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Habiba UE, Khan A, Mmbaga EJ, Green IR, Asaduzzaman M. Use of antibiotics in poultry and poultry farmers- a cross-sectional survey in Pakistan. Front Public Health 2023; 11:1154668. [PMID: 37497033 PMCID: PMC10366442 DOI: 10.3389/fpubh.2023.1154668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/09/2023] [Indexed: 07/28/2023] Open
Abstract
Background Antimicrobial resistance (AMR) which has been ascribed to be due to community carriage of antibiotic-resistant bacteria is highly prevalent in the WHO South-East Asia region. One of the major reasons for this is the misuse of antibiotics in animal farming practices and at the community level, which threatens both human and animal health. However, this problem of antibiotic misuse in poultry farms and in respective farmers is not well studied in countries like Pakistan. Methods We conducted a cross-sectional study in rural Punjab to explore the current practices of antibiotic use in poultry and poultry farmers, associated factors, their healthcare-seeking behavior and biosecurity practices. Results In the context of antibiotic use for poultry, 60% comprised of Colistin sulfate and Amoxicillin trihydrate whereas Colistin is considered as the last resort antibiotic. In addition, the significant consumption of antibiotics in poultry farms (60%) and poultry farmers (50%) was without prescription by either human health physicians or veterinarians. Most of the farms (85%) had no wastewater drainage system, which resulted in the direct shedding of poultry waste and antibiotic residue into the surrounding environment. The lack of farmers' education, professional farm training and farming experience were the most significant factors associated with antibiotic use and knowledge of AMR. Conclusion Our study findings show that it is necessary for an integrated AMR policy with the inclusion of all poultry farmers to be educated, a mass awareness program to be undertaken and that strict antibiotic usage guidelines be available to them. Such initiatives are also important to ensure food safety and farm biosecurity practices.
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Affiliation(s)
- Um e Habiba
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Elia John Mmbaga
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ivan Robert Green
- Department of Chemistry and Polymer Science, Stellenbosch University, Stellenbosch, South Africa
| | - Muhammad Asaduzzaman
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Zaidi SF, Hakami AY, Khan MA, Khalid AA, Haneef AK, Natto SS, Mastour MA, Alghamdi RF. The Awareness and Practice of Self-Medication Among the General Public in Jeddah and Makkah. Cureus 2023; 15:e39706. [PMID: 37398702 PMCID: PMC10309079 DOI: 10.7759/cureus.39706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 07/04/2023] Open
Abstract
Background Self-medication (SM) can be defined as the improper practice of obtaining and consuming a pharmaceutical drug without the consultation or prescription of a licensed physician. This includes evaluating the intensity of signs and symptoms which could lead to treating oneself with a medicine or seeking urgent medical care. Although SM can be deemed as safe for one's health, drug accessibility accounts for an irrational choice of medicines and thus exposes oneself to the adverse effects of these medicines. Several regional studies have provided sufficient evidence about how SM has commonly been practiced and held in some settings, such as pharmacies. Aim In this study, we aimed to assess the practice and awareness of SM in the general public. Thus, we utilized a questionnaire-based survey to analyze SM awareness and practice among the general population in Jeddah and Makkah. In addition, we examined the impact of demographic variables, such as educational level, economic status, age, etc. on SM practice. Methods A cross-sectional survey was distributed via social media platforms in June 2020. The study included Jeddah and Makkah's general public, all different nationalities, and both genders, and it excluded participants below the age 18-year-old and with mental and cognitive instability. After extrapolating the sample size at a 95% confidence level with an estimated 50% response distribution, a margin of error ±5%, and accounting for a 5% non-response rate, the estimated sample size was determined to be 404. Results A total of 642 participants completed the online-based survey, but only 472 responses fit the study criteria. Most of the participants (64.6%) did not consult with a physician, i.e., practiced SM, whereas (34.5%) have visited a doctor. Furthermore, people who did not visit a doctor had the commonest belief (26.1%) that they did not need a doctor to investigate their symptoms. The awareness of SM among the general public in Makkah and Jeddah was assessed by asking whether they deem this practice harmful, harmless, or beneficial. 65.9% of the participants deemed the practice of SM as harmful, and 17.6% regarded the act as harmless. Conclusion This study revealed that 64.6% of the general public of Jeddah and Makkah practice self-medication, even though 65.9% deemed this act harmful. The contradiction between the public's opinion and the actual behavior towards self-medication implies the need for more awareness of self-medication and the importance of exploring the incentives of such behavior.
