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Saleem Z, Mekonnen BA, Orubu ES, Islam MA, Nguyen TTP, Ubaka CM, Buma D, Thuy NDT, Sant Y, Sono TM, Bochenek T, Kalungia AC, Abdullah S, Miljković N, Yeika E, Niba LL, Akafity G, Sefah IA, Opanga SA, Kitutu FE, Khuluza F, Zaranyika T, Parajuli A, Darweesh O, Islam S, Kumar S, Nabayiga H, Jairoun AA, Chigome A, Ogunleye O, Fadare J, Massele A, Cook A, Jelić AG, Godói IPD, Phillip A, Meyer JC, Funiciello E, Lorenzetti G, Kurdi A, Haseeb A, Moore CE, Campbell SM, Godman B, Sharland M. Current access, availability and use of antibiotics in primary care among key low- and middle-income countries and the policy implications. Expert Rev Anti Infect Ther 2025:1-42. [PMID: 40110804 DOI: 10.1080/14787210.2025.2477198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 02/28/2025] [Accepted: 03/04/2025] [Indexed: 03/22/2025]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antimicrobial stewardship (AMS). There is a need to review current evidence on antibiotic use, access, and AMR, in primary care across key countries. AREAS COVERED This narrative review analyzes publications from 2018 to 2024 regarding access, availability, and use of appropriate antibiotics. EXPERT OPINION There were very few studies focussing on a lack of access to antibiotics in primary care. However, there was considerable evidence of high rates of inappropriate antibiotic use, including Watch antibiotics, typically for minor infections, across studied countries exacerbated by patient demand. The high costs of antibiotics in a number of LMICs impact on their use, resulting in short courses and sharing of antibiotics. This can contribute to AMR alongside the use of substandard and falsified antibiotics. Overall, limited implementation of national action plans, insufficient resources, and knowledge gaps affects sustainable development goals to provide routine access to safe, effective, and appropriate antibiotics. CONCLUSIONS There is a clear need to focus health policy on the optimal use of essential AWaRe antibiotics in primary care settings to reduce AMR in LMICs.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Biset Asrade Mekonnen
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ebiowei Samuel Orubu
- Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria
- Institute for Health System Innovation & Policy, Boston University, Boston, MA, USA
| | - Md Ariful Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Thuy Thi Phuong Nguyen
- Pharmaceutical Administration PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Chukwuemeka Michael Ubaka
- Public Health Supply Chain and Pharmacy Practice Research Unit, Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka Campus, Nsukka, Nigeria
| | - Deus Buma
- Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | | | - Yashasvi Sant
- Department of Pharmacology, Karnavati School of Dentistry, Ahmedabad, India
| | - Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
- Saselamani Pharmacy, Saselamani, South Africa
| | - Tomasz Bochenek
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Aubrey C Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Saad Abdullah
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Nenad Miljković
- Hospital Pharmacy, Institute of Orthopaedics Banjica, Belgrade, Serbia
| | - Eugene Yeika
- Programs coordinator/Technical Supervisor for HIV/Malaria, Delegation of Public Health, North West Region, Cameroon
| | - Loveline Lum Niba
- Department of Public Health, The University of Bamenda, Bamenda, Cameroon
- Effective Basic Services Africa, Bamenda, Africa
| | - George Akafity
- Research Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Sylvia A Opanga
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, School of Health Sciences, Makerere University, Kampala, Uganda
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
| | - Felix Khuluza
- Pharmacy Department, Formerly College of Medicine, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Ayuska Parajuli
- HERD International, Lalitpur, Nepal
- Public Health Research Society, Kathmandu, Nepal
| | - Omeed Darweesh
- Department of Clinical Laboratory Sciences, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
- School of Optometry and Vision Science, UNSW Sydney, New South Wales, Australia
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Hellen Nabayiga
- Management Science Department, Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | | | - Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Olayinka Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine Ikeja, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado, Nigeria
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, School of Medicine Kairuki University, Tanzania
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St. George's, University of London, London, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ana Golić Jelić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia & Herzegovina
| | - Isabella Piassi Dias Godói
- Institute of Pharmaceutical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Health Technology Assessment Center - Management, Economics, Health Education and Pharmaceutical Services, Federal University of Rio de Janeiro, Brazil
| | - Amani Phillip
- Department of Clinical Pharmacology and Therapeutics, School of Medicine Kairuki University, Tanzania
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Elisa Funiciello
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St. George's, University of London, London, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St. George's, University of London, London, UK
| | - Amanj Kurdi
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
- Department of Clinical Laboratory Sciences, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK
| | - Abdul Haseeb
- Clinical Pharmacy Department, Al Rayan National College of Health Sciences and Nursing, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St. George's, University of London, London, UK
| | - Stephen M Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St. George's, University of London, London, UK
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St. George's, University of London, London, UK
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Abdallah ZA, Hamid THA, Zaghlool SS, Hendy A, Al-Mugheed K, Abdelaliem SMF, Alabdullah AAS, Sayed S, Hendy A, Farag AAW. Awareness program for controlling the misuse of antibiotics and related resistance among mothers of children under 5 years. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2025; 44:115. [PMID: 40217374 PMCID: PMC11992840 DOI: 10.1186/s41043-025-00823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 03/11/2025] [Indexed: 04/14/2025]
Abstract
BACKGROUND Antibiotics are pharmacological agents synthesized in laboratories or derived from microorganisms to inhibit the growth of other living microorganisms. Antibiotics resistance represents a serious problem described by WHO as "a global public health concern" especially in children. AIM To assess the impact of an antibiotic awareness program on the knowledge, attitude, and reported practices of mothers of children less than 5 years old Methods A quasi-experimental pre-post-test design was conducted at immunization and primary health care centers on 375 mothers. The intervention included a structured awareness program employing lectures, group discussions, and audiovisual materials. Researchers used tools to assess socio-demographic characteristics, knowledge, attitudes, and reported practices, aiming to improve mothers' understanding and behavior regarding antibiotic use. RESULTS The mothers' knowledge exhibited a substantial increase, as reflected in the total mean score rising from 6.25 ± 1.72 in the pre-test to 10.85 ± 2.49 in the post-test. Furthermore, the participants' attitudes witnessed a noteworthy shift, with the pre-test total mean score of 28.19 ± 10.12 experiencing a considerable improvement post-program to reach 59.60 ± 12.40. Additionally, the reported practices of the mothers displayed positive changes, as evidenced by an improvement in the total mean score from 6.36 ± 1.97 in the post-test. CONCLUSION The well-designed awareness programs can play a crucial role in empowering mothers to make informed decisions and adopt responsible practices, contributing to the overall effort in controlling antibiotic misuse and combating resistance in the context of child healthcare.
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Affiliation(s)
- Zainab Attia Abdallah
- Community Health Nursing Faculty of Nursing Modern University for Technology and Information (MTI), Cairo, Egypt
| | - Tanazor Hemdan Abdel Hamid
- Pediatric Nursing Faculty of Nursing Modern University for Technology and Information (MTI), Cairo, Egypt
| | - Sameh S Zaghlool
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Mokattam, Cairo, 11571, Egypt
| | - Abdelaziz Hendy
- Pediatric Nursing, Faculty Nursing Ain Shams University, Cairo, Egypt.
| | | | - Sally Mohammed Farghaly Abdelaliem
- Department of Nursing Management and Education, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Amany Anwar Saeed Alabdullah
- Department of Maternity and Pediatric Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Salwa Sayed
- Technical Health Institute at General Authority for Health Insurance, Benha, Egypt
| | - Ahmed Hendy
- Department of Computational Mathematics and Computer Science, Institute of Natural Sciences and Mathematics, Ural Federal University, Yekaterinburg, 620002, Russian Federation
| | - Ayiat Allah Wagdy Farag
- Faculty of Nursing - Modern University for Technology and Information (MTI), Community Health Nursing, Cairo, Egypt
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Saleem Z, Moore CE, Kalungia AC, Schellack N, Ogunleye O, Chigome A, Chowdhury K, Kitutu FE, Massele A, Ramdas N, Orubu ES, Cook A, Khuluza F, Zaranyika T, Funiciello E, Lorenzetti G, Nantamu M, Parajuli A, Kurdi A, Nabayiga H, Jairoun AA, Haque M, Campbell SM, Van Der Bergh D, Godman B, Sharland M. Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance and stewardship among low- and middle-income countries. JAC Antimicrob Resist 2025; 7:dlaf033. [PMID: 40134815 PMCID: PMC11934068 DOI: 10.1093/jacamr/dlaf033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2025] Open
Abstract
Background There are concerns globally with rising rates of antimicrobial resistance (AMR), particularly in low- and middle-income countries (LMICs). AMR is driven by high rates of inappropriate prescribing and dispensing of antibiotics, particularly Watch antibiotics. To develop future interventions, it is important to document current knowledge, attitudes and practices (KAP) among key stakeholder groups in LMICs. Methods We undertook a narrative review of published papers among four WHO Regions including African and Asian countries. Relevant papers were sourced from 2018 to 2024 and synthesized by key stakeholder group, country, WHO Region, income level and year. The findings were summarized to identify pertinent future activities for all key stakeholder groups. Results We sourced 459 papers, with a large number coming from Africa (42.7%). An appreciable number dealt with patients' KAP (33.1%), reflecting their influence on the prescribing and dispensing of antibiotics. There was marked consistency of findings among key stakeholder groups across the four WHO Regions, all showing concerns with high rates of prescribing of antibiotics for viral infections despite professed knowledge of antibiotics and AMR. There were similar issues among dispensers. Patients' beliefs regarding the effectiveness of antibiotics for self-limiting infectious diseases were a major challenge, although educational programmes did improve knowledge. The development of the AWaRe (Access, Watch and Reserve) system, including practical prescribing guidance, provides a future opportunity for the standardization of educational inputs. Conclusions Similar KAP regarding the prescribing and dispensing of antibiotics across LMICs and stakeholder groups presents clear opportunities for standardization of educational input and practical training programmes based on the AWaRe system.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George’s, University of London, London SW17 0RE, UK
| | - Aubrey C Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa
| | - Olayinka Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja 100271, Nigeria
| | - Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Kona Chowdhury
- Department of Pediatrics, Gonoshasthaya Somaj Vittik Medical College, Dhaka 1344, Bangladesh
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, School of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
- Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - E Sam Orubu
- Department of Biomedical Engineering, Boston University College of Engineering, Boston, MA, USA
- Institute for Health System Innovation & Policy, Boston University, Boston, MA, USA
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George’s, University of London, London SW17 0RE, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Felix Khuluza
- Pharmacy Department, Formerly College of Medicine, Kamuzu University of Health Sciences (KUHeS), Blantyre P.O. Box 278, Malawi
| | - Trust Zaranyika
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP167, Zimbabwe
| | - Elisa Funiciello
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George’s, University of London, London SW17 0RE, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George’s, University of London, London SW17 0RE, UK
| | - Miriam Nantamu
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George’s, University of London, London SW17 0RE, UK
| | - Ayuska Parajuli
- HERD International, Lalitpur, Nepal
- Public Health Research Society, Kathmandu, Nepal
| | - Amanj Kurdi
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Kurdistan Regional Governorate, Erbil, Iraq
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
- College of Pharmacy, Al-Kitab University, Kirkuk 36015, Iraq
| | - Hellen Nabayiga
- Management Science Department, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow G4 0QU, UK
| | - Ammar Abdulrahman Jairoun
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman 346, United Arab Emirates
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai, Besi, 57000 Kuala Lumpur, Malaysia
- Karnavati Scientific Research Center, Karnavati School of Dentistry, Karnavati University, Gandhinagar 382 422, Gujarat, India
| | - Stephen M Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Dena Van Der Bergh
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Brian Godman
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George’s, University of London, London SW17 0RE, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George’s, University of London, London SW17 0RE, UK
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Angelillo S, Paduano G, Sansone V, De Filippis A, Finamore E, Pelullo CP, Di Giuseppe G. Exploring Knowledge, Attitudes, and Behaviors Toward Antibiotics Use Among Adolescents in Southern Italy. Microorganisms 2025; 13:290. [PMID: 40005657 PMCID: PMC11858090 DOI: 10.3390/microorganisms13020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 01/23/2025] [Accepted: 01/26/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND This study explored knowledge, attitudes, and behaviors regarding antibiotics among adolescents. METHODS The cross-sectional study was conducted from February to April 2024. RESULTS Overall, 65.2% of adolescents believed that antibiotics should only be used when prescribed, this was more likely among women and those who needed additional information regarding antibiotics. Women and adolescents without a parent with a chronic disease, who believed that it is not possible to stop antibiotics when symptoms improve and who disagreed that antibiotics are faster treatment for flu were more likely to prefer prescribed antibiotics. Antibiotic use without a medical prescription was reported by 37.4% of participants, and this was more likely among men and adolescents who had a parent with a chronic disease, who needed additional information regarding antibiotics, and who disagreed that antibiotics should only be used when prescribed. Adolescents who are afraid that antimicrobial resistance (AMR) may affect their health, who received previous information about AMR, who know that antibiotics are not useful for viral infection treatment, and who need additional information regarding antibiotics, were more likely to believe that it is important to talk about AMR at school. CONCLUSIONS Interventions on AMR and antibiotic use among adolescents are needed.
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Affiliation(s)
- Silvia Angelillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (G.P.); (V.S.); (A.D.F.)
| | - Giovanna Paduano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (G.P.); (V.S.); (A.D.F.)
| | - Vincenza Sansone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (G.P.); (V.S.); (A.D.F.)
| | - Anna De Filippis
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (G.P.); (V.S.); (A.D.F.)
| | - Emiliana Finamore
- Complex Operative Unit of Virology and Microbiology, University Hospital of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Concetta Paola Pelullo
- Department of Medical, Human Movement and Well-Being Sciences, University of Naples “Parthenope”, 80133 Naples, Italy;
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (G.P.); (V.S.); (A.D.F.)
