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

Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance and stewardship among low- and middle-income countries

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.

Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review

This review documents the status of AMR education and awareness in the WHO African region, as well as specific initiatives by its member states in implementing education and awareness interventions, as a strategic objective of the Global Action Plan on AMR, i.e., improve knowledge and understanding on AMR through effective communication, education, and training. A systematic search was conducted in Google Scholar, PubMed, and African Journals Online Library according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, for articles published in English. Retrieval and screening of articles was performed using a structured search protocol following a pre-set inclusion/exclusion criterion. Eighty-five published articles reporting 92 different studies from 19 Member States met inclusion criteria and were included in the final qualitative synthesis. Nigeria (21) and Ethiopia (16) had most of the studies, while the rest were distributed across the remaining 17 Member States. The majority of the articles were on knowledge, attitude, and practices with regard to AMR and antimicrobial use and most of them documented a general lack and suboptimal knowledge, poor attitude and practices, and widespread self-medication. This review shows low levels of knowledge of AMR coupled with extensive misuse of antimicrobial medicines by different target audiences. These findings underscore the urgent need for enhanced and context-specific educational and positive behavioural change interventions.

First assessment of the knowledge, attitudes, and practices of health actors in Togo and Ivory Coast in regard to antibiotic resistance

Background and Aim: Bacterial resistance to antibiotics has now become a threat to global public health. This study aimed to assess the knowledge, attitudes, and practices of health actors in relation to antibiotic resistance (ABR) in two African countries. Materials and Methods: A cross-sectional and descriptive questionnaire study was conducted in Ivory Coast and Togo from August 2020 to July 2021. Actors were interviewed both in person 63% (n = 141) and remotely due to COVID-19 restrictions. Qualitative variables were described by frequencies and quantitative variables by the mean and associated standard deviation. The bivariate analysis was conducted through the Chi-square test and exact Fisher test with an acceptable risk of 5%. Results: The results showed that 88% and 50% of the actors from Togo and Ivory Coast, respectively, had a good knowledge of ABR even if most of the stakeholders had limited knowledge of antibiotics that are banned or of critical importance in human and animal medicine. More than 75% of the actors had good perceptions in regard to ABR and these were significantly related to their profession. As for the factors leading to an increase in ABR, the interviewees perceived self-medication in humans as the main contributing factor. Approximately 70% of the actors admitted to following inadequate practices in terms of the use and/or distribution of antibiotics, and 58% and 46% of them used preventive antibiotic therapy in Togo and Ivory Coast, respectively. Similarly, in the two countries, 39% and 69% of the actors, respectively, claimed that they do not systematically use the antibiogram, and 69% and 61% of drug distributors, also respectively, admitted to occasionally selling antibiotics without a prescription. Finally, more than 80% thought that the authorities in their country did not communicate sufficiently about ABR. Among the actions that could help to combat ABR, actors considered the strengthening of controls on the distribution of antibiotics and the education of nonprofessionals on the importance of antibiotic preservation as priorities. Conclusion: Although this first study had some limitations, that is, the low number of surveyed actors and non-standardized questionnaire used, it revealed that health actors in Togo and Ivory Coast have a good knowledge and perception in regard to antibiotics and ABR, but also follow inadequate practices.

Antibacterial Activity of Nanoparticles of Garlic (Allium sativum) Extract against Different Bacteria Such as Streptococcus mutans and Poryphormonas gingivalis

To combat the threat of antimicrobial resistance, it is important to discover innovative and effective alternative antibacterial agents. Garlic has been recommended as a medicinal plant with antibacterial qualities. Hence, we conducted this study to evaluate the antibacterial activity of ultrasonicated garlic extract against Escherichia coli, Staphylococcus aureus sub. aureus, Streptococcus mutans, and Poryphyromonas gingivalis. Aqueous ultrasonicated garlic extract was tested against these strains, and their antibacterial activity quantified using both agar disk diffusion and agar well diffusion methods; the plate count technique was used to estimate the total viable count. Moreover, Fourier-transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM), and microplate spectrophotometry were used to characterize garlic nanoparticles. The results confirmed that all tested bacteria were sensitive to both sonicated and non-sonicated garlic extracts. Streptococcus mutans was the most susceptible bacteria; on the other hand, Escherichia coli was the most resistant bacteria. Furthermore, characterization of the prepared garlic nanoparticles, showed the presence of organosulfur and phenolic compounds, carboxyl groups, and protein particles. Based on the obtained results, ultrasonicated garlic extract is a potent antibacterial agent. It can come in handy while developing novel antibiotics against bacteria that have developed resistance.

Misconceptions of Antibiotics as a Potential Explanation for Their Misuse. A Survey of the General Public in a Rural and Urban Community in Sri Lanka

Reducing the growth of antimicrobial resistance (AMR) through public understanding is a goal of the World Health Organization. It is especially important in countries where antibiotics are widely available for common ailments without prescription. This study assessed understanding of antibiotics and AMR alongside perception of antibiotic usage among the general public in two diverse Sri Lankan communities: ordinary urban and indigenous rural. A cross-sectional questionnaire survey was conducted, gaining 182 urban and 147 rural responses. The majority of urban respondents (69.2%) believed that they had very good or good knowledge about antibiotics compared to 40.1% of rural respondents. Belief about knowledge and actual knowledge (measured via a test question) were correlated (r = 0.49, p = 0.001) for rural respondents, but not for urban respondents. Several misconceptions about antibiotics were highlighted, including that Paracetamol, a painkiller, was thought to be an antibiotic by more than 50% of both urban and rural respondents. In addition, 18.5% of urban and 35.4% of rural participants would keep and re-use what they perceived as leftover antibiotics. It is urgent that we pay attention to educating the general public regarding the identified misconceptions of these powerful drugs and their appropriate use.

