Prior knowledge, older age, and higher allowance are risk factors for self-medication with antibiotics among university students in southern China

Mapping socioeconomic factors driving antimicrobial resistance in humans: An umbrella review

Introduction

Antimicrobial resistance (AMR) is one of the biggest public health challenges of our time. National Action Plans have failed so far to effectively address socioeconomic drivers of AMR, including the animal and environmental health dimensions of One Health.

Objective

To map what socioeconomic drivers of AMR exist in the literature with quantitative evidence.

Methods

An umbrella review was undertaken across Medline, Embase, Global Health, and Cochrane Database of Systematic Reviews, supplemented by a grey literature search on Google Scholar. Review articles demonstrating a methodological search strategy for socioeconomic drivers of AMR were included. Two authors extracted drivers from each review article which were supported by quantitative evidence. Drivers were grouped thematically and summarised narratively across the following three layers of society: People & Public, System & Environment, and Institutions & Policies.

Results

The search yielded 6300 articles after deduplication, with 23 review articles included. 27 individual thematic groups of drivers were identified. The People & Public dimensions contained the following themes: age, sex, ethnicity, migrant status, marginalisation, sexual behaviours, socioeconomic status, educational attainment, household composition, maternity, personal hygiene, lifestyle behaviours. System & Environment yielded the following themes: household transmission, healthcare occupation, urbanicity, day-care attendance, environmental hygiene, regional poverty, tourism, animal husbandry, food supply chain, water contamination, and climate. Institutions & Policies encompassed poor antibiotic quality, healthcare financing, healthcare governance, and national income. Many of these contained bidirectional quantitative evidence, hinting at conflicting pathways by which socioeconomic factors drive AMR.

Conclusion

This umbrella review maps socioeconomic drivers of AMR with quantitative evidence, providing a macroscopic view of the complex pathways driving AMR. This will help direct future research and action on socioeconomic drivers of AMR.

Global trends in inappropriate use of antibiotics, 2000-2021: scoping review and prevalence estimates

Introduction

Inappropriate antibiotic use is a major driver of antimicrobial resistance. However, the scope of literature and its prevalence across world regions remain largely unknown, as do the most common indicators and study designs used. In this study, we summarised the current literature on inappropriate use of antibiotics by world regions. We also provided the first global estimates of the overall amount of antibiotics that are potentially used inappropriately each year.

Methods

We considered both patient and provider-mediated inappropriate antibiotic use. We reviewed 412 studies published between 2000 and 2021 and used beta regression and marginal contrasts to compare prevalence of inappropriate use by study design, indicator, world region, and national income level. Country-level sales of antibiotics from 2022 were combined with inappropriate antibiotic use estimates derived from two study designs (clinical audits and patient interviews) and one indicator (lack of indication) to estimate the amount of antibiotics inappropriately used globally.

Results

Clinical audits (50.1%, 208/412) and 'non-prescription' use (37.1%, 153/412) were the most common study design and indicator, respectively, used to estimate inappropriate antibiotic use. Inappropriate antibiotic use prevalence was ~6% higher in low-income and middle-income than in high-income countries. However, this difference disappeared after accounting for a proxy of access to care: physicians per capita. Globally, based on clinical audits, patient interviews and lack of indication, the estimated proportion of inappropriate antibiotic use was 29.5%, 36.5% and 30.8%, respectively, with an average of ~30% (~13 000 000 kg) the equivalent of the annual antibiotic consumption in China.

Conclusions

Inappropriate antibiotic use is highly prevalent across all countries regardless of national income level, with a third of global antibiotic consumption potentially due to unnecessary prescription ('lack of indication'). Antibiotic stewardship efforts and defining internationally standardised indicators are needed to track progress in reducing the occurrence of inappropriate antibiotic use where necessary, as well as identifying gaps in access to care.

Prevalence and associated factors influencing the use of antibiotics for self-medication among Chinese residents: a cross-sectional study in 2021

BACKGROUND

Self-medication with antibiotics (SMA) is increasingly occurring worldwide, yet it is a process that can lead to inappropriate use of antibiotics, with potentially multiple adverse consequences such as an increased risk of antibiotic resistance.

OBJECTIVE

The objective of this study is to assess the prevalence of self-medication with antibiotics among the Chinese population and investigate the factors associated with this behavior.

METHODS

A multi-stage sampling method was employed to carry out a national cross-sectional questionnaire survey among Chinese individuals aged 18 years and above from July 10, 2021, to September 15, 2021. Following the statistical analysis of the collected data, binary logistic regression was applied to identify the factors associated with respondents' self-medication with antibiotics. Model robustness testing was also performed using best subset regression.

RESULTS

From a total of 11,031 questionnaires, 9,344 qualified samples were selected. The prevalence of self-medication with antibiotics among Chinese residents was found to be 34.63% (3,237/9,344). The most important factor considered in SMA was the advice of medical professionals, accounting for 89.00%, including recommendations from doctors (2,524/3,237, 77.97%) and pharmacists (1,905/3,237, 58.85%). The results of the binary stepwise logistic regression analysis showed that female, people older than 36 years, with higher education, had consumed alcohol in the past month, with mild depression, having residential or employee health insurance as the primary form of health coverage, having commercial insurance, having better family health status, and perceiving higher levels of social support were more likely to practice SMA (P < 0.05). Conversely, individuals diagnosed with major depressive disorder were found to be less likely to engage in self-medication with antibiotics (P < 0.05). The best subset regression method and stepwise regression method gave the same results.

CONCLUSION

The SMA issue of Chinese residents is still relatively serious. Residents' SMA was associated with their demographic and sociological characteristics, depression, family health, and perceived level of social support. The primary consideration for resident SMA is the advice of medical staff. The problem of SMA in China should be improved through antibiotic management, education on antibiotic knowledge, and medical staff's correct guidance.

Prevalence and predictors of self-medication practices among adult household members in Hosanna town, Hadiya zone, central Ethiopia

BACKGROUND

Self-medication is a global health concern with serious public health implications. Excessive and inappropriate self-medication practice can lead to recurrent infections and increased antibiotic resistance, which is a major problem impacting morbidity and mortality worldwide. Despite the significance of this issue, no single study has been conducted on self-medication practices in the study area, to the best of the researchers' knowledge.

OBJECTIVE

To assess prevalence and predictors of self-medication practices among adult household members in hosanna town hadiya zone, central Ethiopia 2024.

METHODS

A community-based cross-sectional study was conducted from March 1-30, 2024, among 566 randomly selected households in Central Ethiopia. Households were chosen using a simple random sampling technique. Both bivariable and multivariable binary logistic regressions were used to assess the explanatory variables associated with self-medication practices. Adjusted odds ratios (AOR) with a p-value < 0.05 at a 95% confidence interval were considered statistically significant.

RESULTS

Out of the 566 study participants, 546 respondents were interviewed, yielding a response rate of 96.46%. Among the study participants, 338 (61.9%) with a 95% CI of (57.8-65.9) practiced self-medication in the past two months. Age of respondents ≥ 48 years (AOR = 2.76, 95% CI: (1.27, 5.99)), being married (AOR = 3.24, 95% CI: (2.0-5.26)), having a family size ≥ four members (AOR = 1.69, 95% CI: (1.00-2.87)), and not being a member of a health insurance scheme (AOR = 3.13, 95% CI: (1.95-5.04)) were significantly associated with self-medication practices.

CONCLUSION AND RECOMMENDATIONS

The prevalence of self-medication practice in the study area was relatively high. Self-medication practices were associated with the age of respondents, marital status, family size, and health insurance membership. Public health education and awareness campaigns should be strengthened to emphasize safe and responsible self-medication practices, particularly among older adults and those living in larger families.

Knowledge, attitude, and practices of pharmacy students in 7 Middle Eastern countries concerning antibiotic resistance: A cross-sectional study

Addressing antimicrobial resistance (AMR) stands as a major global health challenge threatening humanity. Resolving this issue can be initiated through emphasizing the significance of AMR education among students in health colleges during their undergraduate studies. Hence, the aim of this study is to assess the pharmacy students' knowledge, attitudes, and practices regarding antibiotic resistance in 7 Middle Eastern countries. A cross-sectional study was conducted among undergraduate pharmacy students at universities in Egypt, Jordan, Saudi Arabia, Lebanon, the United Arab Emirates, Qatar, and Kuwait between March 2021 and January 2022. The first section of the questionnaire gathered demographic information. The knowledge section comprised 7 questions. Subsequently, the questionnaire explored participants' attitudes (6 items) and practices (2 items) concerning antibiotic resistance. Mann-Whitney and Kruskal-Wallis tests were used to compare the median knowledge score between different demographic groups. Logistic regression was used to estimate odds ratios, with 95% confidence intervals (CIs) for being more knowledgeable about antibiotic resistance. A 2-sided P < .05 was considered statistically significant. A total of 4265 pharmacy students were involved in this study (Egypt (2249), Jordan (n = 704), Saudi Arabia (n = 531), Lebanon (n = 401), United Araba Emirates (n = 130), Qatar (n = 129), and Kuwait (n = 121)). The median knowledge score for the participating pharmacy students was 5.00 (IQR = 4.00-6.00) out of 7, equals to 71.4% with 4th, and 5th year students and bachelor of pharmacy program students have higher odds of being more knowledgeable about antibiotics resistance compared to other students (P < .05). The majority of the students agreed that antibiotic resistance is increasing, they should be more concerned regarding antibiotic consumption and that government should create more awareness of antibiotic resistance, and that they should have enough knowledge to prevent antibiotic resistance. Around 3 quarters of the students (73.0%) confirmed that they take antibiotic only after getting prescription from their physician and almost half (51.7%) reported that they take antibiotic to manage their fever. The study concluded good educational programs in Middle East pharmacy schools with the need for targeted educational interventions promoting responsible antibiotic stewardship practices among future pharmacists.

