Knowledge, attitudes, and practices of parents in rural China on the use of antibiotics in children: a cross-sectional study.
ABSTRACT: BACKGROUND: The purpose of the study was to investigate parents' perceptions of antibiotic use for their children, interactions between parents and physicians regarding treatment with antibiotics, and factors associated with parents self-medicating children with antibiotics. METHODS: A cross-sectional study was conducted in vaccination clinics in two rural Chinese counties. Primary caregivers (the child's parents in 97% of cases) visiting these clinics for the vaccination of their young children were given a 55-item structured questionnaire to collect information on the parents' knowledge and attitudes regarding when, why, and how to use antibiotics and on their practices of purchasing antibiotics and medicating children. RESULTS: Of the 854 participating primary caregivers, 79% thought antibiotics could cure viral infections, and half believed that antibiotics could shorten the duration of upper respiratory tract infection. Parents reported a median of two hospital visits for their children during the previous 6 months, equal to the median number of antibiotic prescriptions received from physicians. Sixty-two percent of the parents had self-medicated their children with antibiotics. Living in rural villages (Adj OR?=?1.643, 95% CI: 1.108-2.436), raising more than one child (Adj OR?=?2.174, 95% CI: 1.485-3.183), increasing age of child (Adj OR?=?1.146, 95% CI: 1.037-1.266), purchasing antibiotics without a prescription (Adj OR?=?6.264, 95% CI: 4.144-9.469), storing antibiotics at home (Adj OR?=?2.792, 95% CI: 1.961-3.975) and good adherence to physicians' advice (Adj OR?=?0.639, 95% CI: 0.451-0.906) were independently associated with self-medicating behavior. CONCLUSIONS: Low levels of knowledge on the use of antibiotics and a high prevalence of self-medicating children with antibiotics were observed among parents in rural China. Interventions for the rational use of antibiotics in children should focus on strengthening mass health education, improving effective communication between physicians and patients, and enforcing supervision of the sale of antibiotics in retail pharmacies.
Project description:BACKGROUND:Little is known about the relation between unwanted pregnancy and intention discordance and maternal mental health in low-income countries. The study aim was to evaluate maternal and paternal pregnancy intentions (and intention discordance) in relation to perinatal depressive symptoms among rural Bangladeshi women. METHODS:Data come from a population-based, community trial of married rural Bangladeshi women aged 13-44. We examined pregnancy intentions among couples and pregnancy-intention discordance, as reported by women at enrollment soon after pregnancy ascertainment, in relation to depressive symptoms in the third trimester of pregnancy (N?=?14,629) and six months postpartum (N?=?31,422). We calculated crude and adjusted risk ratios for prenatal and postnatal depressive symptoms by pregnancy intentions. RESULTS:In multivariable analyses, women with unwanted pregnancies were at higher risk of prenatal (Adj. RR?=?1.60, 95% CI: 1.37-1.87) and postnatal depressive symptoms (Adj. RR?=?1.32, 95% CI: 1.21-1.44) than women with wanted pregnancies. Women who perceived their husbands did not want the pregnancy also were at higher risk for prenatal (Adj. RR?=?1.42, 95% CI: 1.22-1.65) and postnatal depressive symptoms (Adj. RR?=?1.30, 95% CI: 1.19-1.41). Both parents not wanting the pregnancy was associated with prenatal and postnatal depressive symptoms (Adj. RR?=?1.34, 95% CI: 1.19-1.52; Adj. RR?=?1.13, 95% CI: 1.06-1.21, respectively), compared to when both parents wanted it. Adjusting for socio-demographic and pregnancy intention variables simultaneously, maternal intentions and pregnancy discordance were significantly related to prenatal depressive symptoms, and perception of paternal pregnancy unwantedness and couple pregnancy discordance, with postnatal depressive symptoms. CONCLUSIONS:Maternal, paternal and discordant couple pregnancy intentions, as perceived by rural Bangladeshi women, are important risk factors for perinatal maternal depressive symptoms.