Impact of targeted educational intervention towards public knowledge and perception of antibiotic use and resistance in the state of Perak, Malaysia

BACKGROUND

Antibiotic resistance is a major public health concern, accelerated by antibiotic overuse. Inadequate knowledge among the public has been associated with inappropriate use of antibiotics. This study determined the impact of a self-developed educational leaflet for addressing specific knowledge gaps in antibiotic use among the public.

METHODS

This was an experimental study conducted at five hospitals and 20 primary health care clinics in the state of Perak. Adults over 18 years of age were recruited using sequential sampling. The first phase of data collection consisted of a pre-intervention assessment, an educational session, and an immediate post-intervention assessment. Each educational session was conducted by trained pharmacists and lasted approximately 15 min for each participant. A two-week post-intervention assessment was then conducted via a phone call to re-assess the participants using the same questionnaire.

RESULTS

Out of 300 questionnaires distributed, 234 were completed for our study. The mean age of participants was 40.7 ± 14.6 years old. Most of the respondents were female (143, 61.1%), Malay (162, 69.2%), and had tertiary education (162, 69.2%). A mean score was generated for each domain, with knowledge towards antibiotic resistance: 2.83 ± 1.28 pre-intervention, 3.76 ± 0.62 immediate post-intervention, and 3.67 ± 0.78 two-weeks post-intervention (total score: 4.00); knowledge towards antibiotic use: 2.03 ± 1.56 pre-intervention, 4.56 ± 1.46 immediate post-intervention, and 4.32 ± 1.48 two-weeks post-intervention (total score: 6.00); perception towards antibiotic use: 2.83 ± 1.38 pre-intervention, 4.25 ± 1.06 immediate post-intervention, and 4.22 ± 1.02 two-weeks post-intervention (total score: 5.00). Significant improvement in the mean scores were found before and after intervention in all domains (p < 0.001).

CONCLUSION

The educational leaflet was able to address salient knowledge gaps in the participants and remained sustainable over a two-week follow-up. Thus, its inclusion into future antibiotic awareness campaigns should be encouraged.

Impact of community-based educational intervention on antibiotic use and resistance awareness among the people living in Ras Al Khaimah, United Arab Emirates

Objectives

Antibiotic resistance is a major global public health concern today. We explored the usefulness of an educational intervention in increasing antibiotic-related awareness of the public.

Methods

This community-based interventional study was conducted among 100 people living in Ras Al Khaimah, UAE. Preintervention awareness regarding antibiotics and antibiotic resistance was assessed using the World Health Organization antibiotic resistance: multicountry public awareness survey. After the baseline assessment of the knowledge, educational intervention was given to the study participants. The same questionnaire was used to assess the impact of this intervention after 4 weeks.

Key findings

The study participants had low baseline knowledge of antibiotics and the phenomenon of antibiotic resistance. A high proportion of study participants (54%) took antibiotics in the past 6 months. Our intervention significantly improved antibiotic-related knowledge and behaviours. Postintervention majority of study participants realized that full course of antibiotics should be taken (% change: 50.0, P &lt; 0.001), leftover antibiotics from family and friends should not be used (% change: 40.0%, P = 0.004), antibiotics are of no use in viral infections (% change: 72.0%, P &lt; 0.001), infections are becoming increasingly resistant to antibiotics (% change: 37%, P &lt; 0.001), bacteria resistant to antibiotics can be spread from person to person (% change: 73%, P &lt; 0.001) and infections from resistant bacteria are difficult to treat (% change: 38%, P &lt; 0.001).

Conclusion

Following the intervention, antibiotic-related awareness was significantly improved among study participants. Further efforts should be made to ensure that this improved awareness is converted to necessary health behaviour changes in the long term.

Knowledge and use of antibiotics in Thailand: A 2017 national household survey

BACKGROUND

The Thailand National Strategic Plan on Antimicrobial Resistance (AMR) 2017-2021, endorsed by the Thai Cabinet in 2016, aims to increase public knowledge about antibiotics and AMR awareness by 20% by 2021. This study assesses the prevalence of antibiotics use, clinical indications and sources; knowledge and access to information related to antibiotics and AMR; and factors related to level of knowledge and access to information among Thai adult population.

METHODS

An AMR module was developed and embedded into the 2017 Health and Welfare Survey; a cross-sectional, two-stage stratified sampling, nationally representative household survey carried out biannually by National Statistical Office. The survey applied a structured interview questionnaire. The survey was conducted in March 2017 where 27,762 Thai adults were interviewed of the AMR module. Data were analyzed using descriptive and inferential statistics.

RESULTS

The one-month prevalence of antibiotic use was 7.9% for three common conditions; flu (27.0%), fever (19.2%) and sore throat (16.8%). The majority of antibiotics (70.3%) were provided by public or private healthcare facilities, and 26.7% by pharmacies. Thai adults have low levels of knowledge about antibiotics; only 2.6 gave correct answers to all six statements related to antibiotics, while 13.5% gave wrong answers to all six statements. A few factors associated with knowledge and having received information on antibiotics were assessed. People who have higher education levels, and belong to richer wealth quintiles, and receive antibiotics and AMR information have significantly higher levels of knowledge about antibiotics. In the last 12 months, only 17.8% of respondents had heard information about the proper use of antibiotics and AMR; mostly from doctors (36.1%), health workers (24.8%) and pharmacists (17.7%).

CONCLUSIONS

There is a large gap of public knowledge about the use of antibiotics. The main communication channel is through healthcare professionals, which indicates they are key persons in communicating information about the proper use of antibiotics to the public.