Key modifiable risk factors for self-medication among university students: An observational study

Background

Self-medication among university students is becoming a health concern, especially during examinations and stress. This pattern of medication use among students could lead to adverse health consequences if it is not addressed and tackled. Thus, this study investigated the most associated factors with this practice among students.

Methods

An observational cross-sectional study was conducted among university students in Northern Borders Province, Saudi Arabia. A total of 220 students were selected and took part in the survey. Data was collected through a self-administered questionnaire. The survey was distributed among participants to answer five sections: demographic and socioeconomic characteristics, health status problems, satisfaction with academic performance, and self-medication questions. The content validity was tested using a pilot sample of 30 students. The descriptive, univariate, and multivariate analyses were conducted using the Statistical Package for Social Science program.

Results

In the present sample of university students, the response rate was 100%. Approximately one-third reported using medications without prescriptions, and 83% of them have used medications three times at most during the past 12 months. Headache was the most common reason for use (59%), followed by fever (20%). Adjusted multivariate analysis showed that students who were 21-24 years of age (OR = 3.79, 95% CI = 1.21-11.82), female (OR = 2.43, 95% CI = 1.03-5.72), and living alone in private housing (OR = 3.62, 95% CI = 1.32-9.90) were at high risk of self-medication as compared to their counterparts. However, students in the last years of college (fourth (OR = 0.14, 95% CI = 0.03-0.62), fifth (OR = 0.21, 95% CI = 0.05-0.95), sixth (OR = 0.05, 95% CI = 0.01-0.35)) were at lower risk as compared to their counterparts.

Conclusion

The study found that self-medication was common among university students, with higher rates among those who were 21-24 years old, female, and living alone in private housing, but lower rates among students in the later years of college. Educational programs and awareness campaigns should target students who are at higher risk of practicing self-medication to avoid misuse of over-the-counter medications.

Prevalence and determinants of antibiotics self-medication among indigenous people of Bangladesh: a cross-sectional study

OBJECTIVES

Self-medication with antibiotics (SMA) contributes significantly to the emergence of antimicrobial resistance (AMR), especially in low-income countries including Bangladesh. This study aimed to generate evidence on the self-reported prevalence of antibiotic self-medication and its determinants among indigenous people residing in Bangladesh's Chittagong Hill Tracts (CHT) districts.

DESIGN

This study used a cross-sectional design with data collected through a survey using a semi-structured questionnaire.

SETTING

This study was conducted from late January to early July 2021; among different indigenous group populations aged 18 years or more olders residing in the three districts of CHT.

PARTICIPANTS

A total of 1336 indigenous people residing in Bangladesh's CHT districts were included.

PRIMARY OUTCOME AND EXPLANATORY VARIABLES

The primary outcome measure was SMA while explanatory variables were socio-demographic characteristics, health status of participants, and knowledge of antibiotics usage and its side effects.

RESULTS

Among the study participants, more males (60.54%) than females (51.57%) reported using antibiotics. The SMA rate was high among individuals with education levels below secondary (over 50%) and those in the low-income group (55.19%). The most common diseases reported were cough, cold and fever, with azithromycin being the most frequently used antibiotic. Levels of education, family income, having a chronic illness and place of residence were found to be the significant predictors of having good knowledge of antibiotic use as found in the ordered logit model. Findings from a logistic regression model revealed that men had 1.6 times higher odds (adjusted OR (AOR) 1.57; 95% CI 1.12 to 2.19) of SMA than women. Participants with ≥US$893 per month family income had lowest odds (AOR 0.14; 95% CI 0.03 to 0.64) of SMA than those who earned

CONCLUSION

Male gender, family income, place of residence and knowledge of antibiotics were the significant predictors of antibiotic self-medication. Hence, it is important to streamline awareness-raising campaigns at the community level to mitigate the practice of SMA in indigenous people and ultimately address the devastating effects of Antimicrobial resistance (AMR) in Bangladesh.

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Key Words

• EPIDEMIOLOGIC STUDIES
• EPIDEMIOLOGY
• PUBLIC HEALTH

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MESH Headings

• Humans
• Female
• Male
• Anti-Bacterial Agents/therapeutic use
• Cross-Sectional Studies
• Bangladesh
• Prevalence
• Indigenous Peoples

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Affiliation(s)

Adnan Mannan Department of Genetic Engineering & Biotechnology, University of Chittagong, Chattogram, Bangladesh Disease Biology and Molecular Epidemiology Research Group (dBme), Chattogram, Bangladesh
Kallyan Chakma Department of Genetic Engineering & Biotechnology, University of Chittagong, Chattogram, Bangladesh Disease Biology and Molecular Epidemiology Research Group (dBme), Chattogram, Bangladesh
Gourab Dewan Department of Medicine, Rangamati Medical College, Rangamati, Bangladesh
Ayan Saha Department of Bioinformatics & Biotechnology, Asian University for Women, Chattogram, Bangladesh
Naim Uddin Hasan A Chy Department of Economics, University of Chittagong, Chattogram, Bangladesh
H M Hamidullah Mehedi Department of Medicine, 250 Bedded General Hospital, Chattogram, Bangladesh
Amzad Hossain Department of Genetic Engineering & Biotechnology, Jagannath University, Dhaka, Bangladesh
Jannatun Wnaiza Department of Biochemistry & Biotechnology, University of Science and Technology Chittagong, Chattogram, Bangladesh
Md Tanveer Ahsan Department of Pharmacy, University of Chittagong, Chattogram, Bangladesh
Md Mashud Rana Disease Biology and Molecular Epidemiology Research Group (dBme), Chattogram, Bangladesh Department of Pharmacology and Therapeutics, Chittagong Medical College, Chattogram, Bangladesh
Nazmul Alam Department of Public Health, Asian University for Women, Chattogram, Bangladesh

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Comparison of knowledge, attitude, practice and predictors of self-medication with antibiotics among medical and non-medical students in Tanzania

Introduction: Self-medication with antibiotics (SMA) is a widespread problem in developing nations, including Tanzania. Methods: This study compared knowledge, attitudes, practices, and factors influencing antibiotic SMA among medical and non-medical students. Results: The prevalence of SMA among medical students was 49.1% and 59.2% among non-medical students, respectively. The mean knowledge score of medical students (6.4) was significantly higher (p-value <0.001) than that of non-medical students (5.6). The main factors influencing SMA practices were the availability of antibiotics without a prescription, easy access to pharmacies, and a lack of knowledge about the risks of SMA. This experience was pivotal in influencing medical students to take antibiotics, with a substantial proportion of 67.5% as opposed to 59.4% of non-medical students. Medical students were 1.6 times more likely to self-medicate with antibiotics than non-medical students (Adjusted Odds Ratio (AOR): 1.6; 95% Confidence Interval (CI): 1.2-2.3, p-value = 0.004). Age was also associated with self-medication, with an AOR of 1.1 (95% CI: 1.04-1.2, p-value = 0.006) per year increase in age. Additionally, attitude was associated with self-medication, with an AOR of 1.05 (95% CI: 1.04-1.1, p-value = 0.001) per unit increase in attitude score. Discussion: No significant associations were found between sex, marital status, having children, year of study, knowledge score, and self-medication with antibiotics. This study emphasizes the importance of educational interventions and public awareness campaigns to promote antimicrobial stewardship, appropriate antibiotic use, and preventing pharmacies from dispensing antibiotics without a prescription.

Self-Medication with Antibiotics Among Children in China: A Cross-Sectional Study of Parents' Knowledge, Attitudes, and Practices

Background

Self-medication with antibiotics (SMA) among children is a common practice in low-income and middle-income countries, which has accelerated antibacterial abuse.

Objective

This study aimed to estimate the prevalence and associated factors of SMA among children in China, including parents' knowledge, attitudes, and practices towards antibiotic use.

Methods

A cross-sectional study based on a structured questionnaire survey of parents was conducted in Nantong between July and September 2020. A total of 1699 respondents participated. Information on participants' demographic and family characteristics, knowledge, attitudes, and practices towards antibiotics use was collected. Hierarchical binary logistic regression was used to examine the predictors of SMA among children.

Results

Among 1699 participants, 23.31% practiced SMA to their children in the past year. Cough (59.6%) was the most common symptom leading to self-medication and penicillins (85.4%) were the most commonly used drugs. Hierarchical regression indicated that parents with higher level of antibiotic knowledge scores (OR=1.163, 95% CI: 1.067-1.268) and buying antibiotics without a prescription from pharmacy (OR=1.475, 95% CI: 1.097-1.983) were more likely to practice SMA to their children both in urban and in rural areas. Storing antibiotics at home resulted in an increased likelihood of self-medication in urban areas but not in rural areas. In addition, there was also a higher probability of non-prescribed antibiotics in children without chronic diseases (OR=1.959, 95% CI:1.072-3.578).

Conclusion

The prevalence of SMA in children is high in China. Higher knowledge scores and practices of buying and storing non-prescribed antibiotics behaviors increased parents' antibiotic self-medication in their children. Practical and effective education intervention for children's rational use of antibiotics is urgently strengthened.

Antifungal resistance and stewardship: a knowledge, attitudes and practices survey among pharmacy students at the University of Zambia; findings and implications

Introduction

Antifungal resistance (AFR) is a growing global public health concern. Little is currently known about knowledge, attitudes and practices regarding AFR and antifungal stewardship (AFS) in Zambia, and across the globe. To address this evidence gap, we conducted a study through a questionnaire design starting with pharmacy students as they include the next generation of healthcare professionals.

Methods

A cross-sectional study among 412 pharmacy students from June 2023 to July 2023 using a structured questionnaire. Multivariable analysis was used to determine key factors of influence.

Results

Of the 412 participants, 55.8% were female, with 81.6% aged between 18 and 25 years. Most students had good knowledge (85.9%) and positive attitudes (86.7%) but sub-optimal practices (65.8%) towards AFR and AFS. Overall, 30.2% of students accessed antifungals without a prescription. Male students were less likely to report a good knowledge of AFR (adjusted OR, AOR = 0.55, 95% CI: 0.31-0.98). Similarly, students residing in urban areas were less likely to report a positive attitude (AOR = 0.35, 95% CI: 0.13-0.91). Fourth-year students were also less likely to report good practices compared with second-year students (AOR = 0.48, 95% CI: 0.27-0.85).