Project description:BACKGROUND:Pharmacists' knowledge about the clinical and legal aspects of antibiotic supply has an impact on appropriate dispensing practice. There are limited studies evaluating community pharmacists' knowledge of antibiotic dispensing in low and middle-income countries, including Sri Lanka. We aimed (i) to evaluate community pharmacy staff's self-reported knowledge about antibiotics and dispensing behaviour of antibiotics without a prescription, and (ii) to identify possible factors impacting their antibiotic dispensing behaviour. METHODS:A cross-sectional survey was conducted among a random sample (n = 369) of community pharmacies across all nine provinces in Sri Lanka using a self-administered questionnaire on their antibiotic knowledge and dispensing practice. Data were analysed using descriptive and inferential statistics including; t-test, one-way ANOVA or chi-square test, and binary and multiple logistic regression. RESULTS:A total of 265 pharmacy staff (210 (79%) pharmacists and 55 (21%) assistants) responded. Overall mean antibiotic knowledge score was 26.1 (SD 3.9; range 1-33, max possible score 34). The overall mean knowledge score t(263) = 2.41, p = 0.017, specific knowledge about antibiotic resistance (ABR) t(262) = 4.98, p = 0.021 and legal aspects of antibiotic dispensing ?2(1, N = 265) = 8.55, p = 0.003) were significantly higher among pharmacists than assistants. One in every three pharmacy staff reported that they dispensed antibiotics without a prescription on patient request; however the proportion was close to half when the patient was known to them. About 30% of the staff reported to have supplied antibiotics for minor infections in the week prior to the survey. However, there was no significant difference in the supply between pharmacists and assistants except for acute sore throat (12% vs 23%, respectively; p = 0.040). Those pharmacists with higher ABR knowledge were less likely to give out antibiotics without a prescription for viral infections in adults (Adj. OR = 0.73, 95% CI: 0.55-0.96; p = 0.027) and children (Adj. OR = 0.55, 95% CI: 0.38-0.80; p = 0.002). Awareness of legal aspects of antibiotic supply reduced overall dispensing (Adj. OR = 0.47, 95% CI: 0.30-0.75; p = 0.001), and specifically for bacterial infections in adults (Adj. OR = 0.45, 95% CI: 0.20-0.99; p = 0.047). Knowledge about antibiotic use and misuse reduced the likelihood of illegal dispensing for common cold (Adj. OR = 0.75, 95% CI: 0.60-0.94; p = 0.011) and acute diarrhoea (Adj. OR = 0.76, 95% CI: 0.58-0.99; p = 0.048). CONCLUSION:Despite the law prohibiting provision, antibiotic dispensing without a prescription continues in community pharmacies in Sri Lanka. Appropriate antibiotic dispensing was associated with high levels of pharmacists' legal and clinical knowledge about antibiotics. Strategies to change the current practice are urgently needed.
Project description:OBJECTIVES:The study's main objective was to describe the prevalence and severity of female sexual dysfunction (FSD) amongst a group of Ghanaian women in the outpatient setting of the predominantly rural Volta region of Ghana. Additionally we determine the predictors of FSD severity and care seeking behaviors of women with the condition. STUDY DESIGN AND SETTING:This was a cross sectional study conducted in the outpatient setting of the Ho Teaching Hospital in the rural-savannah, agro-ecological zone of Volta Region, Ghana. METHODS AND PROCEDURES:FSD was assessed using the Female Sexual Function Index (FSFI) questionnaire. FSD was defined with a cutoff of ?23 so as not to under-estimate the prevalence in this conservative setting. FSFI score >23 was designated "no FSD". We further categorized women with FSD as having mild (FSFI Total score 18-23), moderate (FSFI Total score <18 to >10) or severe (FSFI Total score ?10) FSD. Due to sample size restrictions, we combined the moderate and severe FSD groups in our analyses and defined "moderate/severe FSD" as an FSFI Total score < 18. Participants with FSD were further asked to indicate whether or not they sought help for their conditions, the reasons they sought help, and the