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Nazari J, Ghafoury R, Chezani-Sharahi N, Moradzadeh R, Naghshbandi M. Prevalence and determinants of self-medication consumption of antibiotics in adults in Iran: a population based cross-sectional study, 2019-2020. Front Public Health 2024; 12:1502074. [PMID: 39749248 PMCID: PMC11693702 DOI: 10.3389/fpubh.2024.1502074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 12/09/2024] [Indexed: 01/04/2025] Open
Abstract
Introduction The self-medication of antibiotics is a global crisis, posing a significant challenge to healthcare systems worldwide. This study aimed to investigate the frequency of self-medication in the adult population and the factors influencing it. Methods This population-based cross-sectional study was conducted in Arak, a city in central Iran, from January 2019 to January 2020. Stratified random sampling was used to determine the recruitment criteria, and a total of 6,692 individuals participated in the study. Self-medication of antibiotics was defined as the self-reported annual consumption of antibiotics, as well as a record of antibiotic use registered in insurance services during the same period. The variables examined in this study included age, gender, educational level, occupational status, insurance coverage, and marital status. All gathered data were analyzed using SPSS version 16.0 and STATA version 16.0 software. p-values < 0.05 were considered statistically significant. Results The annual prevalence of antibiotic self-medication was 30.3% (n = 2,033). Chi-square and Mann-Whitney tests identified a significant correlation between educational level and self-medication practices (p = 0.028), while no significant associations were observed with gender, occupation, insurance coverage, or marital status. Logistic regression analysis revealed that female participants were less likely to self-medicate (p = 0.027), and both older age and higher levels of education were associated with a reduced likelihood of antibiotic self-medication (p = 0.001 and p = 0.044, respectively). Conclusion Factors such as female gender, older age, and higher education levels are significant determinants affecting antibiotic self-medication.
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Affiliation(s)
- Javad Nazari
- Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Roya Ghafoury
- Department of Medicine, Student Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Chezani-Sharahi
- Department of Health Services Management, Islamic Azad University, North Tehran Branch, Tehran, Iran
| | - Rahmatollah Moradzadeh
- Department of Epidemiology, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
| | - Mobin Naghshbandi
- Department of Medicine, Student Research Center, Iran University of Medical Sciences, Tehran, Iran
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Zewdie S, Kassa AA, Yayehrad AT, Bizuneh MM, Ayenew W, Zewudie M, Mulat S, Bitew BE, Zewudie S, Meharie BG, Tesfaye TC, Zerga AA, Ayele FY, Toleha HN, Workineh BD, Bayked EM. Non-prescription antibiotic use and its predictors among children in low- and middle-income countries: a systematic review and meta-analysis. Ital J Pediatr 2024; 50:260. [PMID: 39696454 DOI: 10.1186/s13052-024-01808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 10/27/2024] [Indexed: 12/20/2024] Open
Abstract
Globally antibiotics are among the most commonly used drugs. Non-prescription use of antibiotics is a major factor for the emergence and spread of antimicrobial resistance one of the top global public health and development threats. This systematic review and meta-analysis aim to assess non-prescription antibiotic use and predictors among children in Low and middle-income countries.A comprehensive search of electronic databases was conducted from PubMed, Scopus and HINARI to identify primary studies published between 2000 and 2024. Observational studies conducted among children ≤ 18 years old and published in English language were included in the review. After screening, the studies were assessed using Joanna Briggs Institute (JBI) critical appraisal tool and data were extracted using a checklist. Heterogeneity was assessed using forest plot, Chocran's Q Test and I2. The random effects meta-analysis model was employed to pool the prevalence of non-prescription antibiotic use among children in low-and middle-income countries. Sub-group analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's test.The review was conducted among 32 cross-sectional studies with a sample size of 80,133 participants. The pooled prevalence of non-prescription antibiotic use among children in low-and middle-income countries was 38.86% (95% CI 34.32, 43.40; P < 0.0001) with high heterogeneity (I2 = 99.38%, p < 0.001). The prevalence of non-prescribed antibiotic use among studies conducted in upper middle-income countries (30.85% (24.49%, 37.21%)) was low when compared to studies conducted in LMICs (44.00% (37.72%, 52.09%). Penicillin was the most often antibiotic class used without prescription, while upper respiratory infections were the most prevalent illness/symptoms that prompted non-prescription antibiotic use.The pooled prevalence of non-prescription antibiotic use among children in low-and middle-income countries is high indicating that two out of five children used non-prescribed antibiotics. This review is important for international organizations, ministry of health of the low-and middle- income countries, regulatory bodies and researchers.
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Affiliation(s)
- Segenet Zewdie
- Department of Pharmacy, College of medicine and health science, Injibara University, Injibara, Ethiopia.
| | - Assefa Andargie Kassa
- Department of public health, College of medicine and health science, Injibara University, Injibara, Ethiopia
| | | | - Mekonnen Melkie Bizuneh
- Department of Reproductive Health, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondim Ayenew
- Department of social and administrative pharmacy, College of medicine and health science, University of Gondar, Gondar, Ethiopia
| | - Melkamu Zewudie
- Department of pediatrics, Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia
| | - Selomie Mulat
- Department of Medicine, Saint Paul Specialized Hospital, Addis Ababa, Ethiopia
| | - Bayih Endalew Bitew
- Department of Pharmacy, College of medicine and health science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Serkalem Zewudie
- Department of Medicine, Felege Hiwot Regional Referral Hospital, Bahir Dar, Ethiopia
| | - Birhanu Geta Meharie
- Department of Pharmacy, College of medicine and health science, Debre Markos University, Debre Markos, Ethiopia
| | - Tegenu Chanie Tesfaye
- Department of Pharmacy, College of medicine and health science, Debre Markos University, Debre Markos, Ethiopia
| | - Aregash Abebayehu Zerga
- Department of Nutrition, College of medicine and health science, Wollo University, Dessie, Ethiopia
| | - Fanos Yeshanew Ayele
- Department of Nutrition, College of medicine and health science, Wollo University, Dessie, Ethiopia
| | - Husein Nurahmed Toleha
- Department of pharmacy, College of medicine and health science, Wollo University, Dessie, Ethiopia
| | - Birhanu Demeke Workineh
- Department of pharmacy, College of medicine and health science, Wollo University, Dessie, Ethiopia
| | - Ewunetie Mekashaw Bayked
- Department of pharmacy, College of medicine and health science, Wollo University, Dessie, Ethiopia
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Adewusi OJ, Cassidy R, Aboderin A, Bailey S, Hotham S. Gender differences in antibiotic use behaviour and access to antibiotics in low- and middle-income countries: a scoping review protocol. BMJ Open 2024; 14:e081279. [PMID: 39663165 PMCID: PMC11647369 DOI: 10.1136/bmjopen-2023-081279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 09/30/2024] [Indexed: 12/13/2024] Open
Abstract
INTRODUCTION In low- and middle-income countries (LMICs), the persistent lack of access and high inappropriate use of antibiotics, which are fuelled by gender-related factors, continue to facilitate antimicrobial resistance. This in turn reduces the capacity to treat infectious diseases. However, there is a lack of clarity on the nature and extent of the available evidence on gender influence on access to antibiotics and antibiotic use behaviour. This proposed study will systematically review the available literature to map out the scope of evidence on gender differences and, importantly, the related factors influencing antibiotic use and access to antibiotics in LMICs. METHODS AND ANALYSIS This scoping review will be conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews. Major databases (MEDLINE, PsycINFO and CINAHL) will be searched via the EBCOhost and Web of Science platforms for peer-reviewed articles. Title and abstract screening, as well as full paper review, will be conducted by a single reviewer, with 20% of identified citations reviewed independently by two other reviewers. A predefined excel spreadsheet will be used for data extraction and analysis. Findings will be presented thematically in a narrative summary and tables. ETHICS AND DISSEMINATION Obtaining ethics approval is not required for this study. The findings will contribute to understanding gender health inequalities and areas for further research on strategies to incorporate gender considerations in antimicrobial stewardship efforts in LMICs. The study findings will be disseminated through presentations in seminars, scientific conferences and publications in peer-reviewed journals.
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Affiliation(s)
| | - Rebecca Cassidy
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Aaron Aboderin
- Medical Microbiology and Parasitology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Simon Bailey
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Sarah Hotham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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Liu D, Ge P, Li X, Hong W, Huang M, Zhu L, Kaierdebieke A, Yu W, Qi J, Pu K, Ling R, Pan L, Sun X, Wu Y, Feng Q. Status of self-medication and the relevant factors regarding drug efficacy and safety as important considerations among adolescents aged 12-18 in China: a cross-sectional study. Sci Rep 2024; 14:9982. [PMID: 38693178 PMCID: PMC11063147 DOI: 10.1038/s41598-024-59204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 04/08/2024] [Indexed: 05/03/2024] Open
Abstract
The objective of this study was to investigate self-medication behavior among Chinese adolescents aged 12-18 years and explore the factors associated with whether adolescents prioritize drug efficacy or safety when engaging in self-medication behavior. In 2021, a questionnaire investigation was conducted in the Chinese mainland using a multi-stage sampling approach. After a statistical description, logistic regression was used to analyze the factors associated with considering drug efficacy and safety. The self-medication rate among Chinese adolescents aged 12-18 years was 96.61%. Of these, 65.84% considered drug safety to be essential, while 58.72% prioritized drug efficacy. Regression analysis showed that individuals with better healthcare were more likely to consider drug efficacy an important factor. Additionally, those with a healthier family lifestyle were more likely to prioritize efficacy. When individuals engage in self-medication, those residing in urban areas and possessing advanced preventive health literacy and ample family health resources tend to prioritize drug safety to a greater extent. Conversely, those with higher monthly household incomes and only children exhibit a decreased inclination towards prioritizing safety during self-medication. Self-medication is a frequently observed practice among Chinese adolescents aged 12-18. Several factors, such as demographic and sociological characteristics, health literacy, and family health status, have been found to be associated with the extent to which adolescents prioritize medication safety and efficacy when engaging in self-medication practices. Higher levels of health literacy and better family health status were positively correlated with considering both the efficacy and safety of drugs as important factors when self-medicating.
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Affiliation(s)
- Diyue Liu
- International School of Public Health and One Health, Hainan Medical University, Hiaikou, China
| | - Pu Ge
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xialei Li
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | | | - Mengjie Huang
- School of Public Health, ShanDong University, Jinan, China
| | - Lijun Zhu
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | | | - Wenbian Yu
- Zhuhai Institute of Social Development, Zhuhai, China
| | - Jiale Qi
- International School of Journalism and Communication, Zhengzhou University, Zhengzhou, China
| | - Keping Pu
- Institute of School of Nursing, China Medical University, Shenyang, China
| | - Rong Ling
- Jilin University School of Pharmaceutical Sciences, Jilin University, Changchun, China
| | - LuTong Pan
- School of Public Health, Shandong University, Beijing, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China.
| | - Qiqin Feng
- International School of Public Health and One Health, Hainan Medical University, Hiaikou, China.
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Elhaddadi H, Hamami A, Sara A, Elouali A, Babakhouya A, Rkain M. Prevalence and Determinants of the Use of Antibiotics by Self-Medication in the Pediatric Population in Oujda, Morocco. Cureus 2024; 16:e60126. [PMID: 38864035 PMCID: PMC11165378 DOI: 10.7759/cureus.60126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVE Antibiotic resistance driven by antibiotic self-medication and inappropriate use of antibiotics is a growing global health threat. Our study aimed to describe parents' self-medication practices with antibiotics, determine the factors favoring their use in the pediatric population, and assess parents' knowledge of the role of antibiotics and antimicrobial resistance. MATERIALS AND METHODS We conducted a cross-sectional study over two months (September and October 2023). Data collection was performed using a questionnaire-guided interview. We included 460 parents of children consulting or hospitalized in the Pediatric Department of the University Hospital Mohammed VI in Oujda, Morocco. RESULTS A total of 62% of parents questioned were mothers. Self-medication with antibiotics was noted in 313 families (68%). Parents used antibiotics mainly to treat cough (43%) and fever (24%). Betalactams were the antibiotic class most used by parents (72%). Information on dosage and methods of antibiotic administration was provided by pharmacy staff but was not respected by most parents (78%). Efficacy of treatment (58%), saving consultation costs and time (47%), and the ease of obtaining treatment without a prescription (42%) were reported in the majority of cases as reasons for using antibiotics by self-medication. In our context, the probability of self-medicating with antibiotics in the pediatric population is increased by female gender (OR=1.04), low level of education (OR=1.02), low socio-economic status (OR=1.09), and buying antibiotics without a prescription (OR=1.22). CONCLUSION Although antibiotic self-medication in children is a worldwide phenomenon, influenced by several geographical, cultural, and economic factors, there is an urgent need to promote a global health strategy.
