Factors Associated With Inappropriate Attitude Towards Antibiotic Usage Among Outpatients of a Public Primary Care Specialist Clinic: A Cross Sectional Study
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Abstract
Introduction: Antibiotic resistance is one of the biggest global threat in modern medicine especially in lower-and middle-income countries (LMIC) as financial limitations and health literacy become barriers to an impactful health policy. The World Health Organization has urge for an improvement in the community antibiotic awareness through effective educational interventions. This study aims to identify the community’s attitude appropriateness, knowledge gaps, the relationship between antibiotic knowledge and attitude as well as factors associated with inappropriate at- titude towards antibiotic among outpatients attending a primary care clinic. Methods: This is a cross-sectional study which was conducted among 256 respondents. Data collection was conducted for three months using a self-admin- istered questionnaire which has been validated and translated. Results: It was found that the respondents’ mean atti- tude and knowledge score were 29.5 ± 4.19 and 5.94 ± 2.4 respectively. The highest inappropriate attitude response was expecting antibiotic from the doctor for common colds and the most frequent incorrect knowledge response was on the domain of role of antibiotics. There is a weak positive relationship between antibiotic knowledge and attitude (r=0.315, n=256, p=0.0001). Respondents with low education level and poor antibiotic knowledge were at least 2.5 times more likely to have inappropriate attitude when handling antibiotics. Conclusion: Antibiotic education should be incorporated in non-pharmacological measures of viral illnesses in primary care that is targeted among those with low education and poor antibiotic knowledge. The weak relationship between antibiotic knowledge and attitude suggest that health campaign should focus on behavioural change rather than a theoretical approach.
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Marlière GLL, Ferraz MB, Quirino dos Santos J. Antibiotic consumption patterns and drug leftovers in 6000 Brazilian households. Advances in Therapy. 2000;17(1):32-44.
Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiology and molecular biology reviews : MMBR. 2010;74(3):417-33.
Pokharel S, Raut S, Adhikari B. Tackling antimicrobial resistance in low-income and middle- income countries. BMJ Global Health. 2019;4(6)
Ocan M, Obuku EA, Bwanga F, Akena D, Richard S, Ogwal-Okeng J, et al. Household antimicrobial self-medication: a systematic review and meta- analysis of the burden, risk factors and outcomes in developing countries. BMC Public Health. 2015;15(1):742.
Vila J, Pal T. Update on antibacterial resistance in low-income countries: factors favoring the emergence of resistance. The Open Infectious Diseases Journal. 2010;4(1).
Garcia C, Llamocca LP, Garcia K, Jimenez A, Samalvides F, Gotuzzo E, et al. Knowledge, attitudes and practice survey about antimicrobial resistance and prescribing among physicians in a hospital setting in Lima, Peru. BMC Clin Pharmacol. 2011;11:18.
Kong LS, Islahudin F, Muthupalaniappen L, Chong WW. Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross- Sectional Survey. Geriatrics (Basel). 2019;4(4).
Ministry of Health Malaysia PSP. National Antibiotic Guideline (NAG) 2019 [1st February 2020]. Available from: https://www.pharmacy.gov.my/v2/en/documents/national-antimicrobial-guideline-nag-2019-3rd-edition.html.
Lim KK, Teh CC. A Cross Sectional Study of Public Knowledge and Attitude towards Antibiotics in Putrajaya, Malaysia. Southern med review. 2012;5(2):26-33.
Oh A, Hassali M, Haddad M, Sulaiman S, Shafie A, Awaisu A. Public knowledge and attitudes towards antibiotic usage: A cross-sectional study among the general public in the state of Penang, Malaysia. Journal of infection in developing countries. 2011;5:338-47.
Lim VKE, Cheong Y, Suleiman AB. Pattern of antibiotic usage in hospitals in Malaysia. Singapore medical journal. 1994;34:525-8.
Shamsuddin S, Akkawi ME, Zaidi STR, Ming LC, Manan MM. Antimicrobial drug use in primary healthcare clinics: a retrospective evaluation. International Journal of Infectious Diseases. 2016;52:16-22.
Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340
Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. Jama. 1997;278(11):901-4.
Paluck E, Katzenstein D, Frankish CJ, Herbert CP, Milner R, Speert D, et al. Prescribing practices and attitudes toward giving children antibiotics. Can Fam Physician. 2001;47:521-7.
Vanden Eng J, Marcus R, Hadler JL, Imhoff B, Vugia DJ, Cieslak PR, et al. Consumer attitudes and use of antibiotics. Emerg Infect Dis. 2003;9(9):1128-35.
Schwartz RH, Freij BJ, Ziai M, Sheridan MJ. Antimicrobial prescribing for acute purulent rhinitis in children: a survey of pediatricians and family practitioners. Pediatr Infect Dis J. 1997;16(2):185- 90.
Freidoony L, Kim CB, Haghani H, Park MB, Chang SJ, Kim SH, et al. From Visiting a Physician to Expecting Antibiotics: Korean Perspectives and Practices toward Respiratory Tract Infections. J Korean Med Sci. 2017;32(2):278-86.
Kim SS, Moon S, Kim EJ. Public Knowledge and Attitudes Regarding Antibiotic Use in South Korea. J Korean Acad Nurs. 2011;41(6):742-9.
