Assessment of attitudes and practices of young Malaysian adults about antibiotics use: a cross-sectional study

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.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Systematic review and meta-analysis of environmental Vibrio species - antibiotic resistance

Adequate comprehension of the genomics of microbial resistance to an antimicrobial agent will advance knowledge on the management of associated pathologies and public health safety. However, continued emergences and reemergence of pathogens, including Vibrio species, hallmarks a potential knowledge gap. A clear understanding of the process and forecast of the next trend should be in place to nip in the bud, microbial acquisition of resistance to antibiotics. Therefore, this two-decade (1 January 2000 to 31 December 2019) systematic review and meta-analytical study articulated the prevalence and incidence of antibiotics resistance genes in Vibrio species isolated from environmental samples. Articles from the Web of Science and PubMed electronic databases was engaged. Heterogeneity of the data and bias were analyzed with random effect model meta-analysis and funnel plot. A total of 1920 Vibrio sp. were reported by the ten selected articles included in this study; out of which 32.39% of identified isolates displayed antimicrobial resistance and associated genes. The distribution of antibiotics resistance genes in Vibrio sp., reported within six countries was 21% tetracycline (tet), and 20% sulphonamide (sul) and β-lactamase (bla) respectively. The quinolone, tetracycline and sulfonamide resistance genes showed 32.97% (95% CI 0.18–0.53) prevalence while chloramphenicol, macrolides and aminoglycoside resistance genes are expressed in percentages as 28.67% (95% CI 0.15–0.47) and β-lactamase resistance genes 27.93% (95% CI 0.11–0.56) respectively. The Vibrio antibiotics resistance genes (V-ARG) distribution depicts no regular trend or pattern from the analyzed data. Consequently, more studies would be required to articulate the structure of cohesion in the distribution of the resistance determinants in microbes.

Antibiotic use and resistance in a tertiary care hospital: knowledge and attitude among patients of orthopaedic and surgical wards in Malaysia

Objectives

The prevalence of antimicrobial resistance (AMR) is rising globally as well as in Malaysia. AMR can lead to difficulty in the treatment of chronic infection if being neglected. This study aimed to assess the level of knowledge and attitude about antibiotic usage and AMR.

Methods

A cross-sectional study design was carried out at the Hospital Kuala Lumpur (HKL), Malaysia, where participants were recruited by using the non-probability convenience sampling from the six orthopaedic and four surgical wards. A self-administered questionnaire was used to collect the required data which were then analysed by using SPSS.

Key findings

A total number of 390 adult Malaysians (286 from orthopaedic wards and 104 from surgical wards) were involved in the study. This study showed that the level of knowledge and attitude about antibiotics among the majority of respondents were moderate. However, their knowledge regarding AMR was very low (i.e. lack of knowledge). In contrast, the majority of them (69.8%) showed a positive attitude towards antibiotics. Statistical analysis of data revealed that the level of knowledge of AMR was significantly associated with gender, age, race, marital status, educational level and knowledge about antibiotic resistance terms (P &lt; 0.05) while respondents’ attitude towards antibiotic usage was significantly associated with gender, race, marital status and education level (P &lt; 0.05).

Conclusions

It was necessary to formulate and develop strategies to improve the knowledge and awareness about antibiotics and AMR among health professionals. These might help them to improve their skills in delivering health information to the patients through a proper counselling technique.

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.

Information on antibiotics in an Indonesian hospital outpatient setting: What is provided by pharmacy staff and recalled by patients?

Background:

The provision of information by pharmacy staff is a key factor to ensure patients’ understanding and quality use of medications, including antibiotics. However, little is known regarding the transmission of information between pharmacy staff and patients in Indonesia.

Objective:

This study aimed to identify information on antibiotics provided by pharmacy staff and recalled by patients in an Indonesian outpatient setting.