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Affiliation(s)
- Syed F Zaidi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Faculty of Eastern Medicine, Hamdard University Islamabad Campus, Islamabad, PAK
| | - Alqassem Y Hakami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Muhammad A Khan
- Medical Education, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Adil A Khalid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmed K Haneef
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Safwan S Natto
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed A Mastour
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Rayan F Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
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Cruz JC, Perez CZ, Cabrera MCS, Lopez ER, Hoyos PV, Rojas Rojas D, Montaña AO. Factors associated with self-medication of antibiotics by caregivers in pediatric patients attending the emergency department: a case-control study. BMC Pediatr 2022; 22:520. [PMID: 36050652 PMCID: PMC9434513 DOI: 10.1186/s12887-022-03572-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Antibiotic self-medication is a common practice in pediatric caregivers in low-income countries with limited resources and represents a public health problem. Our study sought to determine what factors are associated with this practice, including differences in knowledge or attitudes of caregivers who attend a pediatric emergency service. Methods Case-control study based on surveys of caregivers of pediatric patients brought to the emergency room with clinical symptoms suggestive of acute infection. Cases were defined as those caregivers who reported self-medication of antibiotics for the current illness and controls where those who did not report self-medication. Information was collected through a self-administered questionnaire that inquired about demographic and family characteristics, attitudes and knowledge toward self-medication of antibiotics. Data were compared using logistic regression and are presented with odd ratios and confidence intervals. Results A total of 728 caregivers, 182 cases and 546 controls were included. We found that higher parental education, both in mothers (OR 0.56, 95% CI 0.40-0.79) and fathers (OR 0.62, 95% CI 0.43-0.89) was associated with less self-medication. Attitudes such as always requesting antibiotics from their doctors (OR 3.92, 95% CI 1.59-9.66), frequently buying antibiotics without a prescription (OR 23.66, 95% CI 11.76-47.59) and giving advice on antibiotics among family members (OR 2.90, 95% CI 1.75-4.82) resulted in an increased likelihood of self-medication. There was also a higher probability of antibiotic self-medication in older children (OR 1.13, 95% CI 1.09-1.17), those with a greater number of siblings (OR 1.25, 95% CI 1.09-1.43) and in those cases that received antibiotics within the last 3 months (OR 6.27, 95% CI 4.35-9.04). Overall knowledge of risk of antibiotic self-medication was low. Conclusions Some patient and family characteristics such as age, number of siblings, recent antibiotic usage and inappropriate attitudes are strongly related to antibiotic self-medication. These findings will inform future interventions to reduce self-medication in children.
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Affiliation(s)
- Jhon Camacho Cruz
- Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia. .,Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Calle 10 No.18-75, Bogotá, Colombia.
| | | | | | | | - Pablo Vásquez Hoyos
- Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.,Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Calle 10 No.18-75, Bogotá, Colombia
| | - Diana Rojas Rojas
- Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.,Department of Pediatrics, Hospital Infantil Universitario de San José, Bogotá, Colombia
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Mallah N, Orsini N, Figueiras A, Takkouche B. Income level and antibiotic misuse: a systematic review and dose-response meta-analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1015-1035. [PMID: 34845563 PMCID: PMC9304051 DOI: 10.1007/s10198-021-01416-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/15/2021] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To quantify the association between income and antibiotic misuse including unprescribed use, storage of antibiotics and non-adherence. METHODS We identified pertinent studies through database search, and manual examination of reference lists of selected articles and review reports. We performed a dose-response meta-analysis of income, both continuous and categorical, in relation to antibiotic misuse. Summary odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated under a random-effects random effects model. RESULTS Fifty-seven studies from 22 countries of different economic class were included. Overall, the data are in agreement with a flat linear association between income standardized to socio-economic indicators and antibiotic misuse (OR per 1 unit increment = 1.00, p-value = 0.954, p-value non-linearity = 0.429). Data were compatible with no association between medium and high income with general antibiotic misuse (OR 1.04; 95% CI 0.89, 1.20 and OR 1.03; 95% CI 0.82, 1.29). Medium income was associated with 19% higher odds of antibiotic storage (OR 1.19; 95% CI 1.07, 1.32) and 18% higher odds of any aspect of antibiotic misuse in African studies (OR 1.18; 95% CI 1.00, 1.39). High income was associated with 51% lower odds of non-adherence to antibiotic treatment (OR 0.49; 95% CI 0.34, 0.60). High income was also associated with 11% higher odds of any antibiotic misuse in upper-middle wealth countries (OR 1.11; 95% CI 1.00, 1.22). CONCLUSIONS The association between income and antibiotic misuse varies by type of misuse and country wellness. Understanding the socioeconomic properties of antibiotic misuse should prove useful in developing related intervention programs and health policies.
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Affiliation(s)
- Narmeen Mallah
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Adolfo Figueiras
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Bahi Takkouche
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain.
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
- Department of Preventive Medicine, Faculty of Medicine, University of Santiago de Compostela, 15782, Santiago de Compostela, Spain.