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Affiliation(s)
- Hasnae Elhaddadi
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Amal Hamami
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Anane Sara
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Aziza Elouali
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Abdeladim Babakhouya
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
| | - Maria Rkain
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, MAR
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Mannan A, Chakma K, Dewan G, Saha A, Chy NUHA, Mehedi HMH, Hossain A, Wnaiza J, Ahsan MT, Rana MM, Alam N. Prevalence and determinants of antibiotics self-medication among indigenous people of Bangladesh: a cross-sectional study. BMJ Open 2024; 14:e071504. [PMID: 38448060 PMCID: PMC10973695 DOI: 10.1136/bmjopen-2022-071504] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/14/2024] [Indexed: 03/08/2024] Open
Abstract
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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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
| | | | | | - 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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Imeri M, Krasniqi S, Raka L, Humolli I, Hoti K, Imeri Z, Zhjeqi V. Evaluation of parents' attitudes and practices related to antibiotic use for their children in Kosovo: a cross-sectional survey. J Pharm Policy Pract 2023; 16:168. [PMID: 38093388 PMCID: PMC10717770 DOI: 10.1186/s40545-023-00676-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Self-medication and lack of patient adherence contribute to antibiotic misuse. This article describes parents' attitudes and practices regarding use of antibiotics by their children in Kosovo. METHODS A cross-sectional survey was conducted during data collection. We surveyed a total of 453 parents of children aged 0-15 years, who had experiences with using antibiotics for their children. Correlation tests and regression analysis were used to explore the relationship between variables. RESULTS Our findings showed that 42.2% of parents strongly agreed or agreed with the use of antibiotics as a means to cure a cold or flu in their child more quickly. In addition, 29.8% were not aware of antibiotic side effects. Non-compliance with antibiotic treatment was 35.8%, and 28.9% of surveyed parents suggested that they had pressured their pediatricians to prescribe antibiotics for their children. A total of 10.15% of parents had no information on antibiotic resistance, and 34.38% of parents responded that they did not believe that self-medication with antibiotics could lead to resistance. Regression analysis results indicated that gender and age group have a significant influence on the parents' decision that an antibiotic should be used in children with high fever (p < 0.001). CONCLUSIONS Our findings suggest that antibiotic management by parents in Kosovo is not satisfactory, and more attention should be given to their knowledge of the side effects of antibiotics, bacterial resistance and reduction in the self-medication. Health education, adequate measures and interventions are needed to overcome this situation and ensure rational use of antibiotics in Kosovo.
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Affiliation(s)
- Miradije Imeri
- Hospital and University Clinical Service of Kosova, 10000, Prishtina, Republic of Kosovo
| | - Shaip Krasniqi
- Hospital and University Clinical Service of Kosova, 10000, Prishtina, Republic of Kosovo.
- Faculty of Medicine, University of Prishtina "Hasan Prishtina" (UPHP), Rr. Bulevardi i Dëshmorëve, 10000, Prishtina, Republic of Kosovo.
| | - Lul Raka
- Faculty of Medicine, University of Prishtina "Hasan Prishtina" (UPHP), Rr. Bulevardi i Dëshmorëve, 10000, Prishtina, Republic of Kosovo
- Institute of Public Health of Kosova, 10000, Prishtina, Republic of Kosovo
| | - Isme Humolli
- Faculty of Medicine, University of Prishtina "Hasan Prishtina" (UPHP), Rr. Bulevardi i Dëshmorëve, 10000, Prishtina, Republic of Kosovo
- Institute of Public Health of Kosova, 10000, Prishtina, Republic of Kosovo
| | - Kreshnik Hoti
- Institute of Public Health of Kosova, 10000, Prishtina, Republic of Kosovo
| | - Zana Imeri
- Faculty of Medicine, University of Prishtina "Hasan Prishtina" (UPHP), Rr. Bulevardi i Dëshmorëve, 10000, Prishtina, Republic of Kosovo
| | - Valbona Zhjeqi
- Faculty of Medicine, University of Prishtina "Hasan Prishtina" (UPHP), Rr. Bulevardi i Dëshmorëve, 10000, Prishtina, Republic of Kosovo
- Institute of Public Health of Kosova, 10000, Prishtina, Republic of Kosovo
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Akande-Sholabi W, Oyesiji E. Antimicrobial stewardship: knowledge, perceptions, and factors associated with antibiotics misuse among consumer's visiting the community pharmacies in a Nigeria Southwestern State. J Pharm Policy Pract 2023; 16:120. [PMID: 37821920 PMCID: PMC10566051 DOI: 10.1186/s40545-023-00629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND In middle-income countries like Nigeria, the misuse of antibiotics by consumers is posing serious threats to public health. This is contributing to the alarming increase in antimicrobial resistance, which is reducing the effectiveness of antibiotics against common infections. This study therefore aimed to assess the knowledge, perceptions, and factors associated with antibiotics misuse among consumers visiting selected community pharmacies. METHODS This cross-sectional study conducted in Ibadan, Nigeria, aimed at determining factors influencing antibiotics misuse among consumers. The questionnaires were completed by 509 consumers. The analysis was done using SPSS version 26 and the results were presented using descriptive statistics. The associations between categorical variables were analysed using Pearson's Chi-square with statistical significance set at p < 0.05. RESULTS Results showed that 95.9% of the consumers believed that antibiotics prevent bacterial growth, and 60.7% thought they treat all infections. However, 57.4% were unaware of antibiotic resistance, while only 14.7% had adequate knowledge about antibiotics. Most of the consumers, 72.5% had used antibiotics in the last 12 months and, amoxicillin 42.4% was the most commonly used with, malaria 38.9% as the primary condition for which antibiotics were used. Some of the significant factors influencing antibiotics misuse included delays in test reports (p-value = 0.007), the belief in antibiotics' quick relief (p-value = 0.001), proximity of the pharmacy to their house or workplace (p-value = 0.028), amongst others. CONCLUSION Most of the consumers had inadequate knowledge about rational antibiotic use which contributed to their misuse of antibiotics. Thus, targeted educational interventions are needed to improve knowledge and promote appropriate antibiotic use among consumers. Policies regulating the dispensing and selling of antibiotics with adequate counselling should be further enforced.
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Affiliation(s)
- Wuraola Akande-Sholabi
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Eunice Oyesiji
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Kanan M, Ramadan M, Haif H, Abdullah B, Mubarak J, Ahmad W, Mari S, Hassan S, Eid R, Hasan M, Qahl M, Assiri A, Sultan M, Alrumaih F, Alenzi A. Empowering Low- and Middle-Income Countries to Combat AMR by Minimal Use of Antibiotics: A Way Forward. Antibiotics (Basel) 2023; 12:1504. [PMID: 37887205 PMCID: PMC10604829 DOI: 10.3390/antibiotics12101504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Antibiotic overuse poses a critical global health concern, especially in low- and middle-income countries (LMICs) where access to quality healthcare and effective regulatory frameworks often fall short. This issue necessitates a thorough examination of the factors contributing to antibiotic overuse in LMICs, including weak healthcare infrastructure, limited access to quality services, and deficiencies in diagnostic capabilities. To address these challenges, regulatory frameworks should be implemented to restrict non-prescription sales, and accessible point-of-care diagnostic tools must be emphasized. Furthermore, the establishment of effective stewardship programs, the expanded use of vaccines, and the promotion of health systems, hygiene, and sanitation are all crucial components in combating antibiotic overuse. A comprehensive approach that involves collaboration among healthcare professionals, policymakers, researchers, and educators is essential for success. Improving healthcare infrastructure, enhancing access to quality services, and strengthening diagnostic capabilities are paramount. Equally important are education and awareness initiatives to promote responsible antibiotic use, the implementation of regulatory measures, the wider utilization of vaccines, and international cooperation to tackle the challenges of antibiotic overuse in LMICs.
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Affiliation(s)
- Mohammed Kanan
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh 12211, Saudi Arabia
| | - Maali Ramadan
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Hanan Haif
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Bashayr Abdullah
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Jawaher Mubarak
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Waad Ahmad
- Department of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (W.A.); (S.M.)
| | - Shahad Mari
- Department of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (W.A.); (S.M.)
| | - Samaher Hassan
- Department of Clinical Pharmacy, Jazan College of Pharmacy, Jazan 82726, Saudi Arabia;
| | - Rawan Eid
- Department of Pharmacy, Nahdi Company, Tabuk 47311, Saudi Arabia;
| | - Mohammed Hasan
- Department of Pharmacy, Armed Forces Hospital Southern Region, Mushait 62562, Saudi Arabia; (M.H.); (A.A.)
| | - Mohammed Qahl
- Department of Pharmacy, Najran Armed Forces Hospital, Najran 66256, Saudi Arabia;
| | - Atheer Assiri
- Department of Pharmacy, Armed Forces Hospital Southern Region, Mushait 62562, Saudi Arabia; (M.H.); (A.A.)
| | | | - Faisal Alrumaih
- Department of Pharmacy, Northern Border University, Rafha 76313, Saudi Arabia;
| | - Areej Alenzi
- Department of Infection Control and Public Health, Regional Laboratory in Northern Border Region, Arar 73211, Saudi Arabia;
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Aslan S, Çinar E, Ertürk NE, Baysal P. Investigation of the relationship between rational drug use and healthy lifestyle behaviours of university students. Glob Health Promot 2023; 30:23-30. [PMID: 36627828 DOI: 10.1177/17579759221134054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM the aim of this research is to investigate the relationship between rational drug use and healthy lifestyle behaviours of university students. METHOD this descriptive and cross-sectional study consisted of 1115 students from a university in the Southeast-East Anatolia Region in the autumn semester of the 2019-2020 academic year. In the collection of data, 'Student Introduction Form', 'The Rational Drug Use Scale' and 'The Health-Promoting Lifestyle Profile II' were used. Ethical approval was obtained from the Batman University Ethics Committee. In addition, necessary legal permissions were obtained from the institution where the study was conducted and from the students. Descriptive statistics, number, percentage, independent t-test, ANOVA test and Spearman's rank correlation were used in the Statistical Package for Social Science (SPSS) 22.0 package software to analyse the data. RESULTS the average age of the students was 21.31 ± 2.37 years, and their monthly drug expenditure was 142.63 ± 157.200 Turkish Lira. Some 28.1% of them were third-year students, 59% had graduated from Anatolian high school, 59.6% were living with their nuclear family, 49.1% had an equal level of income and expenditure, 7.7% had no chronic disease, and 9% had regular medication. Some 57.8% of them had health insurance. The Health-Promoting Lifestyle Profile II scale mean score of the students was 124.12 ± 21.37 and the Rational Drug Use Scale mean score was 33.65 ± 6.75. A statistically significant difference was found between the students' class, income, and the total mean scores of the health-promoting lifestyle profile II scale (p < 0.05). A statistically significant difference was found between the school type, family type and income status of the students and the total mean scores of the rational drug use scale (p < 0.05). CONCLUSION a strong positive correlation was found between rational drug use scale and the health-promoting lifestyle profile II scales.
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Affiliation(s)
- Sinan Aslan
- Nursing Department, School of Health Science, Batman University, Batman, Turkiye
| | - Ercan Çinar
- Nursing Department, School of Health Science, Batman University, Batman, Turkiye
| | - Nuriye Efe Ertürk
- Department of Nursing, Kahramanmaraş İstiklal University Health Faculty, Kahramanmaraş, Turkiye
| | - Peyda Baysal
- Pediatric Hematology and Oncology Service,Başakşehir Çam and Sakura City Hospital, İstanbul, Turkiye
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Vicar EK, Walana W, Mbabila A, Darko GK, Opare‐Asamoah K, Majeed SF, Obeng‐Bempong M. Drivers of household antibiotic use in urban informal settlements in Northern Ghana: Implications for antimicrobial resistance control. Health Sci Rep 2023; 6:e1388. [PMID: 37396564 PMCID: PMC10308355 DOI: 10.1002/hsr2.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/09/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023] Open
Abstract
Background Urban informal settlements have been described as the epicenters of frequent antibiotic misuse, which has local and global consequences on the goals of antimicrobial stewardship. The aim of this study was to assess the relationship between knowledge, attitude, and practices of antibiotic use among households in urban informal settlements in the Tamale metropolis of Ghana. Method This study was a prospective cross-sectional survey of the two major informal settlements in the Tamale metropolis, namely Dungu-Asawaba and Moshie Zongo. In all, 660 households were randomly selected for this study. Households with an adult and at least a child under 5 years old were randomly chosen. An adult with knowledge of household healthcare practices was selected to respond to a structured questionnaire. Results In all, 291 (44.1%) of the 660 households reported taking at least one type of antibiotic within the last month before the study and 30.9% (204/660) had used antibiotics without a prescription. Information on which antibiotics to use was obtained mostly from friends/family members 50 (24.5%) and were commonly purchased from a medical store or a pharmacy 84 (41.2%), saved up from a previously used antibiotic 46 (22.5%), a friend/family members 38 (18.6%), and drug hawkers 30 (14.7%). Amoxicillin 95 (26.0%) was the most frequently used antibiotic and the commonest indication for antibiotics use was diarrhea 136 (37.9%). Female respondents (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 2.199-4.301; p < 0.0001), larger households (OR = 2.02; 95% CI = 1.337-3.117; p = 0.0011) and those with higher monthly household income (OR = 3.39; 95% CI = 1.945-5.816; p < 0.0001) were more likely to have good knowledge of appropriate antibiotic use and antibiotic resistance. Furthermore, bad attitudes influenced participants' use of antibiotics without prescription (OR = 2.41; 95% CI = 0.432-4.05; p = 0.0009). Conclusion This study exposes the drivers of inappropriate use of antibiotics at the household level, particularly in urban informal settlements. Policy interventions aimed at controlling the indiscriminate use of antibiotics in such settlements could improve the responsible use of antibiotics. Keywords: antibiotic resistance, informal settlements, Tamale, Ghana.
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Affiliation(s)
- Ezekiel K. Vicar
- Department of Clinical MicrobiologyUniversity for Development StudiesTamaleGhana
| | - Williams Walana
- Department of Clinical MicrobiologyUniversity for Development StudiesTamaleGhana
| | | | | | - Kwame Opare‐Asamoah
- Department of Biological SciencesUniversity for Development StudiesTamaleGhana
| | - Saeed F. Majeed
- Department of Biological SciencesUniversity for Development StudiesTamaleGhana
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Sono TM, Yeika E, Cook A, Kalungia A, Opanga SA, Acolatse JEE, Sefah IA, Jelić AG, Campbell S, Lorenzetti G, Ul Mustafa Z, Marković-Peković V, Kurdi A, Anand Paramadhas BD, Rwegerera GM, Amu AA, Alabi ME, Wesangula E, Oluka M, Khuluza F, Chikowe I, Fadare JO, Ogunleye OO, Kibuule D, Hango E, Schellack N, Ramdas N, Massele A, Mudenda S, Hoxha I, Moore CE, Godman B, Meyer JC. Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance. Expert Rev Anti Infect Ther 2023; 21:1025-1055. [PMID: 37740561 DOI: 10.1080/14787210.2023.2259106] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. AREAS COVERED A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. EXPERT OPINION ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.
