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Asante AA, Bandoh DA, Kenu E. Self-medication with antibiotics among out-patient attendants at Madina Polyclinic prior to medical consultation. Ghana Med J 2023; 57:308-315. [PMID: 38957850 PMCID: PMC11215222 DOI: 10.4314/gmj.v57i4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Objectives The study aimed to determine the prevalence of self-medication with antibiotics among attendants of the Out-patient Department (OPD) at Madina Polyclinic before seeking medical consultation and associated factors. Design Cross-sectional study. Setting The study was conducted at Madina Polyclinic. Participants The study involved 319 general OPD attendants aged 18 years and above accessing healthcare services at the Madina Polyclinic between May and June 2019. Main outcome measures The prevalence of antibiotic self-medication and the factors associated with this practice. Results From the study, 46.4% (95% CI 40.8%- 52.0%) had self-medicated with antibiotics before presenting for medical consultation at the hospital. Less than half of the respondents (44.5%) had adequate knowledge about the use of antibiotics. Having a tertiary level of education was significantly associated with self-medication (aOR= 8.09, 95% CI 2.31-28.4, p = 0.001), whilst adequate knowledge on the use of antibiotics reduced the odds of self-medication by 53% (aOR= 0.47, 95% CI 0.23- 0.66, p<0.001). The level of education modified the relationship between knowledge and self-medication with antibiotics. Conclusion The practice of antibiotic self-medication is rife among OPD attendants. Therefore, adequate public education on the use of antibiotics and the effects of using them inappropriately must be done. The Antimicrobial Resistance (AMR) policy ought to be reinforced and made known to all, especially among the pharmacies that dispense antibiotics indiscriminately. Funding None declared.
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Affiliation(s)
- Adelaide A Asante
- University of Ghana School of Public Health, Department of Epidemiology and Disease Control, College of Health Sciences, Accra, Ghana
| | - Delia A Bandoh
- University of Ghana School of Public Health, Department of Epidemiology and Disease Control, College of Health Sciences, Accra, Ghana
| | - Ernest Kenu
- Internal Medicine Department, Korle-Bu Teaching Hospital, Accra, Ghana
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2
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Yopa Demen DS, Nnanga Nga E, Ohandza CS, Gonsu Kamga H, Kouamen Njikeu ON, Nguefack-Tsague G. Antibiotic consumption history of patients in a referred laboratory in Yaounde. J Public Health Afr 2023; 14:2104. [PMID: 37441124 PMCID: PMC10334438 DOI: 10.4081/jphia.2023.2104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/10/2022] [Indexed: 07/15/2023] Open
Abstract
Background Regulation of antibiotic prescription and consumption remains a major public health burden in low- and middle- income countries. Objective This study aimed to describe the antibiotic consumption of patients who had a positive antibiotic culture in a reference laboratory. Methods A retrospective descriptive study was conducted among 113 participants with positive antibiograms with a documented history of antibiotics intake at the Yaoundé University Teaching Hospital in Cameroon between January 2016 and June 2021. Data were stored and analyzed using the Census and Survey Processing System version 7.3 and Statistical Package for Social Science version 25.0. Descriptive statistics were used to estimate the indicators. Results Of the 113 patients enrolled, 105 had a history of drug use; 56 participants (53.3%) had taken at least 2 antibiotics prior to sampling. Cephalosporins were the most consumed antibiotics (41%), followed by nitroimidazols (28.6%) and penicillins (28.6%). According to the World Health Organization classification, 55 (52.4%) took major priority antibiotics. Conclusion We are on the alert and there is an urgent need to raise awareness among clinicians and patients alike by providing them with good clinical practice guidelines.