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Aslam A, Zin CS, Jamshed S, Rahman NSA, Ahmed SI, Pallós P, Gajdács M. Self-Medication with Antibiotics: Prevalence, Practices and Related Factors among the Pakistani Public. Antibiotics (Basel) 2022; 11:antibiotics11060795. [PMID: 35740201 PMCID: PMC9219843 DOI: 10.3390/antibiotics11060795] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Self-medication with antibiotics (SMA) has become considerably common in developing countries, which is a critical factor for driving antibiotic resistance. Individuals involved in SMA generally do not have adequate knowledge regarding the appropriate use, indications and dosage of these drugs. The objective of the present study was to investigate population SMA practices, knowledge and sociodemographic factors associated with SMA in Islamabad, Pakistan. The study adopted a cross-sectional methodology and data collection was performed through an anonymous, structured and pilot-tested questionnaire, which was interview-administered. Inferential statistics and multivariate logistic regression were performed. Out of 480 participants, 55.6% (n = 267) were male with a mean age of 37.1 ± 10.1 years; the total prevalence of SMA was 32.5%. Ciprofloxacin (42.9%) was the most commonly used antibiotic to treat coughs or colds, a runny nose, flu or sore throat, diarrhea or fevers, which were relevant reasons for SMA. Findings from multivariate logistic regression showed that predictors of SMA were: male gender (95% CI: 0.383–1.005), age (95% CI: 0.317–0.953) and highest level of education (95% CI: 0.961–0.649). Despite reasonable access to healthcare facilities, people are still obtaining antibiotics without prescription, bypassing diagnostic and consultative healthcare services. Thus, the government must implement strict healthcare policies to restrict the sale of antibiotics without prescriptions, while at the same time, targeted public awareness campaigns about the proper use of antibiotics are also required.
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Affiliation(s)
- Adeel Aslam
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.A.R.)
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.A.R.)
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu 20400, Malaysia;
| | - Norny Syafinaz Ab Rahman
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.A.R.)
| | - Syed Imran Ahmed
- School of Pharmacy, College of Science, University of Lincoln, Lincoln LN6 7TS, UK;
| | - Péter Pallós
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, 6720 Szeged, Hungary;
| | - Márió Gajdács
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, 6720 Szeged, Hungary;
- Correspondence:
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Kabir H, Hasan MK, Tutul AH, Islam MS, Jamil S, Das BC, Islam MF, Jannat H, Ara R, Akter O, Biswas L, Miah ME, Mitra DK. Prevalence and Determinants of Antibiotic Self-Administration Among Adult Antibiotic Users: A Cross-Sectional Study. Patient Prefer Adherence 2022; 16:2409-2421. [PMID: 36072917 PMCID: PMC9444032 DOI: 10.2147/ppa.s372501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Humayun Kabir
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Correspondence: Humayun Kabir; Md Kamrul Hasan, Department of Public Health, North South University, Dhaka, 1229, Bangladesh, Tel +880 1785811449; +880 1684867565, Email ;
| | - Md Kamrul Hasan
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Department of Biochemistry and Molecular Biology, Tejgaon College, Dhaka, 1215, Bangladesh
| | | | | | - Safayet Jamil
- Department of Pharmacy, Khwaja Yunus Ali University, Sirajganj, 6751, Bangladesh
| | - Bikash Chandra Das
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Md Fakrul Islam
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Hasina Jannat
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Rawshan Ara
- Prime College of Nursing, Dhaka, 1229, Bangladesh
| | - Ojifa Akter
- School of Medical Sciences, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh
| | - Lila Biswas
- Department of Nursing, CRP Nursing College, Savar, 1343, Bangladesh
| | - Md Ebrahim Miah
- School of Medical Sciences, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh
- Institute of Social Welfare and Research, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
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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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Majid Aziz M, Haider F, Rasool MF, Hashmi FK, Bahsir S, Li P, Zhao M, Alshammary TM, Fang Y. Dispensing of Non-Prescribed Antibiotics from Community Pharmacies of Pakistan: A Cross-Sectional Survey of Pharmacy Staff's Opinion. Antibiotics (Basel) 2021; 10:482. [PMID: 33922058 PMCID: PMC8143445 DOI: 10.3390/antibiotics10050482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022] Open
Abstract
Community pharmacies are the main channel of antibiotics distribution. We aimed to analyze the dispensing of non-prescribed antibiotics and knowledge of pharmacy staff. We conducted a cross-sectional study in Punjab, Pakistan between December 2017 and March 2018. A self-administered, structured, pretested, and validated bilingual questionnaire was used, and we used chi-square tests in the statistical analysis. A total of 573 (91.7%) pharmacy retailers responded to the survey; 44.0% were aged 31-40 years and all were men. Approximately 81.5% of participants declared that dispensing non-prescribed antibiotics is a common practice in community pharmacies, and 51.1% considered themselves to be authorized to dispense these drugs; 69.3% believed this a contributing factor to antimicrobial resistance. Most (79.1%) respondents believed that this practice promotes irrational antibiotics use, and half (52.2%) considered antimicrobial resistance to be a public health issue. Only 34.5% of respondents reported recommending that patients consult with a doctor prior to using antibiotics, and 61.8% perceived that their dispensing practices reduce patients' economic burden. Approximately 44.9% of pharmacy retailers stated that they have proper knowledge about antibiotics use. Nitroimidazole was the main class of antibiotic dispensed without a prescription. Dispensing of injectable and broad-spectrum antibiotics can be potential threat for infection cure. Poor knowledge of staff is associated with dispensing of non-prescribed antibiotics. This inappropriate practice must be addressed immediately.