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Affiliation(s)
- Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Saselamani Pharmacy, Saselamani, South Africa
| | - Eugene Yeika
- Programs coordinator/Technical supervisor for HIV/Malaria, Delegation of Public Health, Cameroon
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Sylvia A Opanga
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Ana Golić Jelić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Vanda Marković-Peković
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Amanj Kurdi
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Bene D Anand Paramadhas
- Department of Health Services Management, Central Medical Stores, Ministry of Health, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
- DestinyMedical and Research Solutions Proprietary Limited, Gaborone, Botswana
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Kingdom of Eswatini
| | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences,University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Evelyn Wesangula
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Margaret Oluka
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Uganda
| | - Ester Hango
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, SouthAfrica
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, School of Veterinary Meicine, University of Zambia, Lusaka, Zambia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Brian Godman
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho HealthSciences University, Garankuwa, Pretoria, South Africa
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Sulis G, Sayood S, Gandra S. How can we tackle the overuse of antibiotics in low- and middle-income countries? Expert Rev Anti Infect Ther 2023; 21:1189-1201. [PMID: 37746828 DOI: 10.1080/14787210.2023.2263643] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Antibiotic overuse is a pressing global health concern, particularly in low- and middle-income countries (LMICs) where there is limited access to quality healthcare and insufficient regulation of antibiotic dispensation. This perspective piece highlights the challenges of antibiotic overuse in LMICs and provides insights into potential solutions to address this issue. AREAS COVERED This perspective explores key factors contributing to antibiotic overuse in LMICs, encompassing weak healthcare infrastructure, limited access to quality services, and deficiencies in diagnostic capabilities. It discusses regulatory frameworks to curb non-prescription sales, the role of accessible point-of-care diagnostic tools, challenges in implementing effective stewardship programs, the expanded use of vaccines, and the importance of health systems, hygiene, and sanitation. EXPERT OPINION In this article, we emphasize the need for a comprehensive approach involving collaboration among healthcare professionals, policymakers, researchers, and educators. We underscore the importance of improving healthcare infrastructure, enhancing access to quality services, and strengthening diagnostic capabilities. The article also highlights the significance of education and awareness in promoting responsible antibiotic use, the role of regulatory measures, the expanded utilization of vaccines, and the need for international collaboration to address the challenges of antibiotic overuse in LMICs.
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Affiliation(s)
- Giorgia Sulis
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sena Sayood
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Sumanth Gandra
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Arnau-Sánchez J, Jiménez-Guillén C, Alcaraz-Quiñonero M, Vigueras-Abellán JJ, Garnica-Martínez B, Soriano-Ibarra JF, Martín-Ayala G. Factors Influencing Inappropriate Use of Antibiotics in Infants under 3 Years of Age in Primary Care: A Qualitative Study of the Paediatricians' Perceptions. Antibiotics (Basel) 2023; 12:antibiotics12040727. [PMID: 37107089 PMCID: PMC10135072 DOI: 10.3390/antibiotics12040727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Antibiotic consumption in infants of less than three years is higher than average the average consumption for general population. The aim of this study was to explore paediatricians' opinions regarding factors influencing inappropriate use of antibiotics in early infancy in primary care. A qualitative study based on the grounded theory using convenience sampling was conducted in Murcia Region, Spain. Three focal discussion groups were developed with 25 participants from 9 health areas (HA) of Murcia Region. Paediatricians perceived that health care pressure was an influential factor in the prescribing behaviour, forcing them to prescribe antibiotics for a rapid cure in unjustified circumstances. Participants believed that antibiotic consuming was related to parents' self-medication due to their perceptions about the curative potential of antibiotics together with facilities to obtain these agents from pharmacies without prescription. The misuse of antibiotics by paediatricians was associated to the lack of education on antibiotic prescription and the limited use of clinical guidelines. Not prescribing an antibiotic in the presence of a potentially severe disease generated more fear than an unnecessary prescription. The clinical interaction asymmetry was more evident, when paediatricians use trapping risk strategies as a mechanism to justify a restrictive prescribing behaviour. The rational model of clinical decision-making in antibiotic prescribing among paediatricians was determined by factors associated with health care management, social awareness and knowledge of the population and pressure of families' demands. The present findings have contributed to the design and implementation of health interventions in the community for improving awareness of the appropriate use of antibiotics, as well as for a better quality of prescription by peadiatricians.
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Affiliation(s)
- José Arnau-Sánchez
- General Directorate of Health Planning, Research, Pharmacy and Citizen Services, Health Counseling of Murcia Region, 30001 Murcia, Spain
- Research Group of Murciano Institute of Biosanitary Research, IMIB, 30120 Murcia, Spain
- Faculty of Health Sciences, University of Murcia, 30120 Murcia, Spain
| | - Casimiro Jiménez-Guillén
- General Directorate of Health Planning, Research, Pharmacy and Citizen Services, Health Counseling of Murcia Region, 30001 Murcia, Spain
- National Plan for Antibiotic Resistance (PRAN) in Murcia Region, 30001 Murcia, Spain
| | | | | | | | - Juan Francisco Soriano-Ibarra
- Regional Paediatric, Murciano Health Service, 30100 Murcia, Spain
- Health Care Center of Lorca Sur, III Health Area, 30800 Murcia, Spain
| | - Gema Martín-Ayala
- General Directorate of Health Planning, Research, Pharmacy and Citizen Services, Health Counseling of Murcia Region, 30001 Murcia, Spain
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Nakakande J, Taremwa IM, Nanyingi M, Mugambe S. The Utility of Internet-Enabled Antibiotic Self-Medication and Its Associated Factors Among Patients Attending Private Clinics in Kawempe Division in Kampala Capital City, Uganda: Community-Based Cross-Sectional Study. Drug Healthc Patient Saf 2023; 15:85-91. [PMID: 37035632 PMCID: PMC10081524 DOI: 10.2147/dhps.s405072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023] Open
Abstract
Introduction The expanding practice of internet-based antibiotic self-medication raises public health concerns as it increases antibiotic resistance and introduces avoidable risks. This study aims to examine the utility of internet-enabled antibiotic self-medication and its associated factors among patients attending private clinics in Kawempe division in Kampala Capital City, Uganda. Methods This was an analytical cross-sectional study that enrolled participants attending private clinics in Kawempe Division's randomly selected zones. These were interviewed using a structured questionnaire, and the data were analyzed using STATA version 12 software. Logistic regression analysis was used, and variables with p ≤ 0.05 were considered as significantly associated with internet-enabled antibiotic self-medication. Results Out of the 313 respondents, 246 (79%) reportedly had ever used internet sources to self-medicate with antibiotics. Factors such as being male; single; had knowledge of antibiotics; believed that Internet should be used for antibiotic self-medication; Distance to the nearest medical center/hospital from your residence/workplace of about 5 km and residing near a drug shop/pharmacy that gives antibiotics without a prescription increased internet-enabled antibiotic self-medication. Furthermore, the variables of more than three household members; common practice of antibiotic self-medication in a household; did not agree that one can recover from the illness without a doctor's prescription and medical workers who did not explain adequately the antibiotics medication given for the illness decreased internet-enabled antibiotic self-medication. Conclusion This study found that internet-enabled antibiotic self-medication practice is highly utilized and is associated with a variety of individual, household, and healthcare system factors. This necessitates strict adherence to national drug policy regulations governing antibiotic use. Furthermore, community health education is critical in combating such medication practices.
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Affiliation(s)
- Joan Nakakande
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
- Correspondence: Joan Nakakande; Ivan Mugisha Taremwa, Email ;
| | - Ivan Mugisha Taremwa
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
| | - Miisa Nanyingi
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | - Samuel Mugambe
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
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20
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Ahmed I, King R, Akter S, Akter R, Aggarwal VR. Determinants of antibiotic self-medication: A systematic review and meta-analysis. Res Social Adm Pharm 2023; 19:1007-1017. [PMID: 37019706 DOI: 10.1016/j.sapharm.2023.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Decreasing the prevalence of antibiotic self-medication among the public requires proper understanding of the risk factors involved. However, the determinants of antibiotic self-medication are not well defined. OBJECTIVES To identify patient and health system-related determinants of antibiotic self-medication among the public. METHODS A systematic review of quantitative observational studies and qualitative studies was undertaken. PubMed, Embase, and Web of Science were searched to identify studies on determinants of antibiotic self-medication. The data were analyzed using meta-analysis, descriptive analysis, and thematic analysis. RESULTS Sixty-eight studies were included in the review. From meta-analyses, male sex (pooled odds ratio [POR]: 1.52, 95% confidence interval [CI]: 1.19-1.75), lack of satisfaction with healthcare services/physicians (POR: 3.53, 95% CI: 2.26-4.75) were associated with antibiotic self-medication. In subgroup analysis, lower age was directly associated with self-medication in high-income countries (POR: 1.61, 95% CI: 1.10-2.36). In low- and middle-income countries, people with greater knowledge of antibiotics were less likely to self-medicate (POR: 0.2, 95% CI: 0.08-0.47). Patient-related determinants identified from descriptive and qualitative studies included previous experience with antibiotics and similar symptoms, perceived low severity of disease, intention to save time and get better quickly, cultural beliefs about curative power of antibiotics, advice from family/friends, and having home stock of antibiotics. Health system-related determinants included high cost of consulting physicians and low cost of self-medication, lack of access to physician/medical care, lack of trust/confidence in physicians, greater trust in pharmacists, long distance of physicians/healthcare facilities, long waiting time at healthcare facilities, easy access to antibiotics from pharmacies, and convenience associated with self-medication. CONCLUSIONS Patient and health system-related determinants are associated with antibiotic self-medication. Interventions to decrease antibiotic self-medication should incorporate community programs along with appropriate policies and healthcare reforms targeting these determinants with specific attention to population at high risk of self-medication.
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21
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Glibić M, Bedeković L, Maglica M, Marijanović I, Vukoja D. Behavioral and Knowledge Patterns Regarding the Use of Antibiotics Among Urban and Rural Population in Bosnia and Herzegovina-a Cross-sectional Study. Mater Sociomed 2023; 35:33-41. [PMID: 37095872 PMCID: PMC10122528 DOI: 10.5455/msm.2023.35.33-41] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023] Open
Abstract
Background Antimicrobial resistance imposes one of the leading global health issues and is strongly associated with the overuse and misuse of antimicrobials. Objective The present study aimed to determine the level of knowledge, attitudes, and behavior regarding the use of antibiotics among urban and rural population in the southeastern European country of Bosnia and Herzegovina. Methods A cross-sectional questionnaire-based study was conducted by convenience sampling technique among people who visited health centers, malls, and also online. In total, 1057 questionnaires were completed, of which 920 were completed in the city of Mostar (i.e. urban area), while 137 in the municipality of Grude (i.e., rural area). Descriptive statistical analysis was performed to process the results. Results Participants from Mostar had better knowledge about antibiotics (p = 0.031) and a higher level of education (p = 0.001). Women showed markedly better knowledge in the group of urban area responders (p = 0.004). Improper use of antibiotics was more common among respondents from Grude; they tend to use antibiotics more frequently and almost half of them are prone to self-medication (p = 0.017). Overall, those classified with adequate knowledge showed less tendency to irregular antibiotic intake. Having a medical worker in a family was significantly associated with better knowledge regarding antibiotics, while educational level was not. Conclusion Although a significant number of respondents showed adequate knowledge about the use of antibiotics, there were noticeable irregular behavioral patterns, while significant differences between urban and rural population were detected as well. Further analysis is required to access the whole specter of the issue and to initiate policies directed toward reducing inappropriate use of antibiotics and bacterial resistance to these medications.
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Affiliation(s)
- Monika Glibić
- Health Center Mostar, Mostar, Bosnia and Herzegovina
| | - Leonora Bedeković
- Department of Histology and Embryology, School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
- Health Center Neum, Neum, Bosnia and Herzegovina
| | - Mirko Maglica
- Department of Human Anatomy, School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
- Health Center Livno, Livno, Bosnia and Herzegovina
| | | | - Damir Vukoja
- Internal Medicine Clinic, University Hospital Dubrava, Zagreb, Croatia
- Health Center Grude, Grude, Bosnia and Herzegovina
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Waffo Tchounga CA, Sacré PY, Ciza Hamuli P, Ngono Mballa R, De Bleye C, Ziemons E, Hubert P, Marini Djang’eing’a R. Prevalence of Poor Quality Ciprofloxacin and Metronidazole Tablets in Three Cities in Cameroon. Am J Trop Med Hyg 2023; 108:403-411. [PMID: 36535257 PMCID: PMC9896317 DOI: 10.4269/ajtmh.22-0221] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022] Open
Abstract
Quality is one of the essential components of medicines and needs to be ensured to preserve the population's health. This can be achieved through post-marketing quality control of medicines and is one of the most important duties of national regulatory authorities. In collaboration with the Cameroonian National Drug Quality Control and Valuation Laboratory, the decision was made to initiate a prevalence study to assess the quality of antiinfective medicines in Cameroon. A total of 150 samples of ciprofloxacin tablets and 142 samples of metronidazole tablets were collected from 76 licensed pharmacies and 75 informal vendors in three cities in Cameroon using a random strategy wherever possible and a mystery shopper approach. Three tests were carried out on each of the samples. Visual inspection allowed to find two falsified samples (0.7%) due to lack of information about the manufacturing company, and five more samples (1.7%) were deemed to be substandard due to flaws in the product. An additional 13 samples (4.5%) failed disintegration testing, and six (2.1%) others failed high-performance liquid chromatography assay testing due to insufficient active pharmaceutical ingredient (API) content. All samples were found to contain some API. A prevalence of 7.9% substandard or falsified (SF) medicines was found. Moreover, the prevalence of outlets selling SF medicines was greater in the informal sector (26.7%) than in the formal sector (2.6%). Although the prevalence of SF medicines found was low, efforts need to be made by national regulatory authorities to monitor the pharmaceutical market more closely.
