الفهرس 
Epidemiology of AOMOnly 14 pages are availabe for public view
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Abstract
Over prescription and abuse of antibiotics in the treatment of AURTIs and diarrhea is a worldwide problem. (36) More than 40% of children with acute diarrhea receive unnecessary antibiotics; up to 60% of children with AURTIs receive antibiotics inappropriately. (18) Bear in mind that in a child recently treated with antibiotics, the resistant bacteria can reside in the throat for up to 3 months; thus posing a potential source of spread in nurseries and day care centers. (27)
Aim of the study:
The aim of the present research was to assess antibiotic prescription for acute upper respiratory tract infections and diarrhea in children under 5 years in Alexandria family health facilities by:
1- Assessment of adherence of family physicians to guidelines for antibiotic prescription in acute upper respiratory tract infections and diarrhea in children under 5 years.
2- Assessment of satisfaction of parents of children under 5 years regarding antibiotic prescription in acute upper respiratory tract infections and diarrhea.
To conduct the present study the following techniques were used:
1- An observation checklist was designed to assess adherence of family physicians to guidelines for antibiotic prescription in AURTIs and diarrhea in children U5 based on IMCI guidelines.
2- An interview questionnaire was designed to assess satisfaction of parents of children U5 regarding antibiotic prescription in AURTIs and diarrhea.
Data were subjected to statistical analysis and interpretation.
The results of the present study could be summarized as follows:
1- The majority of family physicians (71.4%) had been trained on family medicine, half of them (50%) had IMCI training program and less than half of them had postgraduate degrees (46.4%).
2- Acute upper respiratory tract infections accounted for (73%), diarrhea (18.3%) and combined AURTIs and diarrhea in (8.7%) of the consultation sessions of the studied children.
3- History taking adherence practices of family physicians scored poor in the majority of the consultation sessions (85.3%), fair in (14%), while their physical examination adherence practices scored fair in 2/3 of the consultation sessions (66%), good in about 1/5 of them (19.3%) and management adherence practice of the family physicians scored fair in (48.3%) of the sessions and poor in 1/3 of them (35%).
4- Family physicians` history taking adherence practices score was most frequently poor in (90.8%) of AURTIs sessions, fair in (34.7%) of combined AURTIs and diarrhea sessions and those relations were statistically significant. While their physical examination adherence practices score was most frequently fair in (80%) of diarrhea sessions and family physicians` management adherence practices score was most frequently fair in (61.5%) of combined AURTIs and diarrhea sessions.
5- A direct statistically significant correlation existed between family physicians` history taking adherence practices and age of the studied children, that`s family physicians had higher history taking adherence score with older children.
6- An indirect statistically significant correlation existed between family physicians` physical examination adherence practices and age of the studied children and an indirect statistically insignificant correlation existed between their management adherence practices and age of the children that`s family physicians had higher physical examination and management adherence scores with younger children.
7- Physical examination adherence practices scored fair in the majority of trained family physicians on IMCI (70%) and of untrained physicians on family medicine (81%) and management adherence scored fair in (55.1%) of IMCI trained family physicians and (53.1%) of family medicine trained physicians. A direct statistically insignificant correlation existed between family physicians` adherence practices and duration since their IMCI training.
8- Antibiotics were appropriately not prescribed in about half of the sessions (49.7%), were inappropriately prescribed in (43.3%), and were appropriately prescribed only in (5.7%) of the sessions. While antibiotics were inappropriately not prescribed at all, according to IMCI guidelines.
9- In almost all sessions the type of prescribed antibiotic was appropriate (91.8%), verbal and written treatment instructions were given in (96.5%) of the sessions parents did not request antibiotic prescription from physician in the majority of sessions (92%).
10- Follow up was given in (28%) of the sessions. In almost all sessions referral practice was not needed at all (98.3%).
11- Most of the parents of children U5 (96.8%) were satisfied about health care services offered in the studied health facilities and all parents (100%) were satisfied when physician did not prescribe antibiotics in AURTIs and diarrhea. Moreover the illiterate parents had the highest satisfaction score.
12- An indirect statistically insignificant correlation existed between parents` satisfaction with age and gender of the studied children, parents` satisfaction was higher among those with younger and male children.
Accordingly the following can be recommended:
1- Training of all family physicians on IMCI should be organized and attendance of the physicians should be mandatory. IMCI training should be carried out widely to cover all physicians dealing with children.
2- Continuous medical education programs should be carried out for family physicians about appropriate use of antibiotics, consequences of antibiotic overuse and pathogenesis of infections especially AURTIs and diarrhea which do not require antibiotics. Also medical education should be given for all physicians and pharmacists about appropriate use of antibiotics and their role to raise awareness of the community.
3- Continuous supervision, providing feedback about any problem occurring during daily work and good incentives should be provided for motivation of family physicians to improve their performance.
4- Health education of the public should be provided through mass communication, T.V., radio, newspapers and campaign about proper use of antibiotics in general practice and at the community level.
5- Ministry of Health and Population should allocate more money in health sector for provision of necessary supplies, equipment and essential drugs as shortage of these elements was been observed during the study.
6- Ministry of Health and Population should regulate and monitor proper antibiotics use and over-the-counter sales of antibiotics without prescription should be prohibited.