Conclusions

Good knowledge and positive attitudes must translate into good practices toward AFR and AFS going forward. Consequently, there is a need to provide educational interventions where students have low scores regarding AFR and AFS. In addition, there is a need to implement strategies to reduce inappropriate dispensing of antifungals, especially without a prescription, to reduce AFR in Zambia.

Influences on treatment-seeking and antibiotic use for common illnesses in eastern China

BACKGROUND

Antibiotic resistance rates remain high in China where antibiotics are widely used for common illnesses. This study aimed to investigate the influences on people's decisions on treatment and antibiotic use for common illnesses in eastern China.

METHODS

Semi-structured interviews were conducted with 29 patients recruited through convenience sampling between July 2020 and January 2021 in one hospital in County A in Zhejiang Province, and one hospital and one village clinic in County B in Jiangsu Province, respectively. All interviews were audio-recorded, transcribed verbatim and thematically analysed. This study is nested in a larger interdisciplinary mixed method project and we also compared our qualitative findings with quantitative results from a household survey conducted as part of this wider project.

RESULTS

Participants' decisions about treatment-seeking and antibiotic use for common illnesses were found to be influenced by four interactive domains. (i) Self-evaluation of illness severity: Participants tend to self-treat minor conditions with ordinary medicines first and do not resort to antibiotics unless the condition worsens or is considered inflammation- related. Visiting healthcare facilities is seen as the final option. (ii) Access to and trust in care: These treatment-seeking practices are also associated with the perception, in contrast with retail pharmacies, hospitals provide professional and trustworthy care but are difficult to access, and hence require visiting only for severe illness. (iii) Prior experience: previous medical treatment and experiences of self-medication also influence participants' treatment decisions including the use of antibiotics. (iv) Medication characteristics: Participants view antibiotics as powerful medicines with harms and risks, requiring consumers to carefully trade off benefits and harms before use.

CONCLUSIONS

People's treatment decisions in relation to antibiotic use in eastern China are influenced by an interplay of lay conceptual models of illnesses and antibiotics and broader organisational, social, and contextual factors. Interventions focusing on individual education to incorporate biomedical knowledge into lay understandings, and reducing situational and social incentives for self-medicating with antibiotics by strengthening access to quality professional care, would be helpful in promoting antibiotic stewardship.

Exploring the knowledge, practices & determinants of antibiotic self-medication among bangladeshi university students in the era of COVID-19: A cross-sectional study

Self-medication with antibiotics is a growing public health concern. Antibiotics are easily accessible on requested from pharmacies throughout the majority of developing countries. The present study aimed to determine the prevalence of self-medication with antibiotics among university students in Bangladesh, as well as to evaluate their knowledge and practices related to antibiotics and its resistance. A structured questionnaire was administered to 1000 students over a month in January 2022 at three universities of Bangladesh. The results showed that 61.0% of the participants had self-medicated with antibiotics in the last six months. In regards to the participants' level of knowledge and practice, a significant proportion, 60.0% exhibited a substandard understanding of antibiotic resistance and appropriate antibiotic usage. Male students (61.7%) were found to self-medicate more often than female students (38.3%). The highest prevalence of self-medication was observed in the age group of 22-25 years (32.2%). The most common reasons for self-medication were previous experience with the illness (40.9%) and the belief that the illness was not serious (36.2%). The most common illnesses for which self-medication was practiced were fever (40.9%) and cough and cold (29.3%). During multivariate logistic regression analyses age, gender, maintaining diet chart, and habit of exercising regularly were found to be associated with the increased risk of self-medication with antibiotics. The study highlighted the critical need for targeted interventions to promote responsible antibiotic use, enhance knowledge about antibiotic resistance, and discourage self-medication among university students in Bangladesh. Addressing these factors would enable the government to mitigate risks associated with self-medication, prevent antibiotic resistance, and alleviate the burden on health and the economy at large.

Self-Medication Practices Among the Geriatric Population: A Systematic Literature Review

The ageing population is increasingly using self-medication due to comorbidities. Most people who self-medicate use over-the-counter (OTC) medications bought from private pharmacies as their primary source of medicine. The use of self-medication may lead to an increased risk of unfavourable health outcomes. People over the age of 65 are more vulnerable to adverse drug reactions (ADRs). Our article aims to gain insights into self-medication in the geriatric population. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE) via Google Scholar and PubMed databases. The PubMed search technique was customised for each database and was as follows: (self-medication (Title/Abstract)) AND (geriatric (Title/Abstract) OR elderly (Title/Abstract) OR old (Title/Abstract)). Also, we used other databases like the World Health Organization (WHO), the Ministry of Health and Family Welfare(MOHFW) under the Government of India, etc. The keywords used for the search strategy were 'over-the-counter drugs', adverse drug reactions', self-prescribed drugs', and non-prescription drugs'. Articles that were not relevant to the review topic are excluded. Through our review, we found that most geriatric people use self-medication because of their previous experience with that medication, a lack of seriousness regarding the consequences of using OTC medications, and suggestions from family members, friends, or neighbours. Abdominal pain, headache, cough, joint pain, and fever are the conditions for which the geriatric age group mainly uses self-medication. The primary source of self-medication is directly from the pharmacy, and the most commonly consumed drug for self-medication is analgesics. Most people know about the risks associated with self-medication. However, people continue to participate in this risky self-medication behaviour to get quick relief from a mild illness. This issue can be resolved by providing such a group with free consultations or medical insurance. Pharmacists' role in self-medication is also important. Counselling regarding the hazards of self-medication and selling the drugs to consumers without a doctor's prescription must be avoided.

Public knowledge of antibiotics, self-medication, and household disposal practices in Jordan

BACKGROUND

This study aimed to assess public understanding of antibiotics, self-medication, and drug disposal practices.

METHODS

A cross-sectional self-administered online survey was undertaken in Jordan.

RESULTS

The study was completed by 1,105 participants. When asked about their knowledge of antibiotics, rational antibiotic use, and disposal practices, 16% percent believed they should discontinue antibiotics once they felt better, and 12% agreed to take the same antibiotics prescribed to others for the same illness. Self-medication with antibiotics was practiced by 44% of the participants. Prior experience, healthcare costs, and pharmacy location were all major determinants of self-medication. Only 6.4% of unneeded antibiotics were returned to the pharmacy, 60% were kept at home, and 26.6% were disposed of at home. Almost half of those who kept the antibiotics said they would use them again, and one-third said they would give them to friends and family. Respondents who had used antibiotics within the previous 6 months (p = 0.052) and relied on medication leaflets (p = 0.031) and physician recommendations (p = 0.001) were less likely to self-medicate with antibiotics.

CONCLUSIONS

The study highlighted areas of inappropriate use of antibiotics, self-medication and the improper antibiotic disposal that can inform antimicrobial stewardship.

Prevalence and influencing factors of self-medication during the COVID-19 pandemic in the Arab region: a multinational cross-sectional study

BACKGROUND

The novel coronavirus pandemic (COVID-19) has begun with a wave of misinformation and fear of infection. This may have led people to self-medicate inappropriately. The World Health Organization describes self-medication (SM) as utilizing medicines to relieve symptoms or health conditions without consulting a physician. Inappropriate drug use is a burden on both health resources and patient health in the Arab region. This study aimed to detect the prevalence and influencing factors of self-medication among the general Arab population during the COVID-19 pandemic.

METHODS

A multinational cross-sectional study was conducted among the general population of ten Arab countries from early August to late October 2021. Participants aged 18 years or older could join the study via social media platforms. A convenience sampling technique was used. A developed and validated web-based questionnaire was used to collect data on self-medication practice, associated influencing factors, information sources, commonly used medications, and commonly treated conditions. Descriptive, univariate, and multivariate regression analyses were applied using IBM SPSS v 26 and R v 4.0.0 software.

RESULTS

A total of 8163 participants completed the questionnaire, and 518 participants were excluded from the analysis due to inconsistencies in their data. Almost two-thirds (62.7%) of participants reported practicing self-medication during the COVID-19 pandemic. At the country level, Egypt had the highest prevalence of self-medication practice (72.1%), while Palestine had the lowest prevalence (40.4%). The most commonly used drugs were analgesics, antipyretics, and vitamins (86, 65.1, and 57.1%, respectively), while antitussives and antibiotics scored 47.6 and 43.3%, respectively. Experience with similar health conditions (74.6%) and urgency of the problem (47.2%) were the most frequent factors that led to self-medication. Additionally, 38.2% of the self-medicated participants (SMPs) used drugs as prophylaxis against COVID-19. Pharmacist consultation was the most common source of information about self-medication (66.7%). Multivariate analysis showed that predictors of self-medication were older age (p = 0.008), presence of chronic illness (p = 0.015), and having monthly income or medical insurance that does not cover the treatment cost (p = 0.001, p < 0.001, respectively).

CONCLUSION

Self-medication is considered a common practice across the Arab population. It is necessary to regulate policies and raise awareness among the public about self-medication.

The moderating effect of parental skills for antibiotic identification on the link between parental skills for antibiotic use and inappropriate antibiotic use for children in China

BACKGROUND

Inappropriate antibiotic consumption promotes antibiotic resistance. However, findings on the association between antibiotic-related knowledge and behaviors are inconsistent and contradictory, resulting in unjustified guidance of interventions. The mechanisms between the different kinds of antibiotic-related skills contained in knowledge modules in some previous studies are indistinct and rarely studied.

METHODS

A cross-sectional survey was conducted between June 2017 and April 2018 in three Chinese provinces, investigating 9526 parents with children aged 0-13 years old. Data from 1944 parents who self-medicated their children and 2478 respondents whose children sought care were analyzed.