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Affiliation(s)
- Muhammad Majid Aziz
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.M.A.); (P.L.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Global Health Institute, Xi’an Jiaotong University, Xian, Xi’an 710049, China
- Shaanxi Center for Health Reform and Development Research, Xi’an 710061, China
| | - Fatima Haider
- Ghazi Medical College, Jampur Rd, Dera Ghazi Khan, Punjab 32200, Pakistan;
| | - Muhammad Fawad Rasool
- Departmentof Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University Multan, Punjab 60800, Pakistan;
| | | | - Sadia Bahsir
- Department of Pathology, Quaid e Azam Medical College, Punjab 63100, Pakistan;
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.M.A.); (P.L.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Global Health Institute, Xi’an Jiaotong University, Xian, Xi’an 710049, China
- Shaanxi Center for Health Reform and Development Research, Xi’an 710061, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.M.A.); (P.L.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Global Health Institute, Xi’an Jiaotong University, Xian, Xi’an 710049, China
- Shaanxi Center for Health Reform and Development Research, Xi’an 710061, China
| | | | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.M.A.); (P.L.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Global Health Institute, Xi’an Jiaotong University, Xian, Xi’an 710049, China
- Shaanxi Center for Health Reform and Development Research, Xi’an 710061, China
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Torres NF, Chibi B, Kuupiel D, Solomon VP, Mashamba-Thompson TP, Middleton LE. The use of non-prescribed antibiotics; prevalence estimates in low-and-middle-income countries. A systematic review and meta-analysis. ACTA ACUST UNITED AC 2021; 79:2. [PMID: 33390176 PMCID: PMC7780654 DOI: 10.1186/s13690-020-00517-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
Background The global increase in the utilization of non - prescribed antibiotics (NPA), is concerning, with high persistence within the low and middle-income countries (LMICs). With a negative impact on the health of individuals and communities the use of NPA paves the way to the propagation of superbugs that potentially predisposes to changes in bacterial resistance patterns, antibiotic resistance (AR) and antimicrobial resistance (AMR). This study aimed at estimating through a systematic review and meta-analysis, the prevalence of NPA utilisation and describe its primary sources in LMICs. Methods The study is a systematic review and meta-analysis which study protocol was registered in PROSPERO (CRD42017072954). The review used The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The studies searched in databases were deemed eligible if reported evidence of practices of self-medication with antibiotics (SMA) and the prevalence of NPA utilisation within adult participants from LMICs, published between 2007 to 2017. The pooled analyses were carried out using Meta XL statistical software. The pooled prevalence was calculated with a 95% confidence interval (CI). The risk of bias of the included studies was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results The review included a total of 11 cross-sectional studies, involving 5080 participants and conducted in LMICs from Asia (India, Laos, Nepal, Pakistan, Sri Lanka and Yemen), Latin America (Guatemala), Africa (Nigeria). All studies reported existing practices of SMA, with reported prevalence ranging from 50% to 93,8%. The pooled prevalence of SMA was 78% (95% CI: 65–89%). The main sources of NPA were; pharmacies, family and friends, old prescriptions, home cabinet and leftover antibiotics. Conclusion This study revealed a high prevalence of utilisation of NPA in the studied LMICs, these were found to be twice as high in women than men and those participants aged between 18 and 40 years old. The review suggests f considering broader qualitative and comprehensive contextuallized research to better understand the nuances of NPA use. These would be benefitial to uncover uncover gray areas, inform decisions, support the (re) design and implementation of multifaceted interventions towards antibiotic stewardship and conservancy in LMICs.
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Affiliation(s)
- Neusa F Torres
- Instituto Superior de Ciências de Saúde (ISCISA), Maputo, Mozambique. .,Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa.
| | - Buyisile Chibi
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
| | - Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
| | - Vernon P Solomon
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | | | - Lyn E Middleton
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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10
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Makowska M, Boguszewski R, Nowakowski M, Podkowińska M. Self-Medication-Related Behaviors and Poland's COVID-19 Lockdown. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228344. [PMID: 33187315 PMCID: PMC7696561 DOI: 10.3390/ijerph17228344] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 01/14/2023]
Abstract
(1) Background: The SARS-CoV-2 pandemic has changed the functioning of Polish health systems. Telemedicine has been developed and access to prescription drugs (Rx) has been facilitated. This study examined whether these changes and the imposition of a three-month lockdown caused Polish people to engage in more self-medication-related behaviors. (2) Method: After the fourth (final) stage of defrosting the Polish economy, an online survey of a quota sample of 1013 Polish respondents was conducted. (3) Results: Almost half of the respondents (45.6%) indicated that they had engaged in at least one behavior associated with inappropriate self-medication during the lockdown (e.g., 16.6% took medication as a precaution, and 16.8% took an Rx formulation without consultation). Some of these people had never engaged in such behaviors prior to the lockdown. Linear regression showed that higher values of a composite ("lockdown") index of self-medication-related behaviors occurring during lockdown were predicted by greater religiosity and the presence of children in a household. Also, independent samples t-tests showed that people who were afraid for their financial future and people who feared for their health obtained higher lockdown index scores than people not having such worries. (4) Conclusions: Self-medication-related behaviors were more common among Poles before lockdown than during the lockdown (which is unsurprising given that the lengths of the periods compared were hugely different), worryingly, many people exhibited such behaviors for the first time during the lockdown.
