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Abstract In recent decades, the emergence and spread of bacterial resistance to antibiotics is a growing problem worldwide, which presents a significant threat to public health globally in the 21st century. The increase of antibiotics resistance will endanger their therapeutic effectiveness, increase treatment failures and, as a result lead to longer and more severe illness episodes with higher costs and mortality rates. The inappropriate and excessive use of antibiotics are among the key factors for the increase and spread of resistance. The improper use of antibiotics may arise from a complex interaction between numerous factors, such as prescribers’ knowledge and experiences, diagnostic uncertainty, perceptions of patients in relation to the patientprescriber interaction, and insufficient patient education by physicians. In addition, other factors include patients’ knowledge, beliefs and attitudes towards antibiotic use, self medication, patients expectations, and patients’ experience with antibiotics. The current study aims to study self medication with antibiotics among adults in Misurata city, Libya and to assess the impact of a health promotion program on their knowledge and attitudes regarding self medication with antibiotics. The study comprised the following objectives: 1. To estimate the extent of self medication with antibiotics 2. To determine the indication for self medication with antibiotics 3. To identify factors associated with antibiotic self medication 4. To assess knowledge and attitudes regarding antibiotics 5. To construct, implement and evaluate the impact of a health promotion program on the adults’ knowledge and attitudes regarding self medication with antibiotics A cross sectional approach was used for the implementation of the 1st phase of the study and an intervention approach (one group pre-test post-test design) was used in the 2nd phase for subjects who had poor knowledge score in the pre-test . The overall total sample was 277 accompanying the patients attending the hospital adults (102 males and 175 females), selected from different out-patient clinics of Misurata Central Hospital. Data were collected using a pre-designed, structured interviewing questionnaire composed of 4 sections (Socio-demographic data, pattern of self medication with antibiotics, knowledge regarding self medication with antibiotics and attitudes of participants towards self medication with antibiotics). The intervention program was based on the questions posed in the questionnaire and used different types of mass media included eight health education sessions or episodes broadcasted through Misurata local radio station, two issues in Misurata University magazine, and one episode in Misutata TV. The collected data were revised, coded and analyzed using the appropriate statistical methods. The present study revealed the following results: I. The extent and indications of self medication with antibiotics The age of the studied group ranged between 18 and 73 years. Summary 74 Two thirds of participants were females. More than half of participants were married. About 3 quarters of the participants were clericals, teachers and students. The proportion of antibiotics use among adults in Misurata during the previous 6 months was 58.5%. Among those who used antibiotics, about 40% acquired/ used their antibiotics without prescription as self medication. Ailments like toothache (23.5%), common cold (18.4%), urinary tract infection (17.3%), sore throat (14.3%) and tonsillitis (12.2%) were the most common reported indications for prescribed antibiotics, while common cold (49.4%), toothache (20.3%), sore throat (17.2%) and tonsillitis (10.9%) were the most common reported indications for SMA. About two thirds (68.8%) of participants with prescribed antibiotics completed the antibiotic course compared to only one third (31.2%) of participants with SMA. The major reasons for non consulting a physician or self medication with antibiotics included, minor illness and do not worth consultation of physician (37.5%), previous or prior experience (17.2%), confidence in the pharmacist (15.6 %), friends or relative advise (10.9%), unavailability of doctor (9.4%) and avoiding crowding and waiting in visiting doctor (9.4%). Less than half of adults who practiced self medication during the previous 6 months (46.9%) took antibiotics on the advice of pharmacists, 30.2% on self decision, 14.1% on the advice of relatives or friends and 7.8% on the previous prescription. Participants who took prescribed antibiotics, knew about antibiotics through physicians (62.2%) while self-medicated participants, leaflet was the main source of knowledge (28.1%) followed by pharmacists (24%), previous experiences (20.3%), relative or friend (14.1%) and physicians (12.5%). Amoxicillin was the antibiotic most commonly used by the participants who consulted a physician (41.5%), followed by Amoxicillin-Clavulanate (26.4%), then Azithromycin (9.4%), Ciprofloxacin (7.5%) and the least percentages were Ceftriaxone injection, Procaine penicillin injection and Furadantin tablets (3.7% each). The antibiotics most frequently used in self medication were Amoxicillin-Clavulanate (54.8%) followed by Amoxicillin (25.8%), Azithromycin (9.7%), Ciprofloxacin (6.4%) and the least percentage was Cotrimoxazole tablets (3.2%). II. Factors associated with self medication with antibiotics: Male participants using antibiotics as self medication (51.5%) were higher than females (31.2%), while the percentage of females participants using antibiotics on medical prescription (68.8%) were higher than males (48.5%). (p<0.05). III. Adults’ knowledge and attitudes regarding self medication with antibiotics. 1. The knowledge of adults regarding role and identification of antibiotics: Less than two thirds of the participants knew that bacterial infections can be treated by antibiotics (64.3%). The majority of participants did not know that antibiotics would not work against viral infections (81.1%). Summary 75 Less than half of participants (46.1%) did not know that antibiotics do not work on most coughs and cold. Almost one fifth of the participants (20.2%) knew that antibiotics would not always be effective in treatment of the same infection in the future. More than one third of participants (36.5%) knew that antibiotics could not cure all infections. More than half of participants (52.6%) did not know that antibiotics were not indicated to relive pain. Only one fifth of participants (20.9%) knew that antibiotics were not used to stop fever. Two thirds (63.9%) of participants did not know that antibiotics could kill bacteria that normally live on the skin and in the gut. As regards identification of antibiotics, 39% of the participants were able to correctly identify paracetamol as not being an antibiotic. More than half of participants (54.9%) could not correctly identify penicillin as an antibiotic. 