RESULTS

Skills for antibiotic identification were found to be a moderator for the association between skills for antibiotic use and two inappropriate behaviors. Compared with parents with low levels of both skills for antibiotic identification and use, those mastering both skills at either medium (OR = 0.48, 95% CI [0.26-0.88]) or high (OR = 0.15, 95% CI [0.07-0.34]) level were less likely to self-medicate their children with antibiotics. Parents with a medium level of skills for antibiotic identification and high level of skills for antibiotic use (OR = 0.18, 95% CI [0.08-0.44]) and those with a high level of both skills (OR = 0.15, 95% CI [0.05-0.47]) were less likely to ask doctors for antibiotics when seeking care.

CONCLUSION

Parents' high level of skills for antibiotic identification is revealed to promote inappropriate antibiotic use when parents master a low level of skills for antibiotic use. Conversely, based on excellent skills for antibiotic use, better skill for antibiotic identification is associated with a greater reduction in inappropriate behaviors. We recommend future health education to strengthen skills for antibiotic identification along with guidance on antibiotic use.

Evaluation of Self-Medication with Antibiotics in Primary Care Clinics in Palestine

BACKGROUND

Antibiotics are highly effective medications and essential in curing infectious diseases; however, their inappropriate use, such as self-medication, is a significant factor in developing antimicrobial resistance.

OBJECTIVE

This study aimed to evaluate the level of antibiotic self-medication among patients who visited primary care clinics in Palestine.

METHODS

Data were collected via a self-administered questionnaire, either printed or electronically, using google forms (Google Inc., USA). The sample size needed to provide a 95% confidence level and 5% margin error and assuming a prevalence of 50% of SM with antibiotics was 377 patients. A total of 700 questionnaires were randomly distributed to patients aged 18 years or older. However, 87 were excluded due to duplication, incomplete responses, or participants under 18 years old. Finally, 423 patients were included in this study, with 254 patients completing the electronic Google Forms and 181 completing the written survey. The questionnaire consists of patients' demographics, antibiotics knowledge, and self-medication behavior. In addition, descriptive statistics and knowledge scales were performed using SPSS 22 IBM to measure and assess the scope of the problem and find the association between self-medication demographics, education, and socioeconomic status.

RESULTS

Approximately 50% of participants reported self-medication with antibiotics, with a very high use among participants with medical knowledge. Most people have adequate awareness of antibiotics, whereas out of 423 respondents, (40.2%, n = 170) had GKL, (50.4%, n= 213) had AKL, and only (9.5%, n=40) presented PKL. The primary source for self-treatment with antibiotics was community pharmacies (87.1%, n=223), whereas (14.1%, n=36) got antibiotics from family and friends. Convenience, easy access, and experience with community pharmacists contributed to self-medications. The most commonly used antibiotic for self-medication was amoxicillin/clavulanic acid.

CONCLUSION

Self-medication with antibiotics is a common practice in Palestine, regardless of socioeconomic or educational status. Patients' educations about complications from inappropriate use and the possibility of side effects are essential steps to decrease patients' demands for antibiotics. Furthermore, compliance and adherence of community pharmacists in dispensing antibiotics only with a prescription is necessary.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Patterns and Determinants of Antibiotic Use Behaviors among Rural Community Residents in Eastern China

Inappropriate antibiotic use may lead to antibiotic resistance, which has become a serious global crisis. Addressing suboptimal antibiotic use in the general population can play a significant role in the fight against antimicrobial resistance. This study aims to describe antibiotic use and sources of acquisition, and to identify factors influencing antibiotic access among rural community residents in Eastern China. A cross-sectional survey was conducted from July to August 2020, and 1494 participants from two villages in Eastern China were enrolled. Information was obtained using face-to-face interviews with a structured electronic questionnaire. Chi-squared and multinominal logistic regression analysis were used to explore possible determinants. In total, 1379 participants were eligible for the analysis. In the past 12 months, nearly half the respondents had taken any antibiotic (48.4%), and this proportion varied across marital status and age group. Two thirds of them (59.9%) obtained antibiotics from medical facilities with a prescription when they last took antibiotics, while 17.7% and 22.4% chose retail pharmacies and other sources, respectively. Multinominal analysis found that a higher proportion obtained antibiotics outside medical facilities among those aged 15 to 44 years, unmarried, non-white collar workers, with more years of education, lower annual household income per capita and lower levels of antibiotic knowledge. The antibiotic use behavior of rural community residents in Eastern China remains suboptimal. Antibiotic use and access behaviors need to be further addressed. Effective antibiotic stewardship in non-medical facility sources and training programs targeted for rural Chinese is warranted in future.

Self-Medication with Antibiotics: Prevalence, Practices and Related Factors among the Pakistani Public

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.

Prevalence, pattern and predictors of self-medication for COVID-19 among residents in Umuahia, Abia State, Southeast Nigeria: policy and public health implications

BACKGROUND

COVID-19 has led to restrictions on movements and lockdown measures, which have resulted to higher utilization of over-the-counter drugs compared to prescription-only drugs. This study determined the prevalence, pattern and predictors of self-medication for COVID-19 prevention and treatment.

METHODS

A cross-sectional survey was conducted between October and November 2021 among the residents of Umuahia, Abia State. The respondents were selected using a snowball sampling technique, and a self-administered semi-structured questionnaire was used to collect data on the variables via Google forms. Descriptive, bivariate and multivariate analyses were done using IBM SPSS version 26. The level of significance was set at 5%.

RESULTS

A total of 469 respondents participated in the survey. The overall prevalence of self-medication for COVID-19 prevention and treatment was 30.3% (95%CI: 26.7-34.1). The most commonly used medication was herbal products (43.7%). This was mainly self-prepared (41.5%). The major source of information for self-medication was from family members (39.4%). The majority of the respondents reported fear of isolation (76.3%), followed by fear of stigmatization (75.7%) as the triggers of self-medication. Older age (aOR = 1.87, 95% CI: 1.11-3.13), lower educational status [No formal education (aOR = 3.78, 95% CI: 1.28-11.19)], [Primary education (aOR = 2.15, 95% CI: 1.17-3.097)] and perception to cost (aOR = 2.29; 95CI: I.24-4.24) were the predictors of self-medication.

CONCLUSION

Every one in three residents of Umuahia, Abia State, practiced self-medication for COVID-19 prevention and treatment. Some economic and socio-demographic factors were significantly associated with self-medication. We recommend intensifying public awareness campaigns on the risk of self-medication.

Antimicrobial Stewardship in College and University Health Settings: A Public Health Opportunity

Antimicrobial resistance poses a significant threat to public health and safety across the globe. Many factors contribute to antibiotic resistance, most especially are the concerns of excessive prescribing and misuse of antibiotics. Because patient expectations for antibiotics may contribute to prescriber pressures, experts recommend targeting antimicrobial stewardship (AMS) education efforts towards prescribers as well as patients in outpatient settings. Undergraduate university students are a unique and promising target population for AMS efforts because they are in a transformative life stage of social, cognitive, and physical development in which they are learning to independently care for themselves without the presence or influence of parents. By introducing AMS education during this transition, university students may adopt positive antibiotic use behaviors that they will carry throughout their lives. Not only will their personal health be improved, but widespread adoption of AMS in university settings may have a broader effect on public health of present and future generations. Despite public health opportunities, minimal research has examined AMS in university health settings. This article explores current evidence on knowledge, attitudes, and use of antibiotics among university students and discusses opportunities for AMS initiatives in college and university health settings.

Antibiotic Use and Resistance Knowledge: Awareness Among the General Public in Jazan, Saudi Arabia

Background and objective: Antibiotics (Abs) are a class of medication generally prescribed for bacterial infections. Abs misuse, caused by either medication non-compliance or self-medication, may lead to Abs resistance, a problem that is trending around the globe. In 2018, dispensing Abs without a prescription became prohibited in Saudi Arabia. This study aimed to evaluate knowledge and attitude toward Abs use and resistance in Jazan Province.

Materials and methods: A cross-sectional study was conducted in the population of Jazan, using a self-administered electronic questionnaire to assess the knowledge and attitude toward Abs use and resistance and its related factors.

Results: According to our findings, 543 participants responded and most of the participants use Abs with a prescription (n = 280; 75%). About 40% identified correctly that Abs can treat only bacteria, not viruses, and 44% denied that Abs can treat all coughs and common cases. Then, regarding the knowledge about resistance, we found that those who had heard about Abs resistance represented more than half of the participants (56%), and had better knowledge about Abs use. Further, more than half of those who have heard about Abs resistance correctly defined the antibiotic susceptibility test, and about two-thirds were able to answer the related questions about Abs resistance.

Conclusion: To conclude, a positive correlation was found between knowledge about Abs resistance and Abs use. Thus, national Abs regulations and policies with continuous education and awareness must be continued to ensure a better understanding of Abs use.

Parental self-medication with antibiotics in a Tunisian pediatric center

INTRODUCTION

Self-medication of antibiotics among children is a very common problem in Tunisia. Its prevalence isn't well established. The aims of this study are to evaluate parents' knowledge concerning antibiotic use, and identify the factors associated with this problem.

PATIENTS AND METHODS

We conducted a cross-sectional study over a one year period (between August 2019 and July 2020). Data collection was performed using a questionnaire guided interview. We included parents of children consulting or hospitalized in the pediatric department of the university hospital Taher Sfar in Mahdia.

RESULTS

A total of 354 parents were included with an average age of 36.4±9.2 years. The average knowledge score was 2±1.3 points. In fact, 61.6% of the parents had poor knowledge about antibiotics. The frequency of non-prescription antibiotics use among children was 20.6%. Amoxicillin was the most used antibiotic (72.6%). Sore throat, important fever and flu-like symptoms were the main symptoms justifying non-prescription antibiotic use among our pediatric population in 60.3%, 34.2% and 23.3% of cases respectively. The main reason of self-medication was the fact that the same antibiotic was once prescribed to treat the same symptoms (58.9%). The used antibiotic came from an old prescription for the same child in 57.5% of the cases and was recommended by the pharmacist in 39.7% of the cases. After multivariate analysis, the factors associated with parental self-medication with antibiotics were: the advanced parent's age, the ability to name an antibiotic and knowledge's score>2.