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Affiliation(s)
| | | | - Claude Stephan Ohandza
- Department of Infectious and Tropical Diseases, Fann University Teaching Hospital, Dakar, Senegal
| | - Hortense Gonsu Kamga
- Department of Microbiology-Parasitology-Hematology, University of Yaounde I, Cameroon
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3
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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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4
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Aslam A, Zin CS, Ab Rahman NS, Gajdács M, Ahmed SI, Jamshed S. Self-Medication Practices with Antibiotics and Associated Factors among the Public of Malaysia: A Cross-Sectional Study. DRUG HEALTHCARE AND PATIENT SAFETY 2021; 13:171-181. [PMID: 34737648 PMCID: PMC8560071 DOI: 10.2147/dhps.s331427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/06/2021] [Indexed: 12/28/2022]
Abstract
Background Self-medication with antibiotics (SMA) is an important public health issue, which can result in the facilitated development of antibiotic resistance, and may increase the risk of inappropriate utilization of antibiotics. So, the objective of the present study was to estimate the prevalence rate of SMA and to also explore SMA practices among the lay population of Kuala Lumpur (Malaysia). Methods The current study was cross-sectional population-based and used a convenient sampling technique. Moreover, Lorenz’s formula was used to calculate the sample size and the required sample size was 480. Data were collected through face-to-face interviews with a pre-validated questionnaire and the study was conducted in Kuala Lumpur (Malaysia). Descriptive statistics, cross-tabulation, and logistic regression were executed by using SPSS version 24. Results Out of 480 participants, 45.8% were polled male and the prevalence of SMA in this study was found to be 15.1%. The majority of participants 23.1% indicated that they practiced antibiotics at least once in the last six months. The commonly self-medicated antibiotics were amoxicillin-clavulanate 20.6%, ampicillin/cloxacillin 14.2%, and levofloxacin 8.3%. Moreover, 64.8% of participants indicated that they bought their antibiotics from pharmacies. Whereas, most of the participants practice antibiotics to save money 19.2% and time 23.1%. Findings from multivariate logistic regressions showed that predictors of SMA were male gender, (95% CI: 0.300–0.877) occupation (95% CI: 0.122–10.797), health insurance (95% CI: 0.025–0.472), and education (95% CI: 0.084–0.800). Conclusion The results of this study indicate that SMA persists among the community and education level has a significant impact on this behavior. Thus, concerning health management authorities should step in with developing legislation to stop this practice, and by implementing such interventions and policies to educate and to raise awareness about the risk of SMA for the future.
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Affiliation(s)
- Adeel Aslam
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Norny Syafinaz Ab Rahman
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, 6720, Hungary
| | - Syed Imran Ahmed
- School of Pharmacy, College of Science, University of Lincoln, Lincoln, UK
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut, Terengganu, 22200, Malaysia
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Dache A, Dona A, Ejeso A. Inappropriate use of antibiotics, its reasons and contributing factors among communities of Yirgalem town, Sidama regional state, Ethiopia: A cross-sectional study. SAGE Open Med 2021; 9:20503121211042461. [PMID: 34504704 PMCID: PMC8422824 DOI: 10.1177/20503121211042461] [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: 04/08/2021] [Accepted: 08/10/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives The aim of this study was to assess the inappropriate use of antibiotics, its reasons and contributing factors among communities of Yirgalem town, Sidama regional state, Ethiopia. Methods The study was conducted in Yirgalem town from 1 March to 30 March 2019. A cross-sectional study with interviewer administered structured and pretested questionnaire was used. A multistage sampling procedure was employed involving a total of 568 participants who used antibiotics in the past 1 year prior to the study period. Data were entered into Epi data version 3.1, and then exported to statistical package for social science version 20 for analysis. Descriptive statistics, bivariate and multivariate logistic regression analysis were done. p-value < 0.05 was used to consider significant variables. Results The magnitude of inappropriate use of antibiotics was 37.9% (95% confidence interval (34.0, 41.5)). Main reason(s) for inappropriate use were long delays in health facility, cost-cutting and busy day's program. Being employed (adjusted odds ratio = 3.45, 95% confidence interval (1.98, 6.02)), age 25-34 years (adjusted odds ratio = 2.89, 95% confidence interval (1.43, 5.84)), being male (adjusted odds ratio = 1.90, 95% confidence interval (1.20, 3.02)), seeking modern healthcare in private clinic (adjusted odds ratio = 2.54, 95% confidence interval (1.20, 5.36)), delayed waiting time in healthcare facilities (adjusted odds ratio = 4.87, 95% confidence interval (2.17, 10.91)), experienced with similar symptom/disease (adjusted odds ratio = 3.02, 95% confidence interval (1.89, 4.83)) and family size above five (adjusted odds ratio = 8.92, 95% confidence interval (3.56, 22.38)) were predictors positively associated with inappropriate use of antibiotics. Conclusion The magnitude of inappropriate antibiotics use was high. Attention should be given to community education through involvement of the private health sector and healthcare providers about rational use of antibiotics.
