey through internal email. The questionnaire consisted of five sections: demographic information, antibiotic usage, knowledge on antibiotics, antibiotic resistance (AMR), and use of antibiotics in agriculture. The data were analyzed descriptively and appropriate inferential statistics were used accordingly. A total of 130 students returned a completed questionnaire. The result of the study found that 51% (n = 66) of the students had good level of knowledge of antibiotic and antimicrobial resistance with a mean total knowledge score of nine out of 14. Of note, 76% (n = 99) of the respondents mistakenly believed that antibiotic resistance is the result of the body becoming resistant to antibiotics. Only 14% (n = 18) of the respondents were found to have poor knowledge on antibiotics and antimicrobial resistance in the study. Misconceptions in regards to the use of antibiotics for conditions related to viral illnesses like cold and flu (41%, n = 53) were noticed among the respondents in our study. Thus, improving knowledge on antibiotics is crucial to address these beliefs.

Antimicrobial Stewardship Programs in Resource Constrained Environments: Understanding and Addressing the Need of the Systems

World Health Organization (WHO) has identified antimicrobial resistance as one of the top 10 threats to public health. The agency has formulated a global action plan to tackle antimicrobial resistance by reducing incidence of infectious diseases, increasing knowledge and awareness and promoting rational use of antimicrobials amongst other measures. While the core elements of successful antimicrobial stewardship (AMS) programs are much publicized, there application in resource limited settings is fraught with several challenges. The key limiting factors include lack of clear political commitment, inadequate funding, overcrowded healthcare systems, lax legal and regulatory frameworks, non-uniform access to diagnostics, absence of electronic health record systems, limited knowledge and awareness especially with existence of multiple systems of medicines, issues with access to quality assured medicines, in-house pharmacies, and shortage of trained manpower. Since these implementation-impeding issues may differ considerably from those experienced in developed economies, intervention efforts in low- and middle-income countries (LMICs) need to address the context and focus on the root causes prevailing locally. In this article, we review the evidence highlighting the magnitude of these challenges and suggest feasible models with effective application. We also share the evidence from our center where we have contextualized the core elements to resource constrained settings. These domains include delivering prospective audit and feedback, prescriber education, development of evidence-based and implementable guidelines, and optimization of surgical antibiotic prophylaxis. However, there is a tremendous need for scaling up, extending outreach and honing these models while at the same time, addressing the existing strategic challenges that curtail the full potential of global antimicrobial stewardship.

Antibiotic use and resistance: an unprecedented assessment of university students' knowledge, attitude and practices (KAP) in Lebanon

Background

The emergence and spread of pathogenic bacteria that is resistant to antibiotics has become a major public health concern. The incorrect prescription, inappropriate consumption and excess use of antimicrobial drugs, specifically antibiotics, are possibly the main factors contributing to the widespread of antibiotic resistant bacteria. This study aims to evaluate the knowledge, attitude and practices (KAP) towards the use of antibiotics as well as their resistance among Lebanese university students in health and non-health related majors.

Methods

This cross-sectional study was conducted between May and June 2019 in Beirut (Lebanon) in which 750 students completed a questionnaire made up of four dimensions: Socio-demographic characteristics, 3 questions; assessment of knowledge, attitude and practices, 7, 10 and 1 question, respectively. The data was collected in spreadsheets and analysed with descriptive statistics. The difference in mean scores in each of the knowledge, attitude and practices dimensions between health and non-health related major students was analysed using t-student tests and the difference in percentages using chi-square tests.

Results

Almost 78% of respondents from the health related majors scored high knowledge compared to only 41% of non-health related majors (mean = 4.26; standard error = 0.05 versus mean = 3.41; standard error = 0.13, respectively). The attitude score of the health related major students (35.42%) was positive and more satisfactory compared to the non-health related students (7.32%); (mean = 9.34; standard error = 0.05 versus mean = 9.10; standard error = 0.21, respectively). However, the difference in the scores of attitudes was not statistically significant.

Conclusions

Interventions to promote awareness in this area should focus more students in on non-health related majors.

Antibiotic Use and Resistance Pattern in Ethiopia: Systematic Review and Meta-Analysis

BACKGROUND

In the last decades, medicines have had an unprecedented positive effect on health, leading to reduced mortality and disease burden and consequently to an improved quality of life. The rapid and ongoing spread of antimicrobial-resistant organisms threatens our ability to successfully treat a growing number of infectious diseases. In the absence of the development of new generations of antibiotic drugs, appropriate use of existing antibiotics is needed to ensure the long-term availability of effective treatment for bacterial infections. Irrational use of antibiotics is an ongoing global public health problem that deserves more attention. This review is conducted to evaluate the prevalence of inappropriate antibiotic utilization and resistance to antibiotics in Ethiopia.

METHODS

Electronic search in PubMed/MEDLINE and Google was used to find published literature with reference lists of relevant articles searched manually. Titles and abstracts were initially screened for eligibility. The full texts of articles judged to be eligible were reviewed if they meet the inclusion criteria. Data were extracted on important variables like the sample size, region of the study, the inappropriate antibiotic use, bacterial detection rate, multidrug resistance pattern, and more other variables. Microsoft Excel was used for data extraction. Quantitative analysis was performed using STATA version 11.

RESULTS

The electronic searches identified 193 articles of which 33 were found eligible. The random-effects model was used to provide point estimates (with 95% confidence interval (CI)) of bacterial detection rate, inappropriate antibiotic use, and multidrug resistance rate to account for heterogeneity. The pooled bacteria detection rate was 29.1 with 95% CI (16.6-41.7). The pooled prevalence of multidrug resistant strains identified was 59.7% (95% CI: 43.5-75.9). The pooled estimate of inappropriate antibiotic use was 49.2% (95% CI: 32.2-66.2). The pooled proportion of self-antibiotic prescription was 43.3% (95% CI: 15.7-70.9). Other reasons for inappropriate antibiotic use included a wrong indication, wrong duration, improper route of administration, use of leftover antibiotics from a family member, and immature discontinuation of antibiotics.

CONCLUSION AND RECOMMENDATIONS

Inappropriate antibiotic use is a huge problem in Ethiopia, and many bacteria were resistant to commonly used antibiotics and similarly, multidrug-resistant bacterial strains are numerous. Appropriate antibiotic use should be ensured by prohibiting over-the-counter sale of antibiotics and strengthening antimicrobial stewardship.