types of help they sought. We used p<0.05 to determine statistical significance for all analyses and logistic regression models were used to determine crude and age-adjusted effect estimates. RESULTS:FSD Prevalence: Out of 407 women approached, 300 (83.8%) agreed and consented to participate in the study. The prevalence of FSD was 48.3% (n = 145). Compared to those without FSD, over a third of the FSD women resided in rural settings (37.90% vs 20.60%; p = 0.001) and tended to be multiparous, with a significantly greater proportion having at least three children (31.70% vs 18.10%; p = 0.033). FSD Severity: Over a quarter of the sample (27.6%, n = 40) met the cut-off for moderate to severe FSD. In age-adjusted models, lubrication disorder was associated with 45 times the odds of moderate/severe FSD (age-adj. OR: 45.38, 95% CI: 8.37, 246.00; p<0.001), pain with 17times the odds (age-adj. OR: 17.18, 95% CI: 4.50, 65.50; p<0.001) and satisfaction almost 5times the odds (age-adj. OR: 4.69, 95% CI: 1.09, 20.2; p = 0.04). Compared to those with 1-3 children, nulliparous women had 3.5 times higher odds of moderate/severe sexual dysfunction as well (age-adj. OR:3.51, 95% CI:1.37,8.98; p = 0.009). FSD-related Health Seeking Behaviors: Statistically significant predictors of FSD-related care seeking included having FSD of pain disorder (age-adj. OR: 5.91, 95% CI:1.29, 27.15; p = 0.02), having ?4 children (age-adj. OR: 6.29, 95%CI: 1.53, 25.76; p = 0.01). Of those who sought help, seven in 10 sought formal help from a healthcare provider, with General Practitioners preferred over Gynecologist. About one in 3 (31.3%) who did not seek help indicated that they did not know their sexual dysfunction was a medical condition, over a quarter (28.9%) "thought it was normal" to have FSD, and interestingly, 14.1% did not think a medical provider would be able to provide them with assistance. CONCLUSIONS:Sexual dysfunctions are prevalent yet taboo subjects in many countries, including Ghana. Awareness raising and efforts to feminize the physician workforce are necessary to meet the healthcare needs of vulnerable members of Ghanaian society.
Project description:OBJECTIVES:To investigate leftover antibiotics and their influence on self-medication with antibiotics (SMA) for Chinese children, and further explore the different influences of leftovers from two main sources: previous prescriptions and pharmaceutical purchases. DESIGN:A cross-sectional questionnaire study. SETTING:The participants were approached through kindergartens and primary schools as well as in vaccination clinics. PARTICIPANTS:A total of 9526 parents from three Chinese provinces whose children were aged 0-13 years completed the survey. OUTCOME MEASURES:The prevalence of keeping antibiotics at home for children and the proportion of leftover antibiotics from two main sources were measured by a self-administrated questionnaire. Logistic regression models were established to examine the association between keeping antibiotics at home and SMA for children, specifically the risks of leftovers from two main sources. RESULTS:Overall, 4580 (48.1%) reported keeping antibiotics at home for children. Among those who had leftovers, 2891 (63.1%) reported that their leftovers came from previous prescriptions and 1619 (35.3%) reported that their leftovers came from pharmaceutical purchases. Mothers, older age of child, higher household income, higher education level and medical background were significantly associated with keeping antibiotics at home. Keeping antibiotics at home was significantly associated with SMA for children (adjusted OR=4.91, 95%?CI 3.84 to 6.28). Particularly, compared with parents who did not keep antibiotics at home, parents who kept leftover antibiotics from previous prescriptions and those whose leftovers came from pharmaceutical purchases were 3.80 (95%?CI 2.89 to 5.00) and 6.45 (95%?CI 4.89 to 8.51) times more likely to engage in SMA for children, respectively. CONCLUSIONS:Keeping antibiotics at home for children was pervasive in China. Most leftovers came from previous prescriptions, while those from pharmacies had a higher risk of SMA for children.