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Affiliation(s)
- Marta Makowska
- Institute of Sociological Sciences and Pedagogy, Warsaw University of Life Sciences, Nowoursynownska 166 St. 02-787 Warsaw, Poland; (M.M.); (M.P.)
| | - Rafał Boguszewski
- Institute of Sociological Sciences and Pedagogy, Warsaw University of Life Sciences, Nowoursynownska 166 St. 02-787 Warsaw, Poland; (M.M.); (M.P.)
- Correspondence:
| | - Michał Nowakowski
- Department of Social Health Problems, Maria Curie-Skłodowska University in Lublin, Plac Marii Curie-Skłodowskiej 5, 20-031 Lublin, Poland;
| | - Monika Podkowińska
- Institute of Sociological Sciences and Pedagogy, Warsaw University of Life Sciences, Nowoursynownska 166 St. 02-787 Warsaw, Poland; (M.M.); (M.P.)
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11
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Torres NF, Solomon VP, Middleton LE. Pharmacists' practices for non-prescribed antibiotic dispensing in Mozambique. Pharm Pract (Granada) 2020; 18:1965. [PMID: 32922571 PMCID: PMC7470239 DOI: 10.18549/pharmpract.2020.3.1965] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Antibiotics are the most frequently used medicines worldwide with most of the countries defining these as prescription-only medicines. Though, dispensing non-prescribed antibiotics represent one of the chief causal factors to the irrational use of antibiotics that paves the way to the development of antimicrobial resistance. Objective We aimed at describing the practices and the enablers for non-prescribed antibiotic dispensing in Maputo city, Mozambique. Methods A qualitative study was conducted, between October 2018 and March 2019, in nine private pharmacies randomly selected across Maputo city. Eighteen pharmacists were contacted and seventeen enrolled through snowball sampling. In-depth interviews were conducted, audiotaped, and transcribed verbatim. Transcripts were coded and analysed though thematic analysis with guidelines from Braun and Clark. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist by (Tong, 2007) was performed. Results Out of seventeen, fifteen pharmacists admitted non-prescribed dispensing of antibiotics. Common antibiotic dispensing practices included; dispensing without prescription, without asking for a brief clinical history of patients, without clear explanation of the appropriate way of administering, without advising on the side effects. Reasons for non-prescribed antibiotic dispensing are linked to patients' behaviour of demanding for non-prescribed antibiotics, to the patients expectations and beliefs on the healing power of antibiotics, to the physicians' prescribing practices. Other reasons included the pressure for profits from the pharmacy owners, the fragile law enforcement, and absence of accountability mechanisms. Conclusions The practices of non-prescribed antibiotic dispensing characterize the 'daily life' of the pharmacists. On the one hand, the patient's demand for antibiotics without valid prescriptions, and pharmacist's wish to assist based on their role in the pharmacy, the pressure for profits and on the understanding of the larger forces driving the practices of self-medication with antibiotics - rock. On the other hand, pharmacists are aware of the legal status of antibiotics and the public health consequences of their inappropriate dispensing practices and their professional and ethical responsibility for upholding the law - hard place. Highlighting the role of pharmacists and their skills as health promotion professionals is needed to optimizing antibiotic dispensing and better conservancy in Mozambique.
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Affiliation(s)
- Neusa F Torres
- Higher Institute for Health Sciences (ISCISA). Maputo (Mozambique).
| | - Vernon P Solomon
- MSc (Clin Psychol). Discipline of Pharmaceutical Sciences School of Health Sciences, University of KwaZulu Natal. Durban (South Africa).
| | - Lyn E Middleton
- Phd (Nurs & Educ). Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal. Durban (South Africa).