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Affiliation(s)
- Christelle Ange Waffo Tchounga
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Pierre-Yves Sacré
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Patient Ciza Hamuli
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
- Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Rose Ngono Mballa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratoire National de Contrôle des Médicaments et Expertise, Yaoundé, Cameroon
| | - Charlotte De Bleye
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Eric Ziemons
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Philippe Hubert
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Roland Marini Djang’eing’a
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
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Etiology and clinical characteristics of pediatric acute fever among hospitalized children in an endemic malaria transmission area of Cameroon in Central Africa. PLoS One 2023; 18:e0278407. [PMID: 36693048 PMCID: PMC9873149 DOI: 10.1371/journal.pone.0278407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 11/15/2022] [Indexed: 01/25/2023] Open
Abstract
Acute fever in the majority of children in resource-limited countries is attributable to malaria and often treated without laboratory evidence. The aim of the study was to characterize acute pediatric infectious fevers (APIF) in the pediatric department of the Douala Laquintinie Hospital. A cross-sectional study was conducted among children aged 2 months to 15 years who were admitted with an acute fever (anal temperature ≥ 37.5°C less than 5 days in infants and 7 days in adolescents). 200 children were included and followed up during their hospitalization. The mean age was 3.7 (IQ25-75: 1-4.6) years. More than 3 out of 5 patients (62.5%) came from another health facility and anemia accounted for 29% of the reasons for consultation associated with fever. The main symptoms were vomiting (28%), cough (26%), convulsions (21%) and diarrhea (20%). Skin-mucosal pallor (43.0%) and hepatosplenomegaly (26.0%) were the most common physical signs encountered. Among febrile children, 116/200 (58%) were infected with at least 1 pathogen, and 1/200 (0.5%) had a fever of unknown etiology. Malaria (53% vs 80.5% presumptive) associated with anemia (95.3% of cases) was the most common pathology associated with APIF, followed by pneumonia (19.5%), meningitis (11.5%) and urinary tract infections (10% vs 54.5% presumptive). Malaria was over-diagnosed on admission and over-treated as well as urinary tract infection. A better understanding of common pathogens carriage, a better capacity for improved diagnosis and a better applied clinical algorithm for febrile illnesses in children are needed.
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Sadjo YW, Zilefac BN, Tchiekou Audrey K, Kamdem Stephane N, Ntep David Bienvenue N, Valentine N, Messanga Charles B. Evaluation of self-medication habits among patients at the Odontostomatology unit of a secondary health facility in Cameroon. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2023. [DOI: 10.1016/j.adoms.2023.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Kumar KS, Saranya S, Rani NV. Community Pharmacists' Knowledge, Attitude, and Nonprescription Dispensing Practices of Antibiotics: An Explorative Study in a Selected City of South India. J Res Pharm Pract 2022; 11:51-58. [PMID: 36798105 PMCID: PMC9926913 DOI: 10.4103/jrpp.jrpp_48_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
Objective This study aimed to assess the community pharmacists' knowledge of antibiotics, their attitude toward antibiotic usage and antibiotic resistance, and their nonprescription dispensing practices of antibiotics. Methods A cross sectional-questionnaire-based study was conducted among 75 community pharmacists practicing in a selected city of South India. Data on their age, years of experience, and educational qualifications were obtained. A modified, 33-items, prevalidated structured questionnaire was used to assess the community pharmacists knowledge, attitude, and nonprescription antibiotic dispensing practices knowledge, attitudes and practices (KAP). The responses obtained were expressed in descriptive statistics. The association between years of experience and their KAP was assessed using Pearson's correlation. Findings Most pharmacists (60%) agreed that antibiotics are used for bacterial infections, and 35% believed that antibiotics could be given for pain and inflammation. Fourty-one percentage of pharmacists agreed that dispensing antibiotics without prescription increases the risk of antibiotic resistance. Seventy-two percentage agreed that they are responsible for taking a prominent role in antimicrobial resistance and infection-control programs in healthcare. Only 46% of pharmacists stated that they always dispensed antibiotics only with a prescription, and 56% dispensed antibiotics for longer than the doctor prescribed. Amoxicillin, metronidazole, and cephalexin were the most commonly dispensed antibiotics without a prescription. The most common reason for dispensing antibiotics without a prescription was the fear of losing customers. Conclusion The study identified an average KAP interquartile range 1 among community pharmacists, indicating a lack of awareness of antibiotic resistance and dispensing antibiotics without a prescription.
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Affiliation(s)
- K. Sarath Kumar
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - S. Saranya
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Nagasubramanian Vanitha Rani
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Nagasubramanian Vanitha Rani, E-mail:
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Bert F, Previti C, Calabrese F, Scaioli G, Siliquini R. Antibiotics Self Medication among Children: A Systematic Review. Antibiotics (Basel) 2022; 11:1583. [PMID: 36358240 PMCID: PMC9687075 DOI: 10.3390/antibiotics11111583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 09/29/2023] Open
Abstract
The phenomenon of bacterial antimicrobial resistance (AMR) is a rapidly growing global problem. Overuse and misuse of antibiotics as well as self-prescription are among the most important causes contributing to the growth of antibiotic resistance in humans. This systematic review describes the phenomenon of antibiotics self-medication (ASM) in children. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist by searching PubMed, Scopus, and Web of Science until July 2022. Published English language studies containing information regarding parents knowledge, attitudes, and behaviors in self-administration of antibiotics in children were included. A total of 702 articles were identified, and 57 were selected. A higher prevalence of ASM among children was found in the Middle-East (34%), Africa (22%), Asia (20%) and South America (17%), while the lowest prevalence was found in Europe (8%). High distance from hospital, and low income, such as having more than one child, are related with an increased risk of ASM in children. Fever and cough can also promote the misuse of antibiotics by parents. A greater attention to the regulation of the sale of antimicrobial drugs can certainly limit the risk of self-medicating behavior.
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Affiliation(s)
- Fabrizio Bert
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
- Hygiene and Infection Control Unit, ASL TO3, 10098 Turin, Italy
| | - Christian Previti
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Francesco Calabrese
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Giacomo Scaioli
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Roberta Siliquini
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
- AOU City of Health and Science of Turin, 10126 Turin, Italy
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Hodson DZ, Mbarga Etoundi Y, Mbatou Nghokeng N, Mohamadou Poulibe R, Magne Djoko S, Goodwin J, Cheteug Nguesta G, Nganso T, Armstrong JN, Andrews JJ, Zhang E, Wade M, Eboumbou Moukoko CE, Boum Y, Parikh S. Clinical characteristics of Plasmodium falciparum infection among symptomatic patients presenting to a major urban military hospital in Cameroon. Malar J 2022; 21:298. [PMID: 36273147 PMCID: PMC9588226 DOI: 10.1186/s12936-022-04315-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Urban malaria has received insufficient attention in the literature. The prevalence and clinical characteristics of Plasmodium falciparum infection amongst patients presenting with suspected malaria were investigated at a major urban hospital in Douala, Cameroon with a particular focus on anaemia. METHODS A cross-sectional, 18-week demographic and clinical survey was conducted of patients presenting to the Emergency Department of Douala Military Hospital with suspected malaria, largely defined by the presence or recent history of fever. Venous samples were tested for P. falciparum using rapid diagnostic tests and PCR, and anaemia was defined by haemoglobin level according to WHO definitions. Likelihood ratios (LR), odds ratios (OR), and population attributable risk percent (PARP) were calculated. RESULTS Participants were ages 8 months to 86 years, 51% were women (257/503), and all districts of Douala were represented. Overall, 38.0% (n = 189/497) were anaemic, including 5.2% (n = 26/497) with severe anaemia. Anaemia prevalence was significantly higher (OR: 2.20, 95% CI 1.41-3.45) among children < 15 years (53.1%, n = 52/98) compared to adults (34%, n = 133/392). Plasmodium falciparum was detected in 37.2% by nested PCR. Among all participants, several factors were associated with clinically significant LR for P. falciparum infection, including age 10-14 years (positive LR: 3.73), living in the island district of Douala VI (positive LR: 3.41), travel to any of three northern regions (positive LR: 5.11), and high fever > 40 °C at presentation (positive LR: 4.83). Among all participants, 8.7% of anaemia was associated with P. falciparum infection, while the PARP was 33.2% among those < 15 years of age and 81.0% among 10-14-year-olds. CONCLUSIONS The prevalence of P. falciparum infection in the urban hospital was high. Mirroring trends in many rural African settings, older children had the highest positivity rate for P. falciparum infection. Anaemia was also common in all age groups, and for those 10-14 years of age, 80% of the risk for anaemia was associated with P. falciparum infection. Malaria rates in major urban population centres can be high, and more research into the multifactorial causes of anaemia across the age spectrum are needed.
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Affiliation(s)
| | - Yannick Mbarga Etoundi
- Douala Military Hospital, Douala, Cameroon
- Douala Military Hospital School of Nursing, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | | | | | - Justin Goodwin
- Yale School of Medicine, New Haven, USA
- Yale School of Public Health, New Haven, USA
| | - Glwadys Cheteug Nguesta
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Tatiana Nganso
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | | | | | | | - Carole Else Eboumbou Moukoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Malaria Research Service, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Yap Boum
- Epicentre, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Sunil Parikh
- Yale School of Medicine, New Haven, USA.
- Yale School of Public Health, New Haven, USA.
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Edessa D, Assefa N, Dessie Y, Asefa F, Dinsa G, Oljira L. Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis. J Pharm Policy Pract 2022; 15:57. [PMID: 36180895 PMCID: PMC9524137 DOI: 10.1186/s40545-022-00454-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries. METHODS A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage. RESULTS In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40-50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49-62%) than those studies with community surveys (40%; 95% CI: 34-46%) (P = 0.001). It was also varied by the recall period of antibiotics use-56% (95% CI: 50-62%) for instantly observed practice, 36% (95% CI: 22-50%) for within two week recall, 35% (95% CI: 26-45%) for 1-6 months recall, and 46% (95% CI: 37-54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets. CONCLUSIONS We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries. TRIAL REGISTRATION NUMBER CRD42021288971 (PROSPERO). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .
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Affiliation(s)
- Dumessa Edessa
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center-Oak Ridge National Laboratory (UTHSC-ORNL, Memphis, TN, USA
| | - Girmaye Dinsa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Cruz JC, Perez CZ, Cabrera MCS, Lopez ER, Hoyos PV, Rojas Rojas D, Montaña AO. Factors associated with self-medication of antibiotics by caregivers in pediatric patients attending the emergency department: a case-control study. BMC Pediatr 2022; 22:520. [PMID: 36050652 PMCID: PMC9434513 DOI: 10.1186/s12887-022-03572-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Antibiotic self-medication is a common practice in pediatric caregivers in low-income countries with limited resources and represents a public health problem. Our study sought to determine what factors are associated with this practice, including differences in knowledge or attitudes of caregivers who attend a pediatric emergency service. Methods Case-control study based on surveys of caregivers of pediatric patients brought to the emergency room with clinical symptoms suggestive of acute infection. Cases were defined as those caregivers who reported self-medication of antibiotics for the current illness and controls where those who did not report self-medication. Information was collected through a self-administered questionnaire that inquired about demographic and family characteristics, attitudes and knowledge toward self-medication of antibiotics. Data were compared using logistic regression and are presented with odd ratios and confidence intervals. Results A total of 728 caregivers, 182 cases and 546 controls were included. We found that higher parental education, both in mothers (OR 0.56, 95% CI 0.40-0.79) and fathers (OR 0.62, 95% CI 0.43-0.89) was associated with less self-medication. Attitudes such as always requesting antibiotics from their doctors (OR 3.92, 95% CI 1.59-9.66), frequently buying antibiotics without a prescription (OR 23.66, 95% CI 11.76-47.59) and giving advice on antibiotics among family members (OR 2.90, 95% CI 1.75-4.82) resulted in an increased likelihood of self-medication. There was also a higher probability of antibiotic self-medication in older children (OR 1.13, 95% CI 1.09-1.17), those with a greater number of siblings (OR 1.25, 95% CI 1.09-1.43) and in those cases that received antibiotics within the last 3 months (OR 6.27, 95% CI 4.35-9.04). Overall knowledge of risk of antibiotic self-medication was low. Conclusions Some patient and family characteristics such as age, number of siblings, recent antibiotic usage and inappropriate attitudes are strongly related to antibiotic self-medication. These findings will inform future interventions to reduce self-medication in children.