Muhammad Qamar NSA, Jiyauddin Khan, Ahmad Mahmud, Amiruddin Ahmad. Knowledge and Attitude Towards Antibiotic Usage Among General Public in Shah Alam, Malaysia. Pharmaceutical and Biosciences Journal 2014.
Machin D CM, Walters SJ. Medical statistics: a textbook for the health sciences. 4th ed: West Sussex: Wiley Ltd; 2007.
McNulty CA, Boyle P, Nichols T, Clappison P, Davey P. Don’t wear me out--the public’s knowledge of and attitudes to antibiotic use. J Antimicrob Chemother. 2007;59(4):727-38.
Stålsby Lundborg C, Tamhankar AJ. Understanding and changing human behaviour--antibiotic mainstreaming as an approach to facilitate modification of provider and consumer behaviour. Ups J Med Sci. 2014;119(2):125-33.
Chen C CY, Hwang KL, Lin SJ, Yang CC, Tsay RW, Liu CE, Young TG. Behaviour, attitudes and knowledge about antibiotic usage among residents of Changhua, Taiwan. . J Microbiol Immunol Infect. 2005;1(38).
Kuo S-C, Shih S-M, Hsieh L-Y, Lauderdale T-LY, Chen Y-C, Hsiung CA, et al. Antibiotic restriction policy paradoxically increased private drug consumptions outside Taiwan’s National Health Insurance. The Journal of antimicrobial chemotherapy. 2017;72(5):1544-5.
Gaarslev C, Yee M, Chan G, Fletcher-Lartey S, Khan R. A mixed methods study to understand patient expectations for antibiotics for an upper respiratory tract infection. Antimicrob Resist Infect Control. 2016;5:39.
Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. Bmj. 1998;317(7159):637-42.
Yadesa T, Temesgen G, Ahmed Y. Knowledge, Attitudes and Practices of Healthcare Professionals towards Antimicrobial Stewardship and Their Predictors in Fitche Hospital. Bioanalysis & Biomedicine. 2017;9:091-7.
Funke J. How Much Knowledge Is Necessary for Action? In: Meusburger P, Werlen B, Suarsana L, editors. Knowledge and Action. Cham: Springer International Publishing; 2017. p. 99-111.
Montgomery AJ, Bradley C, Rochfort A, Panagopoulou E. A review of self-medication in physicians and medical students. Occupational Medicine. 2011;61(7):490-7.
Nalini GK. Self-Medication among Allopathic medical Doctors in Karnataka, India. British Journal of Medical Practicioner. 2010;3(2):325.
Haenssgen MJ, Charoenboon N, Zanello G, Mayxay M, Reed-Tsochas F, Lubell Y, et al. Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia. BMJ Open. 2019;9(8)
Mbwambo G, Emidi B, Mgabo M, Sigalla G, Charles Kajeguka D. Community knowledge and attitudes on antibiotic use in Moshi Urban, Northern Tanzania: Findings from a cross sectional study. African Journal of Microbiology Research. 2017;11:1018-26.
Ahmad A, Khan, M. U., Patel, I., Maharaj, S., Pandey, S., & Dhingra, S. Knowledge, attitude and practice of B.Sc. Pharmacy students about antibiotics in Trinidad and Tobago. Journal of Research in Pharmacy Practice. 2015;4(1):37-41.
Vallin M, Polyzoi M, Marrone G, Rosales-Klintz S, Tegmark Wisell K, Stalsby Lundborg C. Knowledge and Attitudes towards Antibiotic Use and Resistance - A Latent Class Analysis of a Swedish Population- Based Sample. PLoS One. 2016;11(4)
Zati Sabrina Ahmad Zubaidi, KAM, Zaliha Ismail, editor Empowering Primary Care Towards Universal Health. Family Medicine Scientific Conference 2018 1-4 August 2018; Ipoh, Perak, Malaysia: The Malaysian Family Physician Journal.
Asekun-Olarinmoye EO, Akinwusi PO, Adebimpe WO, Omisore AG, Isawumi MA, Hassan MB, et al. Perceptions and Use of Antimicrobials Among Staff of a University Community in Southwestern Nigeria. SAGE Open. 2014;4(2)
Khalifeh M, Moore N, Salameh P. Public Knowledge and Attitude towards Antibiotic Use in Lebanon. American Journal of Epidemiology and Infectious Disease. 2017;5(2):35-41.
Panagakou SG, Papaevangelou V, Chadjipanayis A, Syrogiannopoulos GA, Theodoridou M, Hadjichristodoulou CS. Risk Factors of Antibiotic Misuse for Upper Respiratory Tract Infections in Children: Results from a Cross-Sectional Knowledge-Attitude-Practice Study in Greece. ISRN Pediatrics. 2012.
Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Therapeutic advances in drug safety. 2014;5(6):229-41.
Ahmad Zubaidi ZS, Malek K, Ismail Z. Factors associated with inappropriate attitude towards antibiotic usage among outpatients of a large public primary care center in Malaysia: A cross sectional study. Preprint at Research square https://www.researchsquare.com/article/rs-17290/v1 (2020).