Methods:

The study was conducted in a hospital outpatient clinic in Malang, Indonesia, in 2019. A checklist was used to obtain the data on information provided by pharmacy staff, while interviews were conducted to determine information recalled by patients (only presenting patients were included); a total of 15 information items – i.e. 14 essential and one secondary – were observed. Descriptive analysis was used to summarise data on the checklists (‘given’ versus ‘not given’) as well as responses from the interviews (‘recalled’ versus ‘missed’).

Results:

Eleven pharmacy staff (two pharmacists and nine pharmacy technicians) were involved in providing information for patients obtaining oral antibiotics during the study period. Of 14 essential information items, only about half was given by pharmacy staff, with pharmacists significantly providing on average more information items than pharmacy technicians (7.96 versus 7.67 respectively; p<0.001). The most frequently information items provided (>90%) included “antibiotic identification”, “indication”, administration directions (i.e. “dosage”, “frequency”, “hour of administration”, “administration before/after meal”, “route of administration”), and “duration of use”. A total of 230 patients consented to the study, giving 79.9% response rate. The average number of information items recalled by patients was 7.09 (SD 1.45). Almost all patients could recall information on administration directions [i.e. “route of administration” (97.0%), “frequency” (95.2%), “dosage” (92.6%), “hour of administration” (85.7%), “administration before/after meal” (89.1%)] and “duration of use” (90.9%). Fewer patients were able to recall “antibiotic identification” (76.5%) and “indication” (77.0%).

Conclusions:

Pharmacy staff provided antibiotic information in a limited fashion, while patients showed adequate ability to recall the information given to them. Further study is needed to better understand the effective process of information transmission between pharmacy staff and patients, especially if more information was provided, to better optimise the use of antibiotics in outpatient settings in Indonesia.

The evaluation of chatbot as a tool for health literacy education among undergraduate students

This study discussed and evaluated the usefulness, performance, and technology acceptance of a chatbot developed to educate users and provide health literacy. A semi-structured interview and analytic sessions were provided on Google Analytics dashboard, and the users' acceptance toward the technology was measured using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2). A total of 75 undergraduate students were involved over a total period of two months. Each respondent explored the health chatbot actively to get advice from it with a phrase that matched the chatbot's intents via mobile devices. The evaluation results showed that 73.3% of the respondents found that the chatbot can help understand several health issues and provide a good conversation. The performance evaluation also showed that the chatbot contributed a low percentage of exit, where less than 37% of users exited the application. The overall assessment showed that the developed chatbot has a significant potential to be used as a conversational agent to increase health literacy, especially among students and young adults. However, more research should be done before the technology can replace humans in a real setting.

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.

Knowledge and Attitude of University Students on Antibiotics: A Cross-sectional Study in Malaysia

Background

Antibiotic resistance has become one of the major global health threats. The lack of knowledge on antibiotics contributes to the indiscriminate use of these medications and subsequent antibiotic resistance.

Objective

To evaluate the knowledge and attitude of university students regarding antibiotics.

Methods

A cross-sectional study was conducted on university students at a private university in Malaysia in 2018, using a self-administered validated questionnaire.

Results

Of the 424 respondents included in this study, 25.7% had taken antibiotics in the previous month while 22.6% had good knowledge about antibiotics. The faculty to which the respondents were attached was the only determinant associated with the respondents’ knowledge level on antibiotics. The odds of respondents from other faculties having poor knowledge level on antibiotics were significantly higher than those from the Faculty of Health and Medical Sciences (P<0.001). The study found that 77.8% of the respondents knew the roles of antibiotics in treating bacterial infections, but only 27.4% knew that antibiotics were not for viral infections. However, 46.5% of the respondents recognized that penicillin is an antibiotic, but only 35.4% and 9.2% knew that aspirin and diphenhydramine, respectively, are not antibiotics. More than 70% of the respondents were aware that antibiotics have side effects and that overuse of antibiotics could lead to resistance. However, 35.6% expected antibiotics to be prescribed for common colds and 33% would not complete their course of antibiotics.

Conclusion

The study shows that university students do not have adequate knowledge and about one-third have misconceptions about antibiotics. This calls for health education interventions at university level as this target population will be the future leaders of the country.

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.