Project description:OBJECTIVES:To determine if children attend the family physician (FP) or the FP/paediatrician for their surveillance medical appointments, as well as analyse the variables associated with the parents' choice between the two physicians. DESIGN:Cross-sectional study. SETTING:Public, semiprivate and private kindergartens in the city of Vila Nova de Famalicão (Portugal). PARTICIPANTS:Parents of children aged 6 years or less without chronic diseases, enrolled in the selected kindergartens. MAIN OUTCOME MEASURES:Proportion of children attending the FP or FP/paediatrician for their surveillance appointments; association between the chosen physician and sociodemographic and household variables (parents' age, educational level, professional situation and marital status; household net income; number of children; the child's age; presence of private health insurance), assessment of the parents' perception of clinical knowledge and accessibility regarding the FP and the paediatrician. RESULTS:A total of 697 children were included in the analysis: 30.6% attended only the FP and 69.4% attended both the FP and the paediatrician. Using a Poisson regression, the mother's age (PR=1.02, 95%?CI 1.00 to 1.03), higher educational level (prevalence ratio (PR=1.15, 95%?CI 1.00 to 1.33), private health insurance (PR=1.30, 95%?CI 1.15 to 1.46), number of children (PR=0.86, 95%?CI 0.78 to 0.94) and the child's age (PR=0.95, 95%?CI 0.91 to 0.98) were statistically associated with attending both the FP and the paediatrician; parents of children who attended only FP rated the FP with a higher accessibility and knowledge mean score than those who consulted both physicians (2.91vs2.38, P<0.001, and 4.11vs3.85, P<0.001). CONCLUSIONS:Our data show that 70% of our sample simultaneously attended an FP and a paediatrician. FPs are equally qualified to provide medical care to healthy children but this information is not properly transmitted to the general population.
Project description:OBJECTIVES:Acute respiratory infections and fever among children are highly prevalent in primary care. It is challenging to distinguish between viral and bacterial infections. Norway has a relatively low prescription rate of antibiotics, but it is still regarded as too high as the antimicrobial resistance is increasing. The aim of the study was to identify predictors for prescribing antibiotics or referral to hospital among children. DESIGN:Secondary analysis of a randomised controlled study. SETTING:4 out-of-hours services and 1 paediatric emergency clinic in Norwegian primary care. PARTICIPANTS:401 children aged 0-6?years with respiratory symptoms and/or fever visiting the out-of-hours services. OUTCOMES:2 main outcome variables were registered: antibiotic prescription and referral to hospital. RESULTS:The total prescription rate of antibiotics was 23%, phenoxymethylpenicillin was used in 67% of the cases. Findings on ear examination (OR 4.62; 95% CI 2.35 to 9.10), parents' assessment that the child has a bacterial infection (OR 2.45; 95% CI 1.17 to 5.13) and a C reactive protein (CRP) value >20?mg/L (OR 3.57; 95% CI 1.43 to 8.83) were significantly associated with prescription of antibiotics. Vomiting in the past 24?hours was negatively associated with prescription (OR 0.26; 95% CI 0.13 to 0.53). The main predictors significantly associated with referral to hospital were respiratory rate (OR 1.07; 95% CI 1.03 to 1.12), oxygen saturation <95% (OR 3.39; 95% CI 1.02 to 11.23), signs on auscultation (OR 5.57; 95% CI 1.96 to 15.84) and the parents' assessment before the consultation that the child needs hospitalisation (OR 414; 95% CI 26 to 6624). CONCLUSIONS:CRP values >20?mg/L, findings on ear examination, use of paracetamol and no vomiting in the past 24?hours were significantly associated with antibiotic prescription. Affected respiration was a predictor for referral to hospital. The parents' assessment was also significantly associated with the outcomes. TRIAL REGISTRATION NUMBER:NCT02496559; Results.