CONCLUSION

Our study confirmed that parental knowledge about antibiotic use is low. In fact, the government should from one hand, organize antibiotic delivery and prohibit off the counter sells and in the other hand promote the education of the public through different procedures to stop this major health problem.

Self-Medication and Antimicrobial Resistance: A Survey of Students Studying Healthcare Programmes at a Tertiary Institution in Ghana

Objectives: Antimicrobial resistance (AMR) is one of the biggest challenges facing mankind. Inappropriate uses of antibiotics including self-medication promote the increase and spread of AMR. Self-medication has not been well-studied among students. This study was undertaken to determine students of healthcare programmes self-medication practices and attitudes in relation to AMR.

Materials and Methods: This was a cross-sectional survey that used a pretested self-administered questionnaire to elicit responses from first-year students of healthcare programmes at the Kwame Nkrumah University of Science and Technology, Ghana from January 2018 to August 2019.

Results: Two hundred and eighty students were recruited with 264 of them returning the questionnaire, giving a response rate of 94.3%. Majority were female (68.9%) and participants ages ranged from 16 to 34 years with a mean age (SD) of 19.5 (1.88) years. 136 students (56.2%) had previously purchased antibiotics without a prescription and 78.3% expressed satisfaction with the outcome of self-medication. Amoxicillin (78%) was the most frequent antibiotic bought without a prescription. Majority (76.3%) agreed that self-medication can lead to AMR. Majority (77.0%) believed that antibiotic abuse is a problem in Ghana and 94.8% agreed that the introduction of a course in the University on the rational use of antibiotic will help improve student's knowledge and practices.

Conclusion: Self-medication is common among participants despite their knowledge that inappropriate use of antibiotic may lead to resistance. Innovative ways including the introduction of new curricula may help to improve knowledge and to curb wrong attitudes and practices related to antibiotic misuse and ultimately to overcome the problem of AMR.

Prevalence and determinants of self-medication with antibiotics among general population in Afghanistan

Objective: Self-medication with antibiotics (SMA) is a common cause of antibiotic resistance, a major public health problem. This research aimed to identify the prevalence of SMA and explore reasons for practicing SMA among people living in Kabul, Afghanistan.Methods: A community-based cross-sectional study was conducted from May to November 2017 in 12 community pharmacies operating across Kabul, Afghanistan. Multivariable logistic regression was conducted to identify the factors associated with the use of SMA.Results: Out of 385 participants, 282 (73.2%) practiced SMA during the last year. Overall, 241 (62.6%) were 'very concerned' about the use of SMA, and 156 (40.5%) highlighted it is bad to practice SMA. The top three antibiotics used for self-medication were penicillin (ATC class: J01C), metronidazole (ATC: P01AB01), and ceftriaxone (ATC: J01DD04). Economic problems, lack of time to visit doctors, and ease of use were cited as the main reasons for practicing SMA. Furthermore, female participants were less likely to practice SMA compared to male counterparts.Conclusion: While efforts should be directed to enforce strict drug regulations system and awareness programs, priority should be given to provide accessible, affordable, and quality health care services to increase citizen's compliance to appropriate drug prescriptions.

Factors influencing inappropriate use of antibiotics in outpatient and community settings in China: a mixed-methods systematic review

BACKGROUND

For decades, antibiotics have been excessively consumed around the world, contributing to increased antimicrobial resistance (AMR) and negatively impacting health outcomes and expenditures. Antibiotic use in China accounts for half of worldwide antibiotic consumption, which mainly takes place in outpatient and community settings, and often unnecessarily for self-limiting community-acquired infections. This study aimed to identify and assess factors of inappropriate use of antibiotics in the Chinese context to inform the development of interventions to mitigate inappropriate consumption in the absence of clinical indications.

METHODS

We conducted a mixed-methods systematic review and included empirical studies with original data conducted in mainland China, Hong Kong and Taiwan that investigated factors of antibiotic use in the community including outpatient care among patients, caregivers and prescribers. We searched MEDLINE, EMBASE, the Cochrane Library, PsycINFO, Google Scholar and one Chinese database CNKI (China Knowledge Resource Integrated Database), using a combination of the key terms 'antibiotic', 'antimicrobial', 'use', 'consumption', 'behaviour', 'prescribe' and related syntax for all peer-reviewed publications published before June 2020. Health Belief Model was employed for data synthesis.

FINDINGS

Fifty-four studies were included in the full-text review: 44 quantitative, 5 qualitative and 5 mixed-methods studies. Despite a high AMR awareness, public perception/misconception of antibiotic efficacy and easy access to antibiotics for self-limiting conditions drive inappropriate demand and use in the community including primary care setting. Providers' prescribing behaviours are influenced by financial incentives, lack of diagnostic capacity and concerns over complications.

CONCLUSIONS

Inappropriate outpatient and community antibiotic use is influenced by non-biomedical factors at the individual, community, health system and societal levels in mainland China, contributing to a high antibiotic use rate. This study calls for context-tailored One Health interventions, restrictive antibiotic drug policy and multifaceted antibiotic stewardship programmes that simultaneously address drivers of inappropriate use from both the supply-side and demand-side within and beyond clinical settings.

PROSPERO REGISTRATION NUMBER

CRD42019139591.

Analysing incompliant attitudes towards antibiotic prescription completion in the UK

Objectives

To analyse demographic, social and geographic predictors of incompliant attitudes towards prescription completion in the UK.

Methods

Two waves of the Eurobarometer survey (85.1 and 90.1) were analysed, with a final sample size of 2016. Using logistic regression, the best-fitting combination of a set of identified variables was specified. The regression output and the model-averaged importance of each variable were analysed.

Results

Compared with a median prevalence region, respondents in the Nomenclature of Territorial Units for Statistics (NUTS) 1 London (OR = 2.358, 95% CI = 1.100–5.398) and Scotland (OR = 2.418, 95% CI = 1.083–5.693) regions were most likely to report an incompliant attitude. Respondents who correctly answered questions about whether unnecessary use of antibiotics could make them ineffective in future (OR = 0.353, 95% CI = 0.230–0.544), whether antibiotics kill viruses (OR = 0.644, 95% CI = 0.450–0.919) and whether antibiotics treat colds (OR = 0.412, 95% CI = 0.287–0.591) were less likely to report incompliant attitudes. Conversely, respondents who correctly responded that antibiotics can cause side effects (OR = 1.419, 95% CI = 1.014–1.999) were more likely to report incompliant attitudes. There was some evidence of associations between political orientation and level of compliance. Uncooperative survey respondents (OR = 2.001, 95% CI = 1.108–3.526) were more likely to report incompliant attitudes.

Conclusions

Incompliant attitudes towards antibiotic prescription compliance in the UK are associated with a variety of factors, including regional geographic variation in attitudes. Knowledge about antibiotics can relate to good stewardship attitudes, but concerns over side effects are associated with poor attitudes. Further research should examine the underlying attitudes and beliefs that political orientation may be a marker for in the context of antibiotic stewardship. Survey samples reliant on self-selection are likely to be biased towards good stewardship.

Knowledge about infections is associated with antibiotic use: cross-sectional evidence from the health survey Northern Ireland

BACKGROUND

Antibiotic overuse is the main modifiable driver of antibiotic resistance. Factors associated with overuse have been inconsistently reported and vary across populations. Given the burgeoning occurrence of infectious diseases around the world, there remains a great need to identify barriers and solutions to the control of infections. We examined whether knowledge about infections and antibiotic resistance is associated with antibiotic use in a northern European population sample.

METHODS

The Health Survey Northern Ireland 2014/15 was completed by a cross-sectional sample of 4135 participants aged > 16 years. Participants were asked whether they had taken an antibiotic in the past 12 months; and six questions were asked concerning knowledge about infections and antibiotic resistance. Correct answers to the six knowledge questions defined a knowledge score (score range 0-6 correct answers). We used multivariable logistic regression to estimate odds of self-reported antibiotic use during the last 12 months in association with knowledge score (lowest score, 0/6, as referent), and response to each knowledge question. Covariates included sex, age group, smoking, alcohol drinking, deprivation index, self-rated health, and satisfaction with life. Results were outputted as Odds Ratios (OR) and 95% Confidence Intervals (CI).

RESULTS

Antibiotic use in the past 12 months was reported by 39.0% (1614/4135); and 84.2% (3482/4135) scored < 6/6 correct on knowledge statements. Compared to the lowest knowledge score (0/6 correct), the highest knowledge score (6/6 correct) was associated with higher odds of antibiotic use (adjusted OR 2.03, 95% CI [1.46, 2.81], p < 0.001), with a P-value < 0.001 for trend with increasing knowledge score. Female sex, age, high deprivation, and poor general health, were independently associated with higher odds of antibiotic use. Stratified analyses showed sex and age group differences.

CONCLUSION

Knowledge, and other modifiable and non-modifiable risk factors, were positively associated with antibiotic use in the past 12 months. While the causal direction of these associations could not be determined, given the high prevalence of lesser knowledge, as well as independent contributions of other factors including socioeconomic characteristics, health literacy campaigns to raise awareness of antibiotic resistance should take a multi-pronged approach.

Prevalence and factors associated with self medication with antibiotics among University students in Moshi Kilimanjaro Tanzania

BACKGROUND

Self medication is a common practice of using medicines without a medical supervision by the people themselves. Self medication is likely to happen when people feel unwell, it is worse in the population with poor helth seeking behavior. Therefore it is important to assess the prevalence and factors associated with self medication with antibiotics among University students in Moshi, Kilimanjaro Tanzania.

METHODS

A cross sectional study was conducted from April-August 2019 at two Universities in Moshi, including one medical and one non medical. The study population were undergraduate students aged 18 and above, A self-filled questionnaire was used for data collection and data analyzed using the SPSS version 16 and association was tested using chi square.