Fighting antibiotic resistance: a narrative review of public knowledge, attitudes, and perceptions of antibiotics use

AIMS

The aims of this study were to ascertain the comprehensive knowledge, perceptions, and attitudes of people from varying socioeconomic regions towards antibiotic use; identify the misperceptions and malpractices; and inform health policy and practice.

METHOD

EBSCO host databases, PubMed, and Google Scholar were searched to obtain relevant primary research papers within the years 2010-2018. Search phrases included the following: 'antibiotics use', 'community perceptions', 'public opinion, knowledge, behaviour, practices, perceptions'. Initially, selected papers were screened using the Preview, Question, Read, Summarize (PQRS) model.

RESULTS

Review of the 20 articles selected was based on six identified themes. It was found that insufficient knowledge and awareness of antibiotics use; self-medication and the use of leftover antibiotics; treating viral diseases with antibiotics or used as painkillers; expecting antibiotic prescription as a culmination of consultation; and the credibility of information obtained are issues that cut across different countries.

CONCLUSION

Evidence from this review suggests that misconceptions of antibiotic use are similar in different countries. Therefore, the need for the development and implementation of transferable policies as well as educating the public is necessary for the fight against ABR.

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults' knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough (p < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course (p < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.

Assessment of General Public's Knowledge and Opinions towards Antibiotic Use and Bacterial Resistance: A Cross-Sectional Study in an Urban Setting, Rufisque, Senegal

Background: Bacterial resistance is a major public health problem worldwide. One solution to this scourge is to sensitize the general public on rational use of antibiotics. Our goal was to assess people’s knowledge and opinions about antibiotic use and bacterial resistance in an urban setting. Method: We performed a cross-sectional study. A convenience sampling was done. A questionnaire was administered to 400 persons during face-to-face interviews. Results: Most respondents thought that antibiotics are effective against colds/flu (69.8%), cough (72.3%) and sore throat (64.4%). At the same time, 42.8% stated that antibiotic therapy can be stopped as soon as the symptoms disappear. Only 8.8% and 41.8% of people knew that handwashing and vaccination prevented bacterial resistance. Globally, 7% of people had a good knowledge. Socio-demographic variables were not associated with the level of knowledge. The main sources of information were entourage and pharmacy staff. Regarding the opinions, 78.3% of surveyed participants the people thought that that people overuse antibiotics. Additionally, 28% said that they have no role to play against bacterial resistance. Conclusion: People living in an urban setting had a low knowledge about antibiotic use and bacterial resistance. There is a need to implement awareness campaigns. Further studies on population practices toward antibiotic use are necessary.

What drives using antibiotic without prescriptions? A qualitative interview study of university students in United Arab Emirates

Background:

Bacterial resistance to antibiotics is considered as natural phenomenon that occurs over the time due to genetic changes. Bacterial resistance to antibiotics is significantly increasing in the UAE. Self-medication with antibiotics has been identified as a major factor for the development of antibiotic resistance, which is significantly increasing in the UAE.

Objectives:

The purpose of this study was to explore the factors that contribute to the use of antibiotics without prescriptions among first year healthcare university students in UAE.

Methods:

Based on the findings of an earlier survey study, a qualitative interview study was designed to explore common themes related to student’s knowledge, awareness, attitude, views, and perceptions. Data were analyzed thematically for the identification of themes and subthemes within the data through the use of coding.

Results:

The interview study identified four main themes with multiple subthemes related to the use of antibiotics without a physician’s prescription by first-year healthcare students. The thematic analysis of the interviews revealed four main themes; medication habits and practices; reasons for self-medication; access to antibiotics without a prescription and gaps in students’ knowledge regarding antibiotic resistance

Conclusions:

Healthcare students in UAE are influenced by several factors including parents and friends influence, successful previous experience and investment of time and money to visit a physician. Our sample of healthcare students has a misconception about the use of antibiotics. The current interview study identified six new reasons for using antibiotics without prescriptions as compared to our earlier survey study. There is a need of multifaceted strategies to decrease unnecessary antibiotic use in our population sample.