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12
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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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13
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Saleem Z, Hassali MA, Godman B, Fatima M, Ahmad Z, Sajid A, Rehman IU, Nadeem MU, Javaid Z, Malik M, Hussain A. Sale of WHO AWaRe groups antibiotics without a prescription in Pakistan: a simulated client study. J Pharm Policy Pract 2020; 13:26. [PMID: 32774870 PMCID: PMC7397594 DOI: 10.1186/s40545-020-00233-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Resistant strains of bacteria are rapidly emerging with increasing inappropriate use of antibiotics rendering them less efficacious. Self-purchasing of antibiotics particularly for viral infections is a key driver of inappropriate use, especially in lower- and middle-income countries. There is a particular issue in countries such as Pakistan. Consequently, there is a need to assess current rates of self-purchasing especially for reserve antibiotics to guide future policies. Aims Assess the extent of current antibiotic sales without a prescription in urban areas of Pakistan. Methodology A multicenter cross-sectional study was conducted in different areas of Punjab, Pakistan using Simulated Client technique. The investigators demanded different predefined antibiotics from WHO AWaRe groups without prescription. Three levels of demand were used to convince the pharmacy staff in order to dispense the antibiotic without a prescription. A data collection form was completed by simulated clients within 15 min of each visit. Results Overall 353 pharmacies and medical stores were visited out of which 96.9% pharmacies and medical stores dispensed antibiotics without demanding a prescription (82.7% at demand level 1 and 14.2% at demand level 2), with only 3.1% of pharmacies refusing to dispense antibiotics. The most frequently dispensed antibiotic was ciprofloxacin (22.1%). Surprisingly, even the reserve group antibiotics were also dispensed without a prescription. In only 25.2% visits, pharmacy staff guided patients about the use of antibiotics, and in only 11.0% pharmacists enquired about other medication history. Conclusion Currently, antibiotics are easily acquired without a legitimate prescription in Pakistan. There is a need for strict adherence to regulations combined with a multi-dimensional approach to enhance appropriate dispensing of antibiotics and limit any dispensing of WHO restricted antibiotics without a prescription.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia.,The University of Lahore, Lahore, Pakistan
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | - Brian Godman
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia.,Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Munazzah Fatima
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Zeenia Ahmad
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Areeba Sajid
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Inaam Ur Rehman
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | - Zaida Javaid
- Punjab Institute of Cardiology, Lahore, Pakistan
| | - Madeeha Malik
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
| | - Azhar Hussain
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
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14
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Aslam A, Gajdács M, Zin CS, Binti Abd Rahman NS, Ahmed SI, Jamshed SQ. Public Awareness and Practices towards Self-Medication with Antibiotics among the Malaysian Population. A Development of Questionnaire and Pilot-Testing. Antibiotics (Basel) 2020; 9:antibiotics9020097. [PMID: 32102325 PMCID: PMC7168161 DOI: 10.3390/antibiotics9020097] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/01/2020] [Accepted: 02/07/2020] [Indexed: 12/13/2022] Open
Abstract
It is well documented that injudicious antibiotic use and practicing self-medication with antibiotics (SMA) can lead to antibiotic resistance. The objective was to validate and develop an instrument in Bahasa Melayu to assess the awareness and practices towards SMA in the Malaysian population. A pilot study was conducted among 100 Malaysians participants. Reliability testing in terms of test-retest, internal consistency, and content validity was performed. One-way ANOVA and t-test were applied to determine significant differences between groups. A panel of nine experts evaluated the research instrument for content validity and it was found to have strong content item validity (Indices = 1). Each domain (level of knowledge and understanding about antibiotic use and antibiotic resistance: Practice towards self-medication) showed good internal consistency of Cronbach’s alpha 0.658 and 0.90. While test-retest reliability value for each domain was 0.773 (p = 0.009), and 0.891 (p = 0.001. The mean ± standard deviation (SD) for level of knowledge about antibiotic use and antibiotic resistance was 21.8 ± 7.02 and for practice scores (SMA) 6.03 ± 2.30. The instrument established sound reliability and validity and, therefore, can be an effective tool for assessing public awareness, and practices toward self-medication with antibiotics in the Malaysian population.
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Affiliation(s)
- Adeel Aslam
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.B.A.R.)
| | - Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Hungary;
- Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, 1089 Budapest, Hungary
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.B.A.R.)
| | - Norny Syafinaz Binti Abd Rahman
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.B.A.R.)
| | - Syed Imran Ahmed
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia;
| | - Shazia Qasim Jamshed
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.B.A.R.)
- Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kauantan, Pahang 25200, Malaysia
- Correspondence:
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15
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Paredes JL, Navarro R, Riveros M, Picon V, Conde F, Suito-Ferrand M, Ochoa TJ. Parental Antibiotic Use in Urban and Peri-Urban Health Care Centers in Lima: A Cross-Sectional Study of Knowledge, Attitudes, and Practices. Clin Med Insights Pediatr 2019; 13:1179556519869338. [PMID: 31488956 PMCID: PMC6710707 DOI: 10.1177/1179556519869338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/15/2019] [Indexed: 12/12/2022] Open
Abstract
In pediatric patients, the antibiotic use is affected by parental beliefs and practices; especially in countries where it is possible to acquire them without prescription. This study aims to describe the knowledge, attitudes, and practices on antibiotic use among parents of children from urban and peri-urban health care centers in Lima. A cross-sectional study was performed at 1 urban and 2 peri-urban health care centers selected in Lima, Perú. Parents of children below the age of 3 years answered a knowledge-attitudes-practices-validated questionnaire about antibiotic use and were categorized as high, moderate, and low knowledge regarding antibiotics. We analyzed potential determinants for low knowledge and having medicated their children with unprescribed antibiotics using bivariate and multivariate analyses. A total of 224 parents were enrolled, and 8% were categorized as low knowledge. Half of the parents could not recognize that antibiotics cannot cure viral infections, 59.4% disagreed with "antibiotics speed up recovery from a cold," and 53.2% stored antibiotics at home. Remarkably 23.5% of parents reported having medicated their children with antibiotics without prescription, which was associated with belonging to the peri-urban health care center, use of antibiotics by their children in the last 12 months, and having purchased antibiotics without physicians' prescription. An alarming overuse of antibiotics without prescription was described among children below the age of 3 years. Educational interventions, addressing parental attitudes and practices, and health policies should be developed to limit inappropriate antibiotic use especially in peri-urban communities.