RESULTS

Out 374 students enrolled 187 from each University, 126 were female and 248 were male with age ranging from 19 to 35 years with mean age of 23.91 years. The prevalence of self medication with antibiotics was 57% and the most common used antibiotics was amoxicillin with prevalence of 32.08%. The common reported symptoms/diseases were headache (31.02%) followed by malaria and coughing with prevalence of 15.24% and 10.96% respectively. The commonest reasons of self medication reported to be emergency illness (38.77%) and delaying of hospital services (24.33%). The commonest effects reported among respondents which practiced self medication with antibiotics were worsening of the condition that they were suffering in (4.55%) and body rashes (2.67). There was no significant difference between self medication practices among medical and non medical students(p = 0.676).

CONCLUSION

The prevalence of self medication with antibiotics was high among University students and there is no significant difference in both medical and non medical students. The most feared outcome on self medication with antibiotics is antibiotic drug resistance which leads to treatment failure along with high financial costs and increase mortality rate following microbial infections.

Prevalence and Predictors of Self-Medication with Antifungal Drugs and Herbal Products Among University Students: A Cross-Sectional Study from Egypt

Background and Purpose

Irrational use of drugs for self-medication (SM) is a worldwide public health problem which results in treatment failure, economic loss, and increased burden of morbidity and mortality. Thus, the purpose of this study was to explore SM with antifungal drugs and herbal products among university students in Egypt.

Methods

A cross-sectional sectional study was conducted over 7 months among 403 university students in Egypt. The students were invited to complete a self-administered questionnaire through an online Google form. Questionnaire items included socio-demographic characteristics of the students, practice of and attitude towards SM with antifungal drugs, and SM with herbal products.

Results

Prevalence of SM with antifungal drugs among students stood at 38.2%. The main reasons for SM with antifungal drugs were perceiving their health problem as being minimal, followed by having fears of a doctor’s visit. About 73% of the students thought that SM was not a safe practice. Older age (AOR = 1.5, 95% CI= 1.3–1.8), affiliation to a private university (AOR = 3.7, 95% CI= 2.2–6.4), and being a medical student (AOR =2.4, 95% CI= 1.3–4.5) were the significant predictors of SM with antifungal drugs. A high prevalence of SM with herbal products (70.7%) was reported, with most students having used some form of herbal weight loss preparation (64%). Being a Cairo resident (AOR= 2.4, 95% CI =1.5–3.8, P<0.05) and being a medical student (AOR= 2.1, 95% CI =1.3–3.4, P<0.05) were the significant predictors of SM with herbal products.

Conclusion

In the current study, SM was common among Egyptian university students. Providing counseling and public health education to university students with regards to SM is crucial. Implementing strict regulations and the full enforcement of excitant laws pertaining to the use of medication supplies is also needed. Herbal products should face the scrutiny of evidence-based medicine. Further studies are needed to evaluate the impact of SM among university students.

Online health information-seeking behaviors and skills of Chinese college students

BACKGROUND

Seeking online health information (OHI) has become a common practice globally. The information seekers could face health risks if they are not proficient in OHI literacy. The OHI-seeking behaviors and skills of Chinese college students, the largest proportion of college students in the world, are understudied. This study was aimed to describe OHI-seeking behaviors and skills of college students in Guangdong, China.

METHODS

College students in the Guangdong province with OHI-seeking experience were invited via WeChat, QQ, and Sina Weibo using QR code posters and flyers for participation in this online anonymized questionnaire-based study. Data on demographics, OHI literacy, information resources, search approaches, and behaviors were collected. The relationship between perceived OHI literacy and high-risk behaviors was investigated by bivariate logistic regression analysis.

RESULTS

Respondents were 1203 college students with a mean age of 20.6 years, females (60.2%), and undergraduates (97.2%). They sought health information via websites (20.3%), WeChat (2.6%), or both (77.1%). Baidu was the main search engine, and baike.baidu.com (80.3%), Zhihu.com (48.4%), and Zhidao.baidu.com (35.8%) were top three among 20 searched websites for information about self-care (80.7%), general health (79.5%), disease prevention (77.7%), self-medication (61.2%), family treatment (40.9%), drugs (37.7%), western medications (26.6%), hospitals (22.7%), physicians (21.4%), and Traditional Chinese Medicine (15.6%). Despite most respondents (78%) lacked confidence in the evidence quality and satisfaction with the results, only 32.4% further consulted doctors. Many (> 50%) would recommend the retrieved information to others. About 20% experienced hacking/Internet fraud. Cronbach's alpha for the internal consistency of OHI literacy was 0.786. Bivariate logistic regression analysis showed that students who believed they can judge the evidence level of OHI were more likely to self-diagnose (OR = 2.2, 95%CI, 1.6-3.1) and look for drug usage (OR = 3.1, 95%CI, 1.9-5.0).

CONCLUSIONS

This study reveals Chinese college students' heavy reliance on OHI to manage their own and others' health without sufficient knowledge/skills to identify misinformation and disinformation. The apparent risky information-seeking behaviors of Chinese college students warrant the provision of regulated, accurate, and actionable health information; assurance of cybersecurity; and health information literacy promotion in colleges by concerned authorities.

Knowledge and behavior of consumers towards the non-prescription purchase of antibiotics: An insight from a qualitative study from New Delhi, India

Background:

In Low-and Middle-Income Countries, including India, consumers often purchase antibiotics over-the-counter (OTC) from retail pharmacies. This practice leads to the inappropriate use of antibiotics in the community which is an important driver for the development of antimicrobial resistance. A better understanding of consumers’ views towards this grave public health concern is critical to developing evidence-based intervention programs for awareness among the general population.

Objective:

To explore knowledge, practice and, behavior of consumers towards antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior of consumers for antibiotics, and to gain insight which will help in developing evidence-based policy interventions.

Methods:

72 in-depth consumer interviews were conducted in all 11 districts of the National Capital Territory of Delhi. The qualitative data were analyzed using thematic analysis.

Results:

Our study found that retail pharmacies were the first point of consultation for common ailments for patients/consumers once home remedies failed; they were largely unaware of the threat of antimicrobial resistance. Consumers’ knowledge of antibiotic use and about antimicrobial resistance was low, they used old prescriptions, and bought antibiotics OTC to save time and money. Despite the presence of regulations constituted to regulate the sale of antibiotics by the Government and the implementation of national campaigns, the practice of self-medication and behaviors such as OTC purchase, non-adherence to prescribed antibiotics was prevalent. Consumers perceive that antibiotics provide quick relief and accelerate the curing process and retail pharmacy shops try to protect their retail business interests by honoring old prescriptions and self-medication for antibiotics.

Conclusions:

The lack of awareness and insufficient knowledge about what antibiotics are and issues such as antimicrobial resistance or antibiotic resistance resulted in misuse of antibiotics by consumers. Limited access to public healthcare and affordability of private healthcare are factors that contribute towards the self-medication/OTC purchase of antibiotics. The regular misuse of antibiotics through irrational use reinforces the need for strong enactment of strategies like continuous community awareness campaigns. Mitigation efforts should focus upon educating consumers continuously and sustainably for the understanding of antibiotic misuse, antimicrobial resistance, and promote better compliance with regulations.

Prevalence of antibiotic self-medication behavior and related factors among children aged 0 to 5 years

Background: Self-medication behavior has great adverse effects on children. The aims of this study were to assess the prevalence of self-medication with antibiotics (SMA) among children aged 0-5 years and explore the related factors.Methods: A cross-sectional survey was conducted from 1 July 2019 to 31 July 2019 in Wuhan, Hubei Province (Central China). A structured questionnaire was used to collect data from 1188 parents of children aged 0-5 years on sociodemographic characteristics, SMA among children, antibiotic knowledge and health beliefs of SMA.Results: Of the 1188 participants, 14.32% had self-medicated their children with antibiotics in the past 6 months. The higher the degree of perceived threat (OR = 0.94, 95%CI: 0.89-1.00) and self-efficacy (OR = 0.94, 95%CI: 0.89-0.98), the less likely parents were to self-medicate their children. On the contrary, the higher the degree of perceived barriers, the more likely parents were to self-medicate their children with antibiotics (OR = 1.058, 95%CI: 1.01-1.11).Conclusions: Health beliefs of parents were significantly associated with SMA among children. In addition to extensive health education, the Chinese government should also improve the accessibility and quality of health services to reduce the barriers of parental behavior change.

Knowledge, attitude, perception and practice of antibiotics usage among the pharmacy students

BACKGROUND

Resistance to antibiotics causes negative impact on health of the patients. Antibiotic resistance is the major global concern that has to be nullified for the better health outcome. The knowledge on antibiotics is very essential for the students who undertake pharmacy and health science courses. Hence a study was aimed to assess the level of knowledge, attitude, perception and practice on antibiotics usage among the pharmacy students of King Khalid University, KSA.

MATERIALS AND METHODS

A prospective online questionnaire based survey was carried out among the pharmacy students about knowledge, attitude perception and practice of antibiotics using 5-point "Likert scale" and true/false responses. The responses range from strongly agree to strongly disagree, and always to never were recorded. The data were analysed by using simple descriptive statistics.

RESULTS

Out of 300 students approached 212 responded and the response rate was found to be 71%. In this study, most (95%) of the students were aware of the emerging problem of antibiotic resistance due to inappropriate use of antibiotics. Majority (89%) of the students agreed the inappropriate use of antibiotics can increase the overall cost of treatment. However, over half of the (54%) students were not aware of the antibiotic resistance that may be a nation-wide problem of Kingdom of Saudi Arabia. The net positive response (NPR) and net other response (NOR) of all items in perception on antibiotics received more or less equal responses.

CONCLUSION

The knowledge of antibiotics usage among the students are considerably good compared with previous studies. However, the attitude, perception and practice on antibiotics usage among the pharmacy students are very poor. It alarms the need of appropriate education to enlighten antibiotic awareness for the better disease prevention and health outcomes for the benefit of patient community.