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Affiliation(s)
- Jhon Camacho Cruz
- Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia. .,Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Calle 10 No.18-75, Bogotá, Colombia.
| | | | | | | | - Pablo Vásquez Hoyos
- Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.,Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Calle 10 No.18-75, Bogotá, Colombia
| | - Diana Rojas Rojas
- Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.,Department of Pediatrics, Hospital Infantil Universitario de San José, Bogotá, Colombia
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Nguyen TTP, Do TX, Nguyen HA, Nguyen CTT, Meyer JC, Godman B, Skosana P, Nguyen BT. A National Survey of Dispensing Practice and Customer Knowledge on Antibiotic Use in Vietnam and the Implications. Antibiotics (Basel) 2022; 11:antibiotics11081091. [PMID: 36009960 PMCID: PMC9405246 DOI: 10.3390/antibiotics11081091] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
Misconceptions and pressures have increased the sales of antibiotics without a prescription across countries. There are concerns with such practices in Vietnam given rising antimicrobial resistance rates. A national survey was conducted among 360 private drugstores located in nine provinces in Vietnam. Anonymous interviews were conducted with participants selected by convenience sampling. Subsequently, multivariable logistic regression analyses were undertaken evaluating the relationship between customer characteristics and antibiotic purchases. A total of 480 out of 1626 surveyed participants purchased antibiotics, 81.7% of which did not have a prescription, involving 29 different antibiotics. In 86.4% of these, participants were prescribed antibiotics by drug sellers. Most antibiotics were sold to treat respiratory tract infections (61.4%), with the ‘Access’ antibiotics (amoxicillin and cephalexin) being the most frequently sold. Only one-fifth of participants understood that they were breaking the law by purchasing antibiotics without a prescription. Participants purchasing antibiotics without a prescription had lower awareness concerning antibiotic laws and treatment duration (p < 0.05). Under 50% agreed to having a doctors’ prescription in the future when purchasing antibiotics. Freelancer occupation (OR = 0.52, 95% CI = 0.83−0.96) and a lower educational level (OR = 0.49, 95% CI = 0.25−0.96) were factors related to purchasing antibiotics without a prescription. Overall, we recommend increasing fines and monitoring of drugs stores, greater promotion of the family doctor system as well as increasing media and educational campaigns to limit self-purchasing of antibiotics in Vietnam and reduce resistance.
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Affiliation(s)
- Thuy Thi Phuong Nguyen
- Department of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi City 10000, Vietnam
| | - Thang Xuan Do
- Department of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi City 10000, Vietnam
| | - Hoang Anh Nguyen
- The National Center of Drug Information & Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi City, 10000, Vietnam
- Bach Mai Hospital, Hanoi City 10000, Vietnam
| | - Cuc Thi Thu Nguyen
- Department of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi City 10000, Vietnam
- Correspondence: (C.T.T.N.); (B.G.)
| | - Johanna Catharina Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
- Correspondence: (C.T.T.N.); (B.G.)
| | - Phumzile Skosana
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Binh Thanh Nguyen
- Department of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi City 10000, Vietnam
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Pogurschi EN, Petcu CD, Mizeranschi AE, Zugravu CA, Cirnatu D, Pet I, Ghimpețeanu OM. Knowledge, Attitudes and Practices Regarding Antibiotic Use and Antibiotic Resistance: A Latent Class Analysis of a Romanian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127263. [PMID: 35742513 PMCID: PMC9224212 DOI: 10.3390/ijerph19127263] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023]
Abstract
Considering the major limitations of the latest studies conducted in Romania on the knowledge, attitudes and practices (KAPs) of antibiotic use and antibiotic resistance, we conducted this study to assess this major public health threat. A cross-sectional survey based on a validated questionnaire was conducted among the general population of Romania for a period of 5 months, i.e., September 2021-January 2022. The questionnaire was distributed using Google Form and it covered demographic characteristics and KAP assessments consisting of 12 items on knowledge, 10 items on attitudes and 3 items on practices. Latent class analyses (LCAs) were conducted to group respondents based on their responses. The response rate was 77%, of which females responded in a greater number (n = 1251) compared to males (n = 674). For most of the respondents (67.32%, n = 1296), the education level was high school, while 23.58% (n = 454) of respondents were college graduates. One in three Romanians (33.3%) know the WHO predictions related to this topic. Overall, the Romanian population is less disciplined when it comes to completing antibiotic treatments, as 29.19% of the respondents stop the course of antibiotic administration if their symptoms improve. The key findings from the present study may help policy makers in designing targeted interventions to decrease confusion, ambiguity or misconceptions about antibiotic use.
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Affiliation(s)
- Elena Narcisa Pogurschi
- Public Health and Food Safety Laboratory, Department Formative Science in Animal Breeding and Food Industry, Faculty of Animal Productions Engineering and Management, University of Agronomic Sciences and Veterinary Medicine of Bucharest, 011464 Bucharest, Romania;
| | - Carmen Daniela Petcu
- Department Animal Production and Public Health, Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine of Bucharest, 050097 Bucharest, Romania;
| | | | - Corina Aurelia Zugravu
- Department-Fundamental Disciplines, Faculty of Midwifery and Nursing, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Daniela Cirnatu
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, “Vasile Goldis” Western University of Arad, 310025 Arad, Romania;
| | - Ioan Pet
- Department of Biotechnologies, Bioengineering, Faculty of Animal Resources, Banat University of Agricultural Science and Veterinary Medicine “Regele Mihai I al Romaniei”, 300645 Timisoara, Romania;
| | - Oana-Mărgărita Ghimpețeanu
- Department Animal Production and Public Health, Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine of Bucharest, 050097 Bucharest, Romania;
- Correspondence: ; Tel.: +40-724529434
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Patterns of Antibiotic Resistance in Enterobacteriaceae Isolates from Broiler Chicken in the West Region of Cameroon: A Cross-Sectional Study. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:4180336. [PMID: 35722039 PMCID: PMC9203226 DOI: 10.1155/2022/4180336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/12/2022] [Accepted: 05/21/2022] [Indexed: 11/18/2022]
Abstract
Background. The emergence of multidrug-resistant food-borne pathogens of animal origin including Enterobacteriaceae is a growing concern. Identifying and monitoring resistance in isolates from human-related environments are of clinical and epidemiological significance in containing antimicrobial resistance. This study aimed to contribute towards the fight against antibiotic resistance and ameliorate the management/treatment of Enterobacteriaceae-linked diseases in Cameroon. Methods. Cloacal swabs from healthy broilers were enriched in buffered-peptone-water and cultured on EMB agar. Antibiotic susceptibility was tested on Mueller-Hinton-Agar by disc diffusion. Plasmid-borne genes for extended-spectrum beta lactamase (ESBL) and resistance to Quinolones (PMQR) and Aminoglycosides were detected by standard endpoint polymerase chain reaction (PCR). Results. A total of 394 isolates were identified belonging to 12 Enterobacteriaceae genera, the most prevalent were Escherichia coli (81/394 = 20.56%), Salmonella spp (74/394 = 18.78%), and Klebsiella spp (39/394 = 9.90%) respectively. Overall, 84/394 (21.32%) were ESBL producers, 164/394 (41.62%) were resistant to quinolones, 66/394 (16.75%) resistant to aminoglycosides with 44.0% (173/394) expressing MDR phenotype. Poor hygiene practice (OR 2.55, 95% CI: 1.67, 3.89,
) and rearing for >45 days, (OR = 7.98, 95% CI: 5.05, 12.6,
) were associated with increased carriage of MDR. Plasmid-borne resistance genes were detected in 76/84 (90.48%) of ESBL-producing isolates, 151/164 (92.07%) quinolone resistant isolates and 59/66 (89.39%) aminoglycoside resistant isolates with co-occurrence of two or more genes per isolate in 58/84 (69.05%) of ESBLs, 132/164 (80.49%) of quinolone resistant isolates and 28/66 (42.42%) of aminoglycoside resistant isolates. Conclusion. This study found high carriage and widespread distribution of Enterobacteriaceae with ESBL and MDR in broiler chicken in the West Region of Cameroon. Most PMQR genes in bacteria were found at levels higher than is seen elsewhere, representing a risk in the wider human community.
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Ahmad T, Khan FU, Ali S, Rahman AU, Ali Khan S. Assessment of without prescription antibiotic dispensing at community pharmacies in Hazara Division, Pakistan: A simulated client's study. PLoS One 2022; 17:e0263756. [PMID: 35176043 PMCID: PMC8853528 DOI: 10.1371/journal.pone.0263756] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/25/2022] [Indexed: 12/30/2022] Open
Abstract
Antibiotics dispensing without a prescription is an irrational practice and can increase the risk of antibiotic resistance, which is a significant public health concern around the globe. This study was aimed to determine the extent to which antibiotics are supplied without prescription in the community pharmacies (CPs) at Hazara Division from November 2020 to February 2021. The simulated client method (SCM) was used, and the data were gathered, recorded, and analyzed through different statistical methods with descriptive and inferential techniques. The antibiotic dispensing was observed in CPs (90.5%), the most dispensed antibiotics were azithromycin (29.4%) and ciprofloxacin (46.5%) respectively. Furthermore, visited medical stores/ drug outlets, 9.5% of the visited stores denied dispensing of antibiotics because they preferred a referral to visit physicians (23. 9%) and (12.8%) did not had the antibiotics at the time of visits. Antibiotics were more obtainable in retail medical stores (AOR = 8.6, 95 percent Cl: 3.0–24.7; p = 0.001) than in pharmacies. In rural areas antibiotics dispensing was more (p = 0.004) as compared to urban areas. Staff members also had asked about patient’s (17.7%) symptoms and drug allergies (12.3% and 3.9%), and (1.5%) they consoled them about their medications. The findings of this study indicate that nonprescription antibiotic sales are very common, despite national rules prohibiting this activity. When the simulated Client requested for any medication to relieve his or her discomfort, many antibiotics were given out without a prescription. Pharmacies/medical stores in Hazara Division selling antibiotics without a prescription are worrying and need immediate action by regulators.
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Affiliation(s)
- Tawseef Ahmad
- Department of Pharmacy, COMSATS University Islamabad-Abbottabad Campus, Abbottabad, Pakistan
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
| | - Sayyad Ali
- Department of Pharmacy, COMSATS University Islamabad-Abbottabad Campus, Abbottabad, Pakistan
| | - Asad Ur Rahman
- Department of Pharmacy, COMSATS University Islamabad-Abbottabad Campus, Abbottabad, Pakistan
| | - Shujaat Ali Khan
- Department of Pharmacy, COMSATS University Islamabad-Abbottabad Campus, Abbottabad, Pakistan
- * E-mail: ,
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Yin L, Wang K, Zhang T, Liu H, Li Y, Luo J. The Survey on Adolescents' Cognition, Attitude, and Behavior of Using Analgesics: Take Sichuan and Chongqing as an Example. Front Public Health 2022; 10:744685. [PMID: 35299697 PMCID: PMC8921534 DOI: 10.3389/fpubh.2022.744685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/17/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives To explore the current situation of knowledge, attitude, and behavior about the correct use of analgesics among adolescents in Western Sichuan and Chongqing and its related factors and to provide a reference for health promotion schools to promote correct medication education and relevant policy-making. Methods A questionnaire survey was conducted among senior high school students in Sichuan and Chongqing by stratified random sampling. A total of 48 classes were surveyed and 2,280 valid questionnaires were obtained. Descriptive analysis, mean value comparison, and multiple regression analysis were conducted for the data using SPSS17.0 statistical analysis software. Results (1) It showed that 65.5% of the students used methods other than drugs to deal with pain, 52.9% of the students took analgesics prescribed by doctors, more than 60% of the students got information about pain treatment from medical professionals or their families members, 71.6% of the students read the use label when using drugs, and only about 20% of the students knew the dosage and side effects of analgesics. (2) The higher the grade, the higher the proportion of students who often take analgesics prescribed by doctors, the higher the proportion of students who use methods other than drugs to relieve pain, the higher the proportion of students who read the label of analgesics, and the more information sources are introduced by family members. The better the knowledge, attitude, efficacy, and accomplishment of using analgesics, the better the behavior of using analgesics correctly. (3) Students who had taken analgesics provided by their family or friends and who had taken anti-inflammatory analgesics did not perform well in the correct use of analgesics. Conclusion The key factors that influence the correct drug use behavior of middle school students are their correct drug use literacy, efficacy, attitude, and reading of analgesics. Therefore, schools should strengthen cooperation with pharmacists and encourage the promotion of parent-child education activities of correct drug use.
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Affiliation(s)
- Lian Yin
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
- Chongqing Medical and Health School, Chongqing, China
| | - Kun Wang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Tingran Zhang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Chonbuk National University, Jeonju-si, South Korea
| | - Hengxu Liu
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Yinghong Li
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Jiong Luo
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
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Perception and practice of self-medication with antibiotics among medical students in Sudanese universities: A cross-sectional study. PLoS One 2022; 17:e0263067. [PMID: 35081149 PMCID: PMC8791537 DOI: 10.1371/journal.pone.0263067] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/11/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction The benefits of antibiotics are under threat by self-medication, which culminated in economic burdening of developing countries, treatment failures, the emergence of antibiotic-resistant strains of bacteria and an increased probability of exposure and infection of the general population by antibiotic-resistant bacterial strains. Objectives This study aimed to evaluate the knowledge and attitude of medical students in Sudan towards the use of antibiotics, the prevalence of self-medication with antibiotics among medical students in Sudan and to identify risk factors which promote self-medication with antibiotics. Materials and methods This was a cross-sectional, descriptive and institution-based study, between November 2020 and May 2021. 1,110 medical students were selected by multistage cluster sampling. Logistic regression was used to identify risk factors of self-medication with antibiotics among the study participants. Results The median knowledge score was 7 out of a maximum of 10 (IQR: 5–8). A moderately positive attitude was observed among the participants (Median: 7/10; IQR: 6–8). Knowledge and attitude scores were significantly associated with academic year and monthly allowance (p < 0.05). 675 (60.8%) self-medicated with antibiotics within the previous 12 months, mostly from community pharmacies (321/675; 47.5%). Antibiotics were most commonly used to treat respiratory tract infections (38.1%) and cough (30.4%). Chi-square analysis demonstrated that self-medication with antibiotics was significantly associated with gender, year of study and monthly income. Conclusions Undergraduate medical students had moderate knowledge and attitude towards antibiotic use and antibiotic resistance, and an alarmingly high prevalence of self-medication with antibiotics. This highlights the urgent need for tighter legislation regarding the sales of antibiotics in community pharmacies by the state and federal health ministries.