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Affiliation(s)
- Azmach Dache
- Department of Social and Population Health, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Aregahegn Dona
- Department of Social and Population Health, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Amanuel Ejeso
- Department of Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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6
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Yeika EV, Ingelbeen B, Kemah BL, Wirsiy FS, Fomengia JN, van der Sande MAB. Comparative assessment of the prevalence, practices and factors associated with self-medication with antibiotics in Africa. Trop Med Int Health 2021; 26:862-881. [PMID: 33942448 DOI: 10.1111/tmi.13600] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate and compare the prevalence, reasons, sources and factors associated with self-medication with antibiotics (SMA) within Africa. METHODS Systematic review and meta-analysis. An electronic search of PubMed and Google Scholar databases was performed for observational studies conducted between January 2005 and February 2020. Two reviewers independently screened abstracts and full texts using the PRISMA flowchart and performed quality assessment of eligible studies. Both qualitative and quantitative syntheses were carried out. RESULTS Forty studies from 19 countries were eligible for qualitative synthesis. The prevalence of SMA in Africa ranged from 12.1% to 93.9% with a median prevalence of 55.7% (IQR 41-75%). Western Africa was the sub-region with the highest reported prevalence of 70.1% (IQR 48.3-82.1%), followed by Northern Africa with 48.1% (IQR 41.1-64.3%). We identified 27 antibiotics used for self-medication from 13 different antibiotic classes. Most frequently used antibiotics were penicillins (31 studies), tetracyclines (25 studies) and fluoroquinolones (23 studies). 41% of these antibiotics belong to the WHO Watch Group. The most frequent indications for SMA were upper respiratory tract infections (27 studies), gastrointestinal tract symptoms (25 studies) and febrile illnesses (18 studies). Common sources of antibiotics used for self-medication were community pharmacies (31 studies), family/friends (20 studies), leftover antibiotics (19 studies) and patent medicine stores (18 studies). The most frequently reported factor associated with SMA was no education/low educational status (nine studies). CONCLUSIONS The prevalence of SMA is high in Africa and varies across sub-regions with the highest prevalence reported in Western Africa. Drivers of SMA are complex, comprising of socio-economic factors and insufficient access to health care coupled with poorly implemented policies regulating antibiotic sales.
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Affiliation(s)
| | - Brecht Ingelbeen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ben-Lawrence Kemah
- University Hospitals North Midlands, Stoke-on-Trent, UK.,Health Education & Research Organization, Buea, Cameroon
| | | | - Joseph Nkeangu Fomengia
- École de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium.,Sintieh Research Academy, Yaoundé, Cameroon
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Global Health, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
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7
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Uchil A, Murali TS, Nayak R. Escaping ESKAPE: A chalcone perspective. RESULTS IN CHEMISTRY 2021. [DOI: 10.1016/j.rechem.2021.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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8
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Evidence of the Practice of Self-Medication with Antibiotics among the Lay Public in Low- and Middle-Income Countries: A Scoping Review. Antibiotics (Basel) 2020; 9:antibiotics9090597. [PMID: 32932630 PMCID: PMC7558641 DOI: 10.3390/antibiotics9090597] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
The current scoping review is an attempt to explore the key reasons, determinants, patterns and prevalence related to self-medication with antibiotics (SMA) among the lay public. An online search was conducted using Google Scholar, Science Direct, ProQuest and PubMed. A two-phase mapping approach was used. In the first phase, studies were screened. In the second phase, the data were extracted from selected studies followed by the assessment of data quality. A total of 24 studies were included; 20 were cross-sectional, 3 were qualitative and one was observational. The most common indications were flu, cough, common colds, sore throat, diarrhea, toothache and fever. The most common determinants reported were past good experience and suggestions from friends or relatives. The use of SMA was observed to be more frequent in younger aged individuals belonging to low- or middle-income groups. The prevalence rate was reported to be high among the South Asian lay public and may be a major contributor to antibiotic resistance. In conclusion, this scoping review identifies a need for education campaigns and mass media campaigns to strengthen lay public awareness about the side effects and risks associated with SMA. In addition to this, there is a need to implement strict policies by government agencies to restrict over the counter availability of antibiotics.