The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment

BACKGROUND

Health care systems in many countries are characterized by limited availability of provider performance data that can be used to design and implement welfare improving reforms in the health sector. We question whether a simple mystery shopper scheme can be an effective measure to improve primary care quality in such settings.

METHODS

Using a randomized treatment-control design, we conducted a field experiment in primary care clinics in a Chinese city. We investigate whether informing physicians of a forthcoming mystery shopper audit influences their prescribing behavior. The intervention effects are estimated using conditional fixed-effects logistic regression. The estimated coefficients are interpreted as marginal utilities in a choice model.

RESULTS

Our findings suggest that the mystery shopper intervention reduced the probability of prescribing overall. Moreover, the intervention had heterogeneous effects on different types of drugs.

CONCLUSIONS

This study provides new evidence suggesting that announced performance auditing of primary care providers could directly affect physician behavior even when it is not combined with pay-for-performance, or measures such as reminders, feedback or educational interventions.

Self-Treatment with Antibiotics: Knowledge level, Prevalence and Indications for Practicing Among University Students in Jordan

BACKGROUND

Self-treatment with antibiotics involves obtaining medicines without a prescription, sharing medicines with members of one's social circle, or using leftover medicines stored at home.

OBJECTIVE

Assess the prevalence, knowledge level, reasons for practicing self-treatment of antibiotic among undergraduate university students.

METHODS

The study was conducted cross-sectional on a sample of 201 students. A pre-validated questionnaire called "self-treatment with antibiotics", containing 27 close-ended questions, was administered to each subject. Data were analyzed using SPSS version 16 and the results were expressed as counts and percentages.

RESULTS AND DISCUSSION

Knowledge about self-treatment with antibiotics was good in general, and health-related students had a better level of knowledge about self-treatment with antibiotics than non-health-related students. The majority of the participants had not used self-treatment with antibiotics. Gender, age, and the last time antibiotic taken affected self-treatment with antibiotics. The most common indication for self-treatment with antibiotics was flu, cold, and tonsillitis. The most common reason for practicing self-treatment with antibiotics was being considered as a convenient and rapid solution. Internet was the main source for university students regarding knowledge about antibiotic use and resistance.

CONCLUSION

Self-treatment with antibiotics is affected by several social and demographic variables, and the role of media, public policies, university curricula as well as physicians and pharmacists should be enforced and activated to eliminate inappropriate uses of antibiotics and to correct misconceptions that encourage self-treatment with antibiotics.

Online availability of fish antibiotics and documented intent for self-medication

Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of having consequences to human misuse. The cost and availability of fish antibiotics was recorded. The proportion of reviews and comments related to human consumption was calculated. Consumer review traffic based on "likes" and "dislikes" received was compared between human- and non-human consumption-related reviews. Selected fish antibiotics were purchased and evaluated for physical appearance and compared to FDA-approved available equivalents. We found 24 website vendors with online ordering available for OTC fish antibiotics. Cost varied significantly by antibiotic and quantity ranging from USD $8.99 to $119.99. There were 2,288 reviews documented for the 9 selected antibiotics being sold. Among consumer reviews, 2.4% were potentially associated with human consumption. Human consumption-related reviews constituted 30.2% of all "likes" received and 37.5% of all "dislikes" received. Human consumption-related reviews received an average of 9.2 likes compared to 0.52 likes for non-human consumption-related reviews. The 8 fish antibiotics purchased were consistent with FDA-approved equivalents in physical appearance. Although infrequent, antibiotics intended for fish use are being purchased online without a prescription for self-medication to circumvent professional medical care. Reviews related to human consumption generate significant online traffic compared to reviews unrelated to human consumption.

Decisions to use antibiotics for upper respiratory tract infections across China: a large-scale cross-sectional survey among university students

OBJECTIVES

To investigate the decision-making process of Chinese university students with respect to antibiotic use for upper respiratory tract infections (URTIs).

DESIGN

A cross-sectional questionnaire study.

SETTING

The participants recruited from six universities across all Chinese regions from September to November 2015.

PARTICIPANTS

A total of 2834 university students sampled across six Chinese regions who self-reported experiencing symptoms of URTI within the past month completed the survey.

OUTCOME MEASURES

The prevalence of decisions for treatment and antibiotic use for URTIs as well as knowledge about antibiotic use were measured by a self-administrated questionnaire. Using regular and multinomial logistic regression a nd adapted health belief model, we identified and measured a number of variables as potential risk factors for antibiotic misuse behaviours in order to explain and predict people's treatment decisions and antibiotic use including knowledge, perceptions, access to antibiotics and cues to action.

RESULTS

Of the 2834 university students who self-diagnosed a URTI, 947 (33.4%) self-reported having taken antibiotics; among them, 462 (48.8%) used non-prescription antibiotics, which came principally from left-over prescriptions (29.0%) and over-the-counter purchases at retail pharmacies (67.3%). One in four who sought care pressured their doctors for antibiotics; all received them. Those who perceived greater severity of the disease, had access to antibiotics, perceived benefits of using antibiotics (for the common cold: adjusted OR (aOR)=2.55, 95% CI 1.93 to 3.38 or as anti-inflammatory drugs: aOR=1.35, 95% CI 1.12 to 1.63), and were cued to action (eg, seeing presence of fever: aOR=2.05, 95% CI 1.62 to 2.60 or self-diagnosing their current infection as severe: aOR=1.86, 95% CI 1.41 to 2.45), keeping antibiotics at home (aOR=2.27, 95% CI 1.83 to 2.81) and access to over-the-counter antibiotics (aOR=2.00, 95% CI 1.63 to 2.45), were more likely to misuse antibiotics.

CONCLUSIONS

Misconceptions of antibiotic efficacy and easy access to antibiotics-with or without a prescription-were associated with antibiotic misuse among Chinese university students, which calls for context-appropriate multifaceted interventions in order to effectively reduce antibiotic misuse.

Serbian students' knowledge, attitudes and behaviour towards antibiotic use: is there room for improvement?

OBJECTIVES

This study has been aimed at evaluating knowledge, attitudes and behaviour of university students regarding the usage of antibiotics focusing on differences between medical and nonmedical students.

METHODS

This cross-sectional questionnaire-based study was performed on 800 students of the University of Novi Sad, Serbia.

RESULTS

The identified predictors of adequate antibiotic knowledge were enrolled in medical program, higher grade average and appropriate use of antibiotics during last infection. Multivariate regression identified following predictors of self-medication: being medical student (B = 0.715; p < 0.001), more frequent (B = 0.628; p < 0.001) and irregular (B = 0.584; p = 0.001) antibiotic use, a family member engaged in medical profession (B = 0.789; p < 0.001), living in dormitory (B = 0.679; p = 0.007) or rented apartment (B = 0.621; p = 0.002), using antibiotics until symptoms resolved (B = 1.616; p < 0.001) or until the bottle was finished (B = 0.628; p < 0.001) during the last infection.

CONCLUSIONS

Although a high number of students showed adequate knowledge about antibiotics, numerous misconceptions were recorded, including self-medication. Further educational interventions are necessary to improve their understanding, perceptions as well as their behaviour towards antibiotic use.

Nursing students' perceived consequences of self-medication: a qualitative study

Background

Self-medication associates with many problems and complications, and is considered as a global health issue. Regarding a lack of information about perception of nursing students, as a part of healthcare workers, in this issue, the current study was aimed to explore the perceived consequences of self-medication from the perspective of nursing students.

Methods

This qualitative study was conducted using semi-structured individual face-to-face interviews. Purposeful sampling method was used for selection of participants. Twelve nursing students in the age range of 21–36 years were enrolled. Five participants were male and seven were female, seven master’s degree and five were undergraduate of bachelor degree. Data were collected using semi-structured interviews and analyzed as content analyses.

Results

Two categories and seven sub-categories were emerged from the data analysis. The main categories included; positive consequences and negative consequences, and subcategories included; time saving, cost savings, disease treatment, harming the health system, drug resistance, physical complications and death.

Conclusion

The participants believed that self-medication has some positive and negative consequences in viewpoints of nursing students. Regarding, Self-medication that potentially has dangerous consequences, it is suggested the students will be educated and warned about the adverse effects of self-medication, and the nursing teachers should try to rectify students’ misconceptions about self-medication.

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

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

Prevalence, associated factors and reasons for antibiotic self-medication among dwellers in Anuradhapura: a community-based study

Background Antimicrobial resistance is cited as one of the leading causes for the increased morbidity and mortality in infectious diseases globally. Antibiotic misuse can accelerate the advent and spread of resistant antimicrobial strains and antibiotic self-medication is one of the main practices of antibiotic misuse. Even though plethora of evidence is available on antibiotic self-medication among health care providers, evidence derived from community-based studies are scarce. Objective We aimed to determine the prevalence, associated factors and reasons for antibiotic self-medication among dwellers of Anuradhapura, Sri Lanka. Setting The study was conducted in Nuwaragam Palatha East, Medical Officer of Health area, Anuradhapura, Sri Lanka. Method A community-based, cross-sectional study was conducted to collect data on antibiotic self-medication during the last 3 months from all selected households using a self-administered questionnaire. Binary logistic regression was performed to determine the significant associations between variables of interest and the practice of antibiotic self-medication. Main outcome measure The prevalence of antibiotic self-medication was computed as a point estimate with 95% Confidence Interval. The reasons for antibiotic self-medication were presented as frequency and percentages. Results Of the 384 participants selected from 125 households, 211 (55%) had consumed antibiotics during the last three months and only ten were found to have self-medicated antibiotics. Hence, the prevalence was 2.6% (95% Confidence Interval = 1.0 to 4.2). The practice of antibiotic self-medication was not significantly associated with age, household size, sex, family income, employment or education level (P > 0.05). The most common symptom and reason to take antibiotics without a prescription was runny nose (80%-8/10) and convenience (70%-7/10) respectively. All have purchased the antibiotic for self-medication from a pharmacy. Information on the use of the antibiotic and the dosage were obtained from a physician's previous prescription (60%-6/10) or a pharmacist (40%-4/10). Conclusion The study revealed a very low prevalence of antibiotic self-medication. However, continuous surveillance of retail pharmacies and training of health care providers is needed to curtail errors in the use of antibiotics.