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Or PL, Ching TY. The effectiveness of raising Hong Kong parents' awareness of antimicrobial resistance through an education program with peer support on social media: a randomized, controlled pilot study. BMC Public Health 2022; 22:315. [PMID: 35168586 PMCID: PMC8845248 DOI: 10.1186/s12889-022-12697-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to address the misuse of antibiotics and test the feasibility of an education program with peer support on social media in improving parents’ knowledge on antimicrobial resistance at a regional level in Hong Kong. This pilot, if successful, will be developed into a main study. Methods A cluster randomized controlled trial with two-arms were implemented. The intervention program consisted of two weekly sessions and each session lasted for 90 min. Parents in the intervention group would join a Facebook Page of Antibiotic Use, this online platform would allow participants to build a social network. A total of 48 parents had participated in the program. Parental knowledge and attitude were measured before and after the program using the Parental Perception on Antibiotics (PAPA) scale and the General Self-Efficacy Scale (GSE) to assess differences between and within the intervention and control groups. Results All parents in the intervention group had an understanding that antibiotics could be effective at treating some infections only, as compared to 40% in the control group. All parents in the intervention group and 85% of the control group disagreed that they should reduce the dose of antibiotics when their children were recovering. The test was statistically significant (p = 0.039) at p < 0.05. There were a significant difference and a strong negative correlation between peer support on Facebook and the parents’ belief that antibiotics could be stopped when their children felt better, with Pearson coefficient of − 0.78 at p < 0.001. In general, there was no significant difference between the two groups with respect to the scale. Conclusions Based on the findings in this pilot study, a further study focused on the education program with enhancement and peer support should be implemented on a larger scale with considerations of how it might support reducing incidence of antimicrobial resistance and potentially influencing prescription expectations of patients when seeking healthcare. Trial registration Retrospectively registered Chinese Clinical Trial Registry ChiCTR2100044870. Registered on 31 March 2021.
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Affiliation(s)
- Pui-Lai Or
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China.
| | - Tai-Yin Ching
- WHO Collaboration Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong, China
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Akodu B, Bisola R, Temitope LA, Abdulrazzaq L, Philip O, Ibukunoluwa B, Patrick O, Olufunmilayo OA, Ganiya O, Chioma O, Oyinlola O. Knowledge, attitude, and prescribing practices of antimicrobials among doctors in the outpatient departments of Lagos university teaching hospital Idi-Araba: A cross sectional study. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_32_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Browne AJ, Chipeta MG, Haines-Woodhouse G, Kumaran EPA, Hamadani BHK, Zaraa S, Henry NJ, Deshpande A, Reiner RC, Day NPJ, Lopez AD, Dunachie S, Moore CE, Stergachis A, Hay SI, Dolecek C. Global antibiotic consumption and usage in humans, 2000-18: a spatial modelling study. Lancet Planet Health 2021; 5:e893-e904. [PMID: 34774223 PMCID: PMC8654683 DOI: 10.1016/s2542-5196(21)00280-1] [Citation(s) in RCA: 405] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a serious threat to global public health. WHO emphasises the need for countries to monitor antibiotic consumption to combat AMR. Many low-income and middle-income countries (LMICs) lack surveillance capacity; we aimed to use multiple data sources and statistical models to estimate global antibiotic consumption. METHODS In this spatial modelling study, we used individual-level data from household surveys to inform a Bayesian geostatistical model of antibiotic usage in children (aged <5 years) with lower respiratory tract infections in LMICs. Antibiotic consumption data were obtained from multiple sources, including IQVIA, WHO, and the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). The estimates of the antibiotic usage model were used alongside sociodemographic and health covariates to inform a model of total antibiotic consumption in LMICs. This was combined with a single model of antibiotic consumption in high-income countries to produce estimates of antibiotic consumption covering 204 countries and 19 years. FINDINGS We analysed 209 surveys done between 2000 and 2018, covering 284 045 children with lower respiratory tract infections. We identified large national and subnational variations of antibiotic usage in LMICs, with the lowest levels estimated in sub-Saharan Africa and the highest in eastern Europe and central Asia. We estimated a global antibiotic consumption rate of 14·3 (95% uncertainty interval 13·2-15·6) defined daily doses (DDD) per 1000 population per day in 2018 (40·2 [37·2-43·7] billion DDD), an increase of 46% from 9·8 (9·2-10·5) DDD per 1000 per day in 2000. We identified large spatial disparities, with antibiotic consumption rates varying from 5·0 (4·8-5·3) DDD per 1000 per day in the Philippines to 45·9 DDD per 1000 per day in Greece in 2018. Additionally, we present trends in consumption of different classes of antibiotics for selected Global Burden of Disease study regions using the IQVIA, WHO, and ESAC-net input data. We identified large increases in the consumption of fluoroquinolones and third-generation cephalosporins in North Africa and Middle East, and south Asia. INTERPRETATION To our knowledge, this is the first study that incorporates antibiotic usage and consumption data and uses geostatistical modelling techniques to estimate antibiotic consumption for 204 countries from 2000 to 2018. Our analysis identifies both high rates of antibiotic consumption and a lack of access to antibiotics, providing a benchmark for future interventions. FUNDING Fleming Fund, UK Department of Health and Social Care; Wellcome Trust; and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Annie J Browne
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michael G Chipeta
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgina Haines-Woodhouse
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emmanuelle P A Kumaran
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bahar H Kashef Hamadani
- Oxford Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sabra Zaraa
- School of Pharmacy and School of Public Health, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nicholas P J Day
- Oxford Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Alan D Lopez
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susanna Dunachie
- Oxford Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Catrin E Moore
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andy Stergachis
- School of Pharmacy and School of Public Health, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Christiane Dolecek
- Oxford Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Sun N, Gong Y, Liu J, Wu J, An R, Dong Y, Zhu Y, Mu K, Zhang G, Yin X. Prevalence of Antibiotic Purchase Online and Associated Factors Among Chinese Residents: A Nationwide Community Survey of 2019. Front Pharmacol 2021; 12:761086. [PMID: 34803704 PMCID: PMC8595837 DOI: 10.3389/fphar.2021.761086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Online sales of antibiotics have increased public access to these medicines. This study aimed to analyze the online antibiotic purchase behavior of the Chinese residents and identify its associated factors. Methods: We conducted a nationwide cross-sectional online survey among Chinese community residents from January 20 to February 28, 2019. A structured questionnaire was used to collect data on their sociodemographic characteristics, health-related variables, and the online antibiotic purchase behavior in the past 3 months. Descriptive statistics and logistic regression analyses were used. The statistical analyses were performed using SAS version 9.4 (SAS Institute Inc.). Results: A total of 101,120 respondents were included in the analysis. The weighted prevalence of antibiotic purchase online was 3.71% (95% CI, 3.53–3.88%). Residents who purchased antibiotics online were more likely to be older (age≥65 years), be a male, live in rural areas, have a higher education level, report an excellent economic status, suffer from chronic diseases, and search for health information on the internet. Conclusion: Numerous residents had purchased antibiotics online in the past 3 months throughout China. We should pay more attention to this behavior. There is a need to strengthen regulation of antibiotic sales online and improve public education on antibiotic purchase online. More comprehensive information on antibiotic purchase online as well as the advantages and disadvantages of online sales of antibiotics should be investigated in the future studies.
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Affiliation(s)
- Na Sun
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaming Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianxiong Wu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongrong An
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Dong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Zhu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ketao Mu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guopeng Zhang
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Burtscher D, Van den Bergh R, Nasim M, Mahama G, Au S, Williams A, Sattar A, Penfold S, Van Overloop C, Bajis S. 'They eat it like sweets': A mixed methods study of antibiotic perceptions and their use among patients, prescribers and pharmacists in a district hospital in Kabul, Afghanistan. PLoS One 2021; 16:e0260096. [PMID: 34797865 PMCID: PMC8604360 DOI: 10.1371/journal.pone.0260096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a growing public health threat. In Afghanistan, high levels of indiscriminate antibiotic use exist, and healthcare programmes are not informed by understanding of local attitudes towards rational antibiotic use. Médecins Sans Frontières is an international non-governmental organization providing healthcare services to the Ahmad Shah Baba (ASB) District Hospital in Kabul, Afghanistan, since 2009. This mixed-methods study aimed to explore the perceptions and attitudes toward antibiotics among patients, prescribers, and pharmacists in the ASB District hospital outpatient department. METHODS AND FINDINGS Knowledge of antibiotics including their purpose and function, how and why they are used, and drivers for choice of antibiotic was examined at patient, prescriber, and provider-level. The first phase of the study, an exploratory qualitative component using an interpretative approach, was used to inform the second phase, a structured survey. Thirty-six interviews were conducted with 39 participants (21 patients or caretakers and 18 hospital health workers). Three hundred and fifty-one (351) patients and caretakers completed the second phase, the structured survey. This study found that poor knowledge of antibiotics and antibiotic resistance is a driving factor for inappropriate use of antibiotics. Participant perceptions of living in a polluted environment drove the high demand and perceived 'need' for antibiotics: patients, doctors and pharmacists alike consider dirty and dusty living conditions as causes of 'disease' in the body, requiring antibiotics to 'clean' and 'strengthen' it. CONCLUSIONS Findings highlight the need for strategies to improve awareness and knowledge of the general public, improve practice of doctors and pharmacists, regulate antibiotic dispensing in private pharmacies, and implement antibiotic stewardship in hospitals.
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Affiliation(s)
- Doris Burtscher
- Vienna Evaluation Unit, Médecins Sans Frontières, Vienna, Austria
| | | | - Masood Nasim
- Médecins Sans Frontières Afghanistan, Kabul, Afghanistan
| | - Gbane Mahama
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Sokhieng Au
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Anita Williams
- Operational Research (LuxOR) Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
- Middle East Medical Unit (MEMU), Médecins Sans Frontières, Beirut, Lebanon
| | - Abdul Sattar
- Ahmad Shah Baba Hospital, Ministry of Public Health, Kabul, Afghanistan
| | - Suzanne Penfold
- Independent Public Health Research Consultant, Trnava, Slovakia
| | | | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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Tertiary hospitals physician's knowledge and perceptions towards antibiotic use and antibiotic resistance in Cameroon. BMC Infect Dis 2021; 21:1116. [PMID: 34715797 PMCID: PMC8555219 DOI: 10.1186/s12879-021-06792-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infections due to resistant bacteria are associated with severe illness, increased risk for complications, hospital admissions, and higher mortality. Inappropriate use of antibiotics, which contributes to increased antibiotic resistance (ABR), is common in healthcare settings across the globe. In Cameroon, antibiotics have been reported as high as 45-70% of prescriptions. We sought to investigate the knowledge, attitudes, and perceptions regarding appropriate antibiotic use and ABR of medical doctors practicing in tertiary hospitals in Yaoundé, Cameroon. METHODS We conducted a cross-sectional survey using a 54-item self-administered questionnaire sent via email to medical doctors working in the four major tertiary hospitals of Yaoundé. The questionnaire recorded socio-demographics, perceptions on antibiotic use and ABR, sources and usefulness of education on ABR, and clinical scenarios to appraise knowledge. RESULTS A total of 98/206 (48%) doctors responded. Years of experience ranged between 1 and 17 years. Most participants agreed that ABR is a problem nationwide (93%) and antibiotics are overused (96%), but only one third (32%) thought that ABR was a problem in their wards. Most respondents (65%) were confident that they use antibiotics appropriately. We found a mean knowledge score of 56% (± 14), with prescribers not influenced by patient-exerted pressure for antibiotic prescribing scoring better compared to those influenced by patients (67% vs 53%, p = 0.01). Overall, most participants (99%) expressed interest for further education on both appropriate antibiotic use and ABR. CONCLUSION Confidence of prescribers in their ability to appropriately use antibiotics conflicts with the low level of knowledge on antibiotic use in this group of doctors. Moreover, the opinion of the majority, that ABR is not a problem in their own backyard is in keeping with similar studies in other countries and is of significant concern. Introduction of formal antibiotic stewardship programmes in Cameroon may be a useful intervention.