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Mouiche MMM, Moffo F, Akoachere JFTK, Okah-Nnane NH, Mapiefou NP, Ndze VN, Wade A, Djuikwo-Teukeng FF, Toghoua DGT, Zambou HR, Feussom JMK, LeBreton M, Awah-Ndukum J. Antimicrobial resistance from a one health perspective in Cameroon: a systematic review and meta-analysis. BMC Public Health 2019; 19:1135. [PMID: 31426792 PMCID: PMC6700798 DOI: 10.1186/s12889-019-7450-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is widely acknowledged as a global health problem, yet in many parts of the world its magnitude is not well elucidated. A baseline assessment of the AMR prevalence is a priority for implementation of laboratory-based AMR surveillance This review, focused on a One health approach, aimed at describing the current status of AMR in Cameroon. Methods PubMed, Google Scholar and African Journals Online databases were searched for articles published in English and French in accordance with the PRISMA guidelines. Retrieval and screening of article was done using a structured search string with strict inclusion/exclusion criteria. Free-text and grey literature were obtained by contacting the authors directly. The pooled prevalence and 95% confidence intervals were calculated for each pathogen–antibiotic pairs using random-effects models. Result Amongst 97 full-text articles reviewed, 66 met the eligibility criteria. The studies originated from the Centre (24; 36.4%), South-West (16; 24.2%), West (13; 19.7%), Littoral (9; 13.6%) and other (4; 6.1%) regions of Cameroon. These studies reported AMR in human (45; 68.2%), animals (9; 13.6%) and the environment (12; 18.2%). Overall, 19 species of bacteria were tested against 48 antibiotics. These organisms were resistant to all classes of antibiotics and showed high levels of multidrug resistance. Escherichia coli, Klebsiella pneumoniae and Staphylococcus spp were reported in 23, 19 and 18 of the human studies and revealed multidrug resistance (MDR) rates of 47.1% [95% CI (37.3–57.2%)], 51.0% [95% CI (42.0–59.9)] and 45.2% [95% CI (38.0–54.7)], respectively. Salmonella spp was reported in 6 of the animal studies and showed a MDR rate of 46.2% [95% CI (39.2–53.5%)] while Staphylococcus spp in 8 of environment studies showed MDR rate of 67.1% [95% CI (55.2–77.2%)]. Conclusion This review shows that resistance to commonly prescribed antibiotics in Cameroon is high. The findings emphasize the urgent need to address gaps in the standardization of AMR diagnostics, reporting and use of available information to optimize treatment guidelines for the arsenal of antibiotics. Effective AMR surveillance through continued data sharing, large-scale collaboration, and coordination of all stakeholders is essential to understand and manage the AMR national burden.
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Affiliation(s)
- Mohamed Moctar Mouliom Mouiche
- Department of Pharmacy, Pharmacology and Toxicology, School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon. .,MOSAIC, Yaoundé, Cameroon.
| | - Frédéric Moffo
- Department of Pharmacy, Pharmacology and Toxicology, School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon.,Laboratory of Animal Physiology and Health, Department of Zootechnics, Faculty of Agronomy and Agricultural Sciences, University of Dschang, Dschang, Cameroon
| | | | - Ndode Herman Okah-Nnane
- Department of Pharmacy, Pharmacology and Toxicology, School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon.,Institute of Agricultural Research for Development, Veterinary Research Laboratory, Wakwa Regional Center, Ngaoundéré, Cameroon
| | - Nabilah Pemi Mapiefou
- Department of Pharmacy, Pharmacology and Toxicology, School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon
| | | | - Abel Wade
- National Veterinary Laboratory (LANAVET), Yaounde, Cameroon
| | | | | | - Henri René Zambou
- Epidemiology-Public Health-Veterinary Association (ESPV), Yaounde, Cameroon
| | - Jean Marc Kameni Feussom
- Epidemiology-Public Health-Veterinary Association (ESPV), Yaounde, Cameroon.,Cameroon Epidemiological Network for Animal Diseases (RESCAM), Ministry of Livestock, Fisheries and Animal Industries (MINEPIA), Yaoundé, Cameroon
| | | | - Julius Awah-Ndukum
- Department of Pharmacy, Pharmacology and Toxicology, School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon.,Laboratory of Animal Physiology and Health, Department of Zootechnics, Faculty of Agronomy and Agricultural Sciences, University of Dschang, Dschang, Cameroon.,College of Technology, University of Bamenda, Bambili, Cameroon
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10
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Haque M, Rahman NAA, McKimm J, Binti Abdullah SL, Islam MZ, Zulkifli Z, Saidin NB, Azhar NIK, Binti Lutfi SNN, Binti Othman NSA. A cross-sectional study evaluating the knowledge and beliefs about, and the use of antibiotics amongst Malaysian university students. Expert Rev Anti Infect Ther 2019; 17:275-284. [DOI: 10.1080/14787210.2019.1581607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Nor Azlina A. Rahman
- Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Swansea, UK
| | - Shahidah Leong Binti Abdullah
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | | | - Zainal Zulkifli
- Sultan Haji Ahmad Shah Hospital, Temerloh, Pahang Darul Makmur, Malaysia
| | - Nurfarhana Binti Saidin
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Nadia Iman Khairul Azhar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Siti Nur Najihah Binti Lutfi
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Nur Syamirah Aishah Binti Othman
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
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