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Affiliation(s)
- Jose L Paredes
- Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Rafaella Navarro
- Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Maribel Riveros
- Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Veronica Picon
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Francisco Conde
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Theresa J Ochoa
- Laboratorio de Enfermedades Entéricas, Nutrición y Resistencia Antimicrobiana, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
- School of Public Health, University of Texas, Houston, TX, USA
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Saleem Z, Hassali MA, Hashmi FK, Godman B, Saleem F. Antimicrobial dispensing practices and determinants of antimicrobial resistance: a qualitative study among community pharmacists in Pakistan. Fam Med Community Health 2019; 7:e000138. [PMID: 32148717 PMCID: PMC6910752 DOI: 10.1136/fmch-2019-000138] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/19/2022] Open
Abstract
Background There are concerns with the extent of dispensing of antibiotics among community pharmacists in Pakistan often without a prescription adding to antimicrobial resistance (AMR) rates. Objective To explore the determinants of AMR and the pattern of antimicrobial dispensing among community pharmacists. Design In this qualitative study design, a semistructured interview guide was developed based on an in-depth review of published papers. Audio-recorded interviews with transcripts were analysed by thematic content analysis. Setting Interviews were conducted among community pharmacists in Lahore, Pakistan. Participants In order to obtain individual points of view, in-depth face-to-face interviews with purposively selected pharmacists were conducted. Results A total of 12 pharmacists were interviewed for the study. After analysis, four major themes emerged: (1) knowledge and perception of community pharmacists about antimicrobials, (2) antimicrobial dispensing practices of community pharmacists, (3) determinants of AMR, (4) potential interventions to control AMR. Most of the pharmacists have limited knowledge about AMR, antimicrobial stewardship programmes and related guidelines. However, all the pharmacists strongly agreed that different appropriate actions should be taken in order to rationalise future antimicrobial use. Conclusion The results indicated that irrational antimicrobial dispensing and use is common among community pharmacists in Pakistan owing to lack of knowledge. The community pharmacists perceived that behaviour of patients and the societal environment contributed to irrational antimicrobial use and subsequent development of AMR. They suggested a need for a multidisciplinary framework in order to improve future antimicrobial use and reduce AMR in Pakistan.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | | | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
| | - Fahad Saleem
- Faculty of Pharmacy and Health sciences, University of Balochistan, Quetta, Pakistan
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Ha TV, Nguyen AMT, Nguyen HST. Self-medication practices among Vietnamese residents in highland provinces. J Multidiscip Healthc 2019; 12:493-502. [PMID: 31456640 PMCID: PMC6620316 DOI: 10.2147/jmdh.s211420] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Monitoring self-medication practice, which refers to individuals using medicine without instructions of physicians, is critical to control its harmful effects. However, in Vietnam, evidence about self-medication among individuals in highland areas is constrained. This study examined self-medication practice among residents living in highland areas in Vietnam and determined associated factors. Materials and methods: A cross-sectional study was performed in five highland provinces with 1000 individuals. Information about individual and household's socioeconomic status and self-medication practice in the last 12 months was surveyed. Multivariate logistic and Poisson regressions were used to identify associated factors with self-medication. Results: 83.3% reported self-medication in the last 12 months, with the mean times of self-medication being 4.5 times (SD=4.1). Female (OR=0.62, p<0.01), ethnic minorities, higher number of members having health insurance in family (OR=0.82, p<0.01) and higher annual household income (OR=0.78, p<0.05) were associated with the lower likelihood of "Only buy medicines at pharmacy stores when having illness in the last 12 month". Moreover, people who were females (OR=0.59, p<0.05), white-collar worker (OR=0.25, p<0.01) and had higher number of children in the family (OR=0.68, p<0.05) were less likely to practice self-medication. People who were ethnic minorities, white-collar worker (Coef.=-0.32, p<0.01) and higher number of members having health insurance in family had lower times of self-medication in the last 12 months compared to other groups. Meanwhile, individuals having higher number of members in the family (Coef.=0.07, p<0.01) and higher annual household income (Coef.=0.08, p<0.01) had highertimes of self-medication in the last 12 months. Conclusion: Residents in highland areas in Vietnam had a considerably high 12-month prevalence of self-medication. Medical products quality management and self-medication guideline are potential to maximize the effects of self-medication. Moreover, promoting the use of health insurance should also be concerned as a solution to address this issue.