2. The knowledge of adults regarding antibiotics use and resistance. More than half of participants (53.8%) knew that antibiotics should be given with prescription. About three quarters of the respondents (75.1%) had correct knowledge of the need to complete the full course of antibiotics when symptoms of infection were improving. The majority of participants (85.1%) knew that taking incomplete antibiotics course than prescribed was not healthy than taking the full complete course prescribed. As regards the antibiotics resistance, almost one third of participants (32.5%) knew the meaning of antibiotic resistance. Less than half of participants (41.9%) knew that infection by antibiotic resistant bacteria cannot be easily cured. More than half of participants (55.6%) knew that if antibiotics are taken for long time, bacteria become more resistance to antibiotics. More than half of participants (52%) knew that using of antibiotics without medical consultation may cause bacterial resistant to antibiotics. 3. The knowledge of adults regarding antibiotics side effects Almost one third (33.2%) of the participants did not know that antibiotics caused side-effects. The proportion of those who did not know ranged from 31.8% for ”antibiotics can cause allergic reaction ”to 80.5% for ”antibiotics can impair bone growth”. About two thirds (65%) of participants knew that antibiotics were not safe to be used with other medication and 75.5% knew that overuse of antibiotics could lead to losing the effectiveness on the long term. Regarding the level of knowledge of adults regarding antibiotics, about two thirds of participants (62.5%) had poor knowledge level while 23.1% and 14.4% of participants had fair and good knowledge levels respectively. 4. The attitude towards physician visit for diagnosis and treatment: About 15% of participants agreed that they expected antibiotics to be prescribed if they suffered from common cold symptoms. Summary 76 The majority of participants (84.8%) demonstrated negative attitudes in taking antibiotics according to the instructions of physician and pharmacist. More than half of participants (56.7%) greed that they were less satisfied if the doctor did not prescribe antibiotics for treatment of common cold. Only 18.1% of participants agreed that they would prefer to visit the doctor if they get the disease. 5. The attitude towards administration and reuse of antibiotics. Less than half of participants (44.1%) agreed that antibiotics should be stopped when they feel better. Only 4% of participants agreed that they normally look at the expiry dates of antibiotics before using it. Only 6.1% of participants agreed that they read the leaflet that came with antibiotic packet. About three quarters (74.4%) agreed that there was no difference if not committed with one or two doses of prescribed antibiotic. Almost 16% of participants agreed that the long term use of antibiotics would affect their effectiveness in future. The statement that ” antibiotic resistance could not affect me and my family” was agreed upon by 44% of participants. Only 2.5% of participants would like to get more information about antibiotics. Regarding reuse of antibiotics, more than three quarters of participants (78.7%) agreed that they would give their medicines to a sick family member. Nearly one third (32.5%) agreed that they would keep antibiotics stocks at home in case of emergency. The statement that ”frequent use of antibiotics would not decrease their effectiveness” was agreed upon by 53.4% of participants. 6. The parental attitude toward antibiotics use in children. One quarter of participants (25.9%) agreed that they would give antibiotics to children to treat cough and or common cold. About one tenth of participants (10.8%) agreed that they would give their children antibiotic without medical prescription. Almost one fifth of participants (20.2%) agreed that they would give their children antibiotics for treatment of fever. When their children were feeling better, about more than quarter of participants (26.6%) agreed that they would reduce the dose of antibiotic. The statement that ”if my child start feeling better, I would stop giving him antibiotic ” was agreed upon by 20.9% of participants. Almost one tenth of participants (10.8%) agreed that they would visit another doctor if the doctor does not prescribe antibiotic for their children. Only 11.5% of participants agreed that they would ask the doctor to prescribe antibiotics to their children. Less than on quarter (23%) agreed that they would not wake up their children to take antibiotic if they were sleep. Summary 77 More than half of participants (57.5%) agreed that they would store antibiotic syrup in the refrigerator. The level of attitude of adults regarding antibiotics use showed that half of participants (50.5%) had neutral attitude toward antibiotics use, 35.8% had a positive attitude while only 13.7% had a negative attitude Logistic regression analysis of the results of the current study showed that the factors affecting knowledge score were age, level of education and occupation. knowledge. Logistic regression analysis of the results of the current study showed that the factors affecting attitude score were Gender and knowledge score. IV. Evaluation of the health promotion intervention program: The current study showed that 62.5%, 23.1% and 14.4% of participants in the pre intervention program had poor, fair and good level of knowledge respectively, compared to 15.5%, 34.8% and 49.7% respectively post intervention. The difference between two groups was statistically significant (p<0.05). Comparison of the pre and post intervention scores for the total study showed a significant increase in the post intervention mean cumulative knowledge scores. The current study revealed that 13.7% , 50.5% and 37.8% of the participants in the pre intervention program had negative, neutral and positive level of attitude respectively, compared to 11.5% , 12.9% and 75.6% respectively, post intervention. The difference between the pre and post intervention program regarding the level of attitude was statistically significant (p<0.05). The following are the main recommendations of the study: Policies of auditing antibiotic prescriptions in the healthcare facilities. Improve communication about antibiotic appropriateness between healthcare professionals and patients. Public education programs using all media means that should be targeted more efficiently at those who have low knowledge, negative attitude and inappropriate practice to wards antibiotic use. Highlighting pharmacists’ role in health education and promotion, and responsibility in prohibiting antibiotic dispensing without prescription. Reliable information in school curricula regarding health education. Further research on SMA behavior should involve people in all cities of Libya to capture its determinants geographical characteristics. This will be useful to develop strategies in improving the safe use of antibiotics among community members. |