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Ben Mabrouk A, Larbi Ammari F, Werdani A, Jemmali N, Chelli J, Mrabet HE, Rassas A, Sfar MH, El Mhamdi S, Mahjoub B. Parental self-medication with antibiotics in a Tunisian pediatric center. Therapie 2021; 77:477-485. [PMID: 34776255 DOI: 10.1016/j.therap.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/31/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Asma Ben Mabrouk
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia.
| | - Fatma Larbi Ammari
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia; Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia
| | - Amina Werdani
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Pediatric Department, 5100 Mahdia, Tunisia
| | - Nesrine Jemmali
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Pediatric Department, 5100 Mahdia, Tunisia
| | - Jihene Chelli
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia; Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia
| | - Houcem Elomma Mrabet
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia
| | - Ahmed Rassas
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Pediatric Department, 5100 Mahdia, Tunisia
| | - Mohamed Habib Sfar
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia; Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia
| | - Sana El Mhamdi
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Community and Preventive Medicine Department, 5100 Mahdia, Tunisia
| | - Bahri Mahjoub
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Pediatric Department, 5100 Mahdia, Tunisia
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Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, Saleem Z, Sneddon J, Hoxha I, Islam S, Mwita J, do Nascimento RCRM, Dias Godói IP, Niba LL, Amu AA, Acolatse J, Incoom R, Sefah IA, Opanga S, Kurdi A, Chikowe I, Khuluza F, Kibuule D, Ogunleye OO, Olalekan A, Markovic-Pekovic V, Meyer JC, Alfadl A, Phuong TNT, Kalungia AC, Campbell S, Pisana A, Wale J, Seaton RA. Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries. Life (Basel) 2021; 11:life11060528. [PMID: 34200116 PMCID: PMC8229985 DOI: 10.3390/life11060528] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia
- Correspondence: ; Tel.: +44-0141-548-3825; Fax: +44-0141-552-2562
| | - Abiodun Egwuenu
- AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia;
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya;
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda
| | - Natalie Schellack
- Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa;
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India;
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan;
| | - Jacqueline Sneddon
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania;
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | - Julius Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana;
| | - Renata Cristina Rezende Macedo do Nascimento
- Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil;
| | - Isabella Piassi Dias Godói
- Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil;
- Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon;
- Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini;
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana;
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya;
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
| | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia;
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria;
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria;
- Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria
| | - Vanda Markovic-Pekovic
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Abubakr Alfadl
- National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan;
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam;
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia;
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Janney Wale
- Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia;
| | - R. Andrew Seaton
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
- Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
- Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK
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No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies. BMC Public Health 2021; 21:1056. [PMID: 34082726 PMCID: PMC8173982 DOI: 10.1186/s12889-021-11163-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Non-prescription dispensing of antibiotics, one of the main sources of antibiotic misuse or over use, is a global challenge with detrimental public health consequences including acceleration of the development of antimicrobial resistance, and is facilitated by various intrinsic and extrinsic drivers. The current review aimed to systematically summarise and synthesise the qualitative literature regarding drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries. METHODS Four electronic databases (PubMed, CINAHL, Scopus and Google Scholar) and reference lists of the relevant articles were searched. The Joanna Briggs Institute's Critical Appraisal Checklist for qualitative studies was used to assess the quality of included studies. The enhancing transparency in reporting the synthesis of qualitative research statement was used to guide reporting of results. Data were coded using NVivo 12 software and analysed using both inductive and deductive thematic analysis. RESULTS A total of 23 articles underwent full text review and 12 of these met the inclusion criteria. Four main themes were identified in relation to facilitators of non-prescribed sale of antibiotics among community drug retail outlets: i) the business orientation of community drug retail outlets and tension between professionalism and commercialism; ii) customers' demand pressure and expectation; iii); absence of or a lax enforcement of regulations; and iv) community drug retail outlet staff's lack of knowledge and poor attitudes about antibiotics use and scope of practice regarding provision. CONCLUSIONS This review identified several potentially amendable reasons in relation to over the counter dispensing of antibiotics. To contain the rise of antibiotic misuse or over use by targeting the primary drivers, this review suggests the need for strict law enforcement or enacting new strong regulation to control antibiotic dispensing, continuous and overarching refresher training for community drug retail outlet staff about antibiotic stewardship, and holding public awareness campaigns regarding rational antibiotic use.
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Kotwani A, Joshi J, Lamkang AS, Sharma A, Kaloni D. Knowledge and behavior of consumers towards the non-prescription purchase of antibiotics: An insight from a qualitative study from New Delhi, India. Pharm Pract (Granada) 2021; 19:2206. [PMID: 33828621 PMCID: PMC8005328 DOI: 10.18549/pharmpract.2021.1.2206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/21/2021] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Anita Kotwani
- PhD (Pharmacol). Professor & Head of Pharmacology Department, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi. Delhi (India).
| | - Jyoti Joshi
- MD, MBBS (Commun Med). Adjunct Professor. Amity Institute of Public Health, Center for Disease Dynamics, Economics and Policy (CDDEP), Amity University and Head-South Asia. New Delhi (India).
| | - Anjana S Lamkang
- PhD (Anthropol). Fellow. Center for Disease Dynamics, Economics and Policy (CDDEP). New Delhi (India).
| | - Ayushi Sharma
- MSc (Anthropol). Senior Research Fellow. Pharmacology Department, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi. Delhi (India).
| | - Deeksha Kaloni
- MTech. (Biotechnol). Junior Research Fellow. Pharmacology Department, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi. Delhi (India).
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Kagoya EK, Royen KV, Waako P, Royen PV, Iramiot JS, Obakiro SB, Kostyanev T, Anthierens S. Experiences and views of healthcare professionals on the prescription of antibiotics in Eastern Uganda: A qualitative study. J Glob Antimicrob Resist 2021; 25:66-71. [PMID: 33667701 DOI: 10.1016/j.jgar.2021.02.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/22/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This study aimed to explore the experiences and views of healthcare professionals on antibiotic prescription in Eastern Uganda. METHODS This was an exploratory qualitative study using semi-structured interviews. Participants included 16 healthcare professionals from Mbale and Soroti Regional Referral Hospitals. Additionally, two workshops were held (one in each hospital) with a total of 56 healthcare professionals to discuss the findings. Thematic analysis was used to analyse the data. RESULTS Healthcare professionals' prescriptions are influenced by (i) healthcare workers' perceptions and practices, (ii) patients' perceptions and beliefs, and (iii) contextual factors. Healthcare workers' prescriptions depend on the presence of bacterial infection and the severity of the condition, the availability and cost of medication, previous experience with antibiotic prescribing, patient characteristics, and trial and error. They also have limited knowledge and share little information on the use of antibiotics with patients. Patient factors included demand for a particular antibiotic, inability to afford expensive drugs, and limited knowledge about antibiotic use and resistance. Contextual factors that contributed to antibiotic prescribing were an overburdened healthcare system, the influence of pharmaceutical companies and pharmacies, the use of (treatment) guidelines, and difficulties with laboratory services. CONCLUSION This study showed that healthcare professionals are aware of the problem of antibiotic resistance but do not feel ownership of the problem. Instead, they rather blame the overburdened system, local drug shops, pharmacies, drug representatives and patients. There is a need for a multisectoral and holistic approach toward fighting antibiotic resistance.
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Affiliation(s)
- Enid Kawala Kagoya
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Uganda.
| | - Kathleen Van Royen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul Waako
- Department of Pharmacology and Therapeutics, Faculty of Health Sciences, Busitema University, Uganda
| | - Paul Van Royen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jacob Stanley Iramiot
- Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Uganda
| | - Samuel Baker Obakiro
- Department of Pharmacology and Therapeutics, Faculty of Health Sciences, Busitema University, Uganda
| | - Tomislav Kostyanev
- Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Zhang A, Hobman EV, De Barro P, Young A, Carter DJ, Byrne M. Self-Medication with Antibiotics for Protection against COVID-19: The Role of Psychological Distress, Knowledge of, and Experiences with Antibiotics. Antibiotics (Basel) 2021; 10:antibiotics10030232. [PMID: 33668953 PMCID: PMC7996601 DOI: 10.3390/antibiotics10030232] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Self-medication with antibiotics is a major contributing factor to antimicrobial resistance. Prior research examining factors associated with antibiotic self-medication has focused on an individual’s knowledge about antibiotics, antibiotic usage practices, accessibility to antibiotic medication, and demographic characteristics. The role of psychological distress associated with perceived health risks in explaining antibiotic self-medication is less understood. This study was designed to address this knowledge gap in the context of the COVID-19 pandemic in Australia. An online survey of 2217 participants was conducted at the height of the initial outbreak and revealed that 19.5% of participants took antibiotics to protect themselves from COVID-19. Multivariate logistic analysis examined the predictors of taking antibiotics for protection against COVID-19. An integrative framework developed from the results illustrates potential pathways and facilitating factors that may contribute to prophylactic self-medication with antibiotics. Specifically, COVID-19 pandemic-induced psychological distress was significantly positively related to self-medication. Preventive use of antibiotics was also facilitated by a lack of understanding about antibiotics, inappropriate antibiotics usage practices, the nature of the patient-doctor relationship, and demographic characteristics. The findings highlight that to combat antimicrobial resistance due to self-medication, interventions need to focus on interrupting entrenched behavioural responses and addressing emotional responses to perceived health risks.
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Affiliation(s)
- Airong Zhang
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD 4102, Australia; (P.D.B.); (A.Y.)
- Correspondence:
| | - Elizabeth V. Hobman
- Land & Water, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD 4102, Australia;
| | - Paul De Barro
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD 4102, Australia; (P.D.B.); (A.Y.)
| | - Asaesja Young
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD 4102, Australia; (P.D.B.); (A.Y.)
| | - David J. Carter
- Faculty of Law, University of Technology Sydney, Sydney, NSW 2007, Australia;
| | - Mitchell Byrne
- College of Health and Human Sciences, Charles Darwin University, Darwin, NT 0815, Australia;
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Marzan M, Islam DZ, Lugova H, Krishnapillai A, Haque M, Islam S. Knowledge, Attitudes, and Practices of Antimicrobial Uses and Resistance Among Public University Students in Bangladesh. Infect Drug Resist 2021; 14:519-533. [PMID: 33603416 PMCID: PMC7886243 DOI: 10.2147/idr.s289964] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022] Open
Abstract
Background Antibiotics are lifesaving drugs, and inappropriate uses lead to the resistance that renders them ineffective. This study aims to understand knowledge, attitude, and practice (KAP) concerning antibiotic use and resistance among university students in Bangladesh. Methods A cross-sectional study was performed from January to April 2020 among students at Jahangirnagar University (JU), Bangladesh. Purposive sampling was conducted through an in-person interview using a structured questionnaire. Students from the faculties of biological sciences and non-biology background were included. The univariate ordinal regression technique was used to analyze the relationship between predictors and good knowledge about the antibiotics. A two-tailed p-value was calculated to determine statistical association. Results Out of 205 study participants, 92 and 113 responders were from biological science faculty and non-biology disciplines, respectively. Less than half of the students (42.4%) showed a good knowledge level (scores higher than 80%). Biology-background students possess better knowledge than non-biology students [odds ratio (OR) = 4.44, 95% confidence level (CL) (2.56, 7.70), p < 0.001]. A better attitude was noticed among all students. The self-medication rate was quite low, and more than 90% of students were found to consume antibiotics according to the physician’s prescription. Lack of treatment adherence was recorded, and students admitted to stop-taking antibiotics when symptoms disappeared (48.67% biology and 36.26% non-biology). Multivariate regression analysis was unable to detect any significant association between self-medication and gender, student category or the level of knowledge about antibiotics. Conclusion Students of biological science background possessed better knowledge indicating the importance of appropriate curriculum imparted in knowledge buildup. Introducing a short course about the risk and development of antibiotic resistance will grow the students’ awareness to avoid the resistance phenomenon.
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Affiliation(s)
- Mahfuza Marzan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Dewan Zubaer Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Halyna Lugova
- The Unit of Community Medicine, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, 57000, Malaysia
| | - Ambigga Krishnapillai
- The Unit of Family Medicine, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, 57000, Malaysia
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
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Tompkins K, Juliano JJ, van Duin D. Antimicrobial Resistance in Enterobacterales and Its Contribution to Sepsis in Sub-saharan Africa. Front Med (Lausanne) 2021; 8:615649. [PMID: 33575265 PMCID: PMC7870712 DOI: 10.3389/fmed.2021.615649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
Antibiotic resistant Enterobacterales (formerly Enterobactereaceae) are a growing threat to Sub-Saharan Africa. Genes causing antibiotic resistance are easily spread between the environment and humans and infections due to drug resistant organisms contribute to sepsis mortality via delayed time to appropriate antimicrobial therapy. Additionally, second or third-line antibiotics are often not available or are prohibitively expensive in resource-constrained settings leading to limited treatment options. Lack of access to water and sanitation facilities, unregulated use of antibiotics, and malnutrition are contributors to high rates of antibiotic resistance in the region. Improvements in the monitoring of drug resistant infections and antibiotic stewardship are needed to preserve the efficacy of antibiotics for the future.
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Affiliation(s)
- Kathleen Tompkins
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | - Jonathan J Juliano
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States.,Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - David van Duin
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
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Belachew SA, Hall L, Selvey LA. Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2021; 10:13. [PMID: 33446266 PMCID: PMC7807893 DOI: 10.1186/s13756-020-00880-w] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/26/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The development of antimicrobial resistance, which is partially attributable to the overuse and/or misuse of antibiotics in health care, is one of the greatest global public health challenges. In Sub-Saharan African (SSA) countries, non-prescribed dispensing of antibiotics in community drug retail outlets (CDROs) has been flagged as one of the contributing factors for the widespread misuse of antibiotics in the community. OBJECTIVE The current review aimed to estimate the proportion of non-prescription antibiotics requests or consultations that resulted in provision of antibiotics without a valid prescription among CDROs in SSA region, and describe the type of antibiotics dispensed. METHODS A literature search was conducted using PubMed, CINAHL, Scopus and Google Scholar. We also searched reference lists of relevant articles. Random effect model meta-analysis was employed to determine the pooled proportion of over the counter sale of antibiotics. Subgroup and meta-regression was undertaken to explore the potential cause of heterogeneity in effect size across studies. RESULTS Of 671 total citations retrieved, 23 met the inclusion criteria (seven cross-sectional questionnaire-based surveys and 16 cross-sectional client-based studies). The overall pooled proportion of non-prescription antibiotics requests or consultations that resulted in supply of antibiotics without prescription was 69% (95% CI 58-80). Upper respiratory tract infections and/or acute diarrhoea were the most frequently presented case scenarios, and amoxicillin and co-trimoxazole were the most frequently dispensed antibiotics to treat those symptoms. CONCLUSIONS Non-prescribed dispensing of antibiotics was found to be a common practice among CDROs in several SSA countries. Ease of access to and overuse of antibiotics can potentially accelerate the emergence of resistance to antibiotics available in the region. Our review highlights the need for a stringent enforcement of existing policies and/or enacting new regulatory frameworks that would regulate antibiotic supply, and training and educational support for pharmacy personnel (e.g. pharmacists, pharmacy assistants) regarding judicious use of antibiotics and the importance of antimicrobial stewardship.
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Affiliation(s)
- Sewunet Admasu Belachew
- School of Public Health, The University of Queensland, 288 Herston Rd, Herston, QLD, 4006, Australia. .,School of Pharmacy, Faculty of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Lisa Hall
- School of Public Health, The University of Queensland, 288 Herston Rd, Herston, QLD, 4006, Australia
| | - Linda A Selvey
- School of Public Health, The University of Queensland, 288 Herston Rd, Herston, QLD, 4006, Australia
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