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Affiliation(s)
- Thuy Van Ha
- Department of Health Insurance, Ministry of Health of Vietnam, Hanoi 100000, Vietnam
| | - An Mai Thi Nguyen
- Department of Planning and Financing, Ministry of Health of Vietnam, Hanoi 100000, Vietnam
| | - Ha Song Thi Nguyen
- Department of Pharmacoeconomics and Management, Hanoi University of Pharmacy, Hanoi 100000, Vietnam
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Ateshim Y, Bereket B, Major F, Emun Y, Woldai B, Pasha I, Habte E, Russom M. Prevalence of self-medication with antibiotics and associated factors in the community of Asmara, Eritrea: a descriptive cross sectional survey. BMC Public Health 2019; 19:726. [PMID: 31182071 PMCID: PMC6558833 DOI: 10.1186/s12889-019-7020-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Development of drug resistance caused by self-medication with antibiotics, can be seen as one of the growing global threats. Self-medication is defined as the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms. The purpose of this study is to assess the practice of self-medication with antibiotics and associated factors among the community of Asmara, Eritrea. METHODS This was a community based descriptive cross-sectional study conducted in 16 selected sub-districts of Asmara from September to November 2017. A Two-stage cluster sampling was employed to select study sites and participants. Data was collected in a face to face interview with a structured questionnaire and entered to CSPro version 6.2. Descriptive statistics, cross-tabulation and logistic regression were executed using SPSS version 22. RESULTS A total of 580 study participants were recruited with a response rate of 99.5% (N = 577). The prevalence of Self-medication with antibiotics (SMA) in this study was found to be 45.1% [95% CI (40.5, 49.6)] and majority of them practiced once or twice in a period of 12 months. The main reasons for SMA were previous successful experience (34.4%) and the illness being 'not serious enough to seek medical care' (25.7%). Of those who self-medicated, 84.1% of used amoxicillin at least once. Wound infection (17.9%) and sore throat (13.9%) were the most self-recognized complaints that required self-medication. Antibiotics were supplied and recommended mostly by the community drug outlets. Only Sex (p = 0.046), knowledge (p = 0.019) and attitude (p < 0.001) of the participants were found significantly associated with the practice of SMA in the multivariate logistic regression. CONCLUSIONS Though majority of the respondents considered self-medication with antibiotics as inappropriate practice, about half of them were practicing it anyway. Therefore immediate attention from relevant bodies is required.
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Affiliation(s)
- Yonatan Ateshim
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Batseba Bereket
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Feruz Major
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Youel Emun
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Biruck Woldai
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Ismail Pasha
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Eyasu Habte
- Biostatistics and Epidemiology Unit, School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
| | - Mulugeta Russom
- Eritrean Pharmacovigilance Centre, National Medicine and Food Administration, Ministry of Health, Asmara, Eritrea
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Haque M, Rahman NAA, McKimm J, Kibria GM, Azim Majumder MA, Haque SZ, Islam MZ, Binti Abdullah SL, Daher AM, Zulkifli Z, Rahman S, Kabir R, Lutfi SNNB, Aishah Binti Othman NS. Self-medication of antibiotics: investigating practice among university students at the Malaysian National Defence University. Infect Drug Resist 2019; 12:1333-1351. [PMID: 31190922 PMCID: PMC6529675 DOI: 10.2147/idr.s203364] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Self-medication of drugs to alleviate symptoms is a common global behavior, helping relieve burdens on health services, but many drugs eg, antibiotics are prescription-only. Self-medication of antibiotics (SMA) is an irrational use of drugs, contributing to microbial resistance increasing health care costs and higher mortality and morbidity. This study aimed to assess SMA among university students. Methods: This was a cross-sectional study conducted among medical and non-medical students of the National Defence University of Malaysia. A validated instrument was used to gather data. Ethics approval was obtained. Random and universal sampling was adopted, and SPSS 21 was used for data analysis. Results: A total of 649 students participated in the study: 48.5% male and 51.5% female, 39.3% reported self-medicating with antibiotics. Penicillin, doxycycline, clarithromycin were the antibiotics most used with the majority reporting no adverse drug reactions. Cost savings and convenience were the principal reasons for SMA which were mainly obtained from local retail pharmacies. Despite medical students (particularly the more senior) having better knowledge of antibiotic use than non-medical students, 89% of all research participants responded that practicing SMA was a good/acceptable practice. Conclusion: SMA is common amongst Malaysian students and, despite understanding why SMA is unwise, even medical students self-medicate.
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Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, 25200, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Swansea, Wales, SA2 8PP, UK
| | - Golam Mohammad Kibria
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
| | - Md Anwarul Azim Majumder
- Department of Medical Education, Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados, West Indies
| | - Seraj Zohurul Haque
- Department of Orthopedic Surgery, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Scotland, UK
| | - Md Zakirul Islam
- Department of Pharmacology, Eastern Medical College, Burichang3520, Bangladesh
| | - Shahidah Leong Binti Abdullah
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
| | - Aqil Mohammad Daher
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
| | - Zainal Zulkifli
- Department of Surgery, Sultan Haji Ahmad Shah Hospital, Temerloh, Pahang, 28000, Malaysia
| | - Sayeeda Rahman
- Department of Pharmacology and Public Health, School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Siti Nur Najihah Binti Lutfi
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
| | - Nur Syamirah Aishah Binti Othman
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
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