Demographic, socio-economic and other associated risk factors for self-medication behaviour among university students of Sri Lanka: a cross sectional study

Background

Self-prescribing practices are considered as a significant issue in the health sector due to mal-practices. This has become a more worsen issue in developing countries with easy access to medication. Current study was undertaken to estimate the prevalence of self-medication and to evaluate the driving factors behind this behavior, among university students of Sri Lanka.

Method

A total of 700 randomly selected undergraduates of three state universities in Sri Lanka, were recruited as the study population for the cross-sectional study. Information on socio-demographic, Knowledge, Attitudes and Practices relevant to Self-Medication (SM) were gathered using an interviewer administered questionnaire. Binary logistic regression was used to calculate the Odds Ratios (OR) and the 95% confidence intervals of the OR for socio-demographic risk factors on SM.

Results

Around 78% of the studied population denoted a SM behaviour. Only, 37.7% of respondents were familiar with the classification of “Over the Counter” (OTC) drugs, while majority were well aware of the risks of SM (> 50%). Fever (61.3%) and cough (56.7%) were the major health issues for SM, while antipyretics and drugs for cough and runny nose (73.6%) were the mostly used medication. Previous experience (76%) and trivial nature of health issues (73%) were recognized as the major reasons for SM. Majority of respondents declared that community pharmacies (86.9%) and left over medication from previous prescriptions (51%) were the sources for SM. Based on the binary logistic regression, age, residence locality, field of study and academic year were recognized as significant risk factors (P < 0.05) for SM within the studied undergraduate population.

Conclusion

Based on the high prevalence rate of SM, the health authorities of Sri Lanka should pay more attention towards the wellbeing and responsible medication usage of undergraduates. Designing of effective tools and regulations to monitor the selling of medication and improving the health education are recommended to ensure responsible SM within the country.

Self-Medication Practice and Associated Factors Among University of Gondar College of Medicine and Health Sciences Students: A Cross-Sectional Study

PURPOSE

Self-medication is the use of medicines by individuals to treat self-recognized illnesses or symptoms without any medical supervision. Such practices may cause antimicrobial resistance, which causes treatment failure, economic loss, serious health hazards, missed diagnosis, delayed appropriate treatment, drug dependency, and adverse drug effects. However, empirical evidence is limited to the current status of its practices and associated factors among university students. Thus, the aim of this study was to assess the magnitude and associated factors of self-medication practices among medicine and health science students at the University of Gondar.

METHODS

An institution-based cross-sectional study was employed from February to March 2017. A total of 792 randomly selected students were surveyed with a self-administered structured questionnaire. Epi Info version 7 and SPSS version 20 were used for data entry and analysis, respectively. Binary logistic regression analysis was performed. In multivariable analysis, P-value <0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to identify associated factors.

RESULTS

Self-medication practice was found to be 52.4% (95% CI: (49%, 56%)) among university students. For most students, the major reason for using self-medication was taking the illness as less serious (71.1%). Females (AOR: 1.48; 95% CI: 1.08-2.01), income category (USD 44.01-175.87) (AOR: 0.47; 95% CI: 0.29-0.78), sixth year students (AOR: 8.71; 95% CI: 4.04-18.77) and health officer students (AOR: 2.36; 95% CI: 1.20-4.63) were found to be significantly associated with self-medication practice.

CONCLUSION

More than half of the students practiced self-medication, which is moderately higher than other findings. Gender, income, year of study, and field of study were the major factors that affected self-medication. Therefore, interventions that can halt the high magnitude of self-medication and factors associated with it are crucial. Special attention should be given to students who stay in the university for longer years.

The Association between Changes in External Environment Caused by Migration and Inappropriate Antibiotic Use Behaviors among Chinese University Students: A Cross-Sectional Study

Objectives: This study aims to explore how changes in external factors caused by migration impact antibiotic use behaviors among Chinese university students in comparison to their peers from host areas and origin areas. Migration status was determined by host universities and origin areas, which were broadly defined as eastern vs. western regions in China. Methods: This study analyzed secondary data from a cross-sectional study conducted in China about the antibiotic use behaviors of university students in 2015. Students were divided into four groups: eastern local students (E-Es), western local students (W-Ws), eastern–western migrant students (E-Ws), and western–eastern migrant students (W-Es). Results: After controlling for gender, grade, major, hometown (rural or urban), and parents’ education, E-Ws reported a significantly higher odds of asking for antibiotics (OR = 2.13; 95% CI = 1.54–3.03; p < 0.001) and taking antibiotics prophylactically (OR = 1.85; 95% CI = 1.32–2.56; p < 0.001) compared with E-Es; W-Es reported a significantly lower odds of asking for antibiotics (OR = 0.56; 95% CI = 0.37–0.83; p < 0.01) and taking antibiotics prophylactically (OR = 0.57; 95% CI = 0.41–0.81; p < 0.01) compared with W-Ws. Discussion: Regional differences likely interacted with students’ migration status in forming different antibiotic use behaviors. Factors including financial incentives and loose regulations of antibiotic over-prescription by health providers and peer influence may contribute to worsened antibiotic use behaviors among E-Ws.

Knowledge, attitudes and practices regarding antibiotic use in Maputo City, Mozambique

Background

Irrational use of antibiotics is a major driver of antimicrobial resistance (AMR) worldwide. Sub-Saharan Africa, where the risk of spread of AMR is highest, lacks data on the knowledge, attitudes and practices regarding antibiotic prescription and use. This is the first study in Mozambique to address this gap.

Methods

A cross-sectional study was conducted in 2016 in 1091 adults (age ≥18 years) living in five districts in peri-urban areas of Maputo City. Three stage cluster sampling was used to select the households. A semi-structured questionnaire was used to collect information on the knowledge, attitudes and practices regarding antibiotics and their use and socio-demographic data.

Results

Of the 1091 participants, 20.9% (228/1091) had used non-prescribed antibiotics. Most of the non-prescribed antibiotics were purchased in pharmacies (199/228; 87.3%). The proportion of use of non-prescribed antibiotics was higher in those who purchased from informal markets (82.6%; 14/17) and home stores (66.7%; 12/18), compared to pharmacies (24.6%; 199/810) (p = 0.000). Variables significantly associated with use of non-prescribed antibiotics were male gender (p = 0.004), living in the Central A (p<0.001), Aeroporto B (p<0.001) or 25 de Junho (p<0.001) neighborhoods, purchase of antibiotics in informal markets (p<0.002) or obtaining from home stores (p = 0.026), not completing the course (p<0.001) and having poor knowledge on the use of antibiotics (p<0.001). Main reasons for use of non-prescribed antibiotics were a perception that there was no need to attend a health facility (26.8%), followed by someone else’s advice (7.7%), symptoms similar to a previous episode (6.2%) and poor quality of care in health facilities (6.7%).

Conclusions

Our study shows for the first time that knowledge regarding antibiotics is poor in Maputo City. Purchase of non-prescribed antibiotics is a common practice and most are sold in pharmacies, indicating deficient inspection. Interventions to reinforce adherence by pharmacies to current legislation for dispensing antibiotics, combined with community education are urgently needed.

University students' knowledge, attitudes, and practice regarding antibiotic use and associated factors: a cross-sectional study in the United Arab Emirates

Purpose: Antibiotic resistance is one of the world’s most fatal health crises. Medical students are the antibiotic prescribers of tomorrow, so better understanding of their knowledge, attitudes, and practice (KAP) pertaining to antibiotic use is crucial.

Objectives: This study aimed to assess the KAP of antibiotics and associated factors among university students in the United Arab Emirates (UAE).

Methods: This was a descriptive cross-sectional study conducted among a random sample of undergraduate students from Ajman University in the UAE. A self-administered pretested questionnaire was used to collect data on students’ demographics and their KAP regarding antibiotic use. Data were analysed using STATA version 14.2. P<0.05 was considered statistically significant.

Results: This study showed that university students have a high rate of antibiotic self-medication. The average KAP score was 56% (95% CI 55%–57%). Statistical modeling showed that major, study year, age, and sex were strong determinants of KAP regarding antibiotic use.

Conclusion: There is a need to develop an effective and comprehensive antibiotic-stewardship program as part of undergraduate education. Moreover, reinforcing antibiotic-use policies, involving pharmacies, drug supply, distribution, and sale, are also urgently needed.

Knowledge, attitude, and practice of self-medication with antibiotics among community residents in Addis Ababa, Ethiopia

Background: Self-medication with antibiotics, which may cause significant antibiotic resistance, is predominant in developing countries. The aim of this study is to assess the knowledge, attitude, and practice of self-medication with antibiotics among community residents in Ethiopia. Methods: A cross-sectional study design was conducted from June to August 2017. Knowledge-Attitude-Practice questionnaire was developed and distributed to eligible household respondents in Addis Ababa and its surrounding area. Logistic regression analysis was used to identify factors associated with self-medication with antibiotics. Results: Among the 605 invited participants, 595 respondents were participated in this study (response rate = 98.3%) and 67.3% of the respondents had reported self-medication with antibiotics in the past 6 months. The median score of knowledge about antibiotics was 3 (Inter quarter range: 2-4) of a maximum possible score of 6 and the median score of attitude was 19 (Inter quarter range: 16-22) from a maximum of 29. Self-medication with antibiotics was significantly associated with age, educational status, and average monthly income of the communities. Conclusions: Respondents have inadequate knowledge and inappropriate practice toward rational use of antibiotics. Policies such as restricting the purchase of antibiotics without a medical prescription and educating appropriate use of antibiotics are urgently needed.