Project description:BACKGROUND:Despite the high asthma rates described in Latin America, asthma risk factors in poor urban settings are not well established. We investigated risk factors for acute asthma among Ecuadorian children. METHODS:A matched case-control study was carried out in a public hospital serving a coastal city. Children with acute asthma were age- and sex-matched to non-asthmatics. A questionnaire was administered, and blood, as well as stool, and nasopharyngeal swabs were collected. RESULTS:Sixty cases and 119 controls aged 5-15 were evaluated. High proportions of cases were atopic with population-attributable fractions for atopy of 68.5% for sIgE and 57.2% for SPT. Acute asthma risk increased with greater titers of mite IgE (3.51-50 kU/l vs. <0.70kU/l - OR 4.56, 95% CI 1.48-14.06, p = 0.008; >50kU/l vs. <0.70kU/l - OR 41.98, 95% CI: 8.97-196.39, p < 0.001). Asthma risk was significantly independently associated with bronchiolitis (adj. OR: 38.9, 95% CI 3.26-465), parental educational level (adj. OR 1.26, 95% CI: 1.08-1.46), and presence of sIgE (adj. OR: 36.7, 95% CI: 4.00-337), while a reduced risk was associated with current contact with pets (adj. OR: 0.07, 95% CI: 0.01-0.56). Rhinovirus infection was more frequent in cases (cases 35.6% vs. controls 7.8%, p = 0.002). None of the cases were on maintenance therapy with inhaled corticosteroids and most relied on emergency department for control. CONCLUSIONS:A high proportion of children presenting to a public hospital with acute asthma were allergic to mite, particularly at high IgE titer. Poor asthma control resulted in overuse of emergency care.
Project description:INTRODUCTION:According to Joint National Committee-7 (JNC-7) guidelines, a systolic blood pressure (SBP) of 120 to 139 mm Hg and/or diastolic blood pressure (DBP) of 80 to 89 mm Hg is considered as pre-hypertension. Existing evidence suggest that the cardiovascular morbidities are increasing among pre-hypertensive individuals compared to normal. OBJECTIVE:To assess the magnitude and factors associated with pre-hypertension among young adults (20-30 years) in coastal villages of Udupi Taluk (an area of land with a city or town that serves as its administrative centre and usually a number of villages), Udupi District, Karnataka state, India. DESIGN:Community based cross sectional study. SETTING:6 (out of total 14) coastal villages of Udupi Taluk, Karnataka state, India. SAMPLE:1,152 young adults (age group: 20-30 years) selected by stratified random sampling in 6 coastal villages of Udupi Taluk, Karnataka state, India. METHOD:A semi structured pre-tested questionnaire was used to elicit the details on socio-demographic variables, dietary habits, tobacco use, alcohol consumption, physical activity, family history of hypertension and stress levels. Anthropometric measurements and blood pressure were recorded according to standard protocols. Serum cholesterol was measured in a sub sample of the study population. Multivariate logistic regression was applied to identify the independent correlates of pre-hypertension among young adults (20-30 years). MAIN OUTCOME MEASURES:Prevalence, Odds ratio (OR) and adjusted (adj) OR for pre-hypertension among young adults (20-30 years). RESULTS:The prevalence of pre-hypertension in the study population was 45.2% (95%CI: 42.4-48). Multivariate logistic regression analysis revealed that age group of 25-30 years (adj OR: 4.25, 95% CI: 2.99-6.05), white collared (adj OR: 2.29, 95% CI: 1.08-4.85) and skilled occupation (adj OR: 3.24, 95% CI: 1.64-6.42), students (adj OR: 2.46, 95% CI: 1.22-4.95), using refined cooking oil (adj OR: 0.53, 95% CI: 0.29-0.95), extra salt in meals (adj OR: 2.46, 95% CI: 1.52-3.99), salty food items (adj OR: 6.99, 95% CI: 3.63-13.48), pre-obese (adj OR: 1.66, 95% CI: 1.03-2.67) and obese (adj OR: 9.16, 95% CI: 2.54, 36.4) were the significant correlates of pre-hypertension. CONCLUSION:In the study population, prevalence of pre-hypertension among young adults (20-30 years) was high (45.2%). Biological (age 25-30 years, pre-obesity and obesity) and behavioral (sedentary occupation, intake of extra salt in meals/salty food and not using refined cooking oil) factors were associated with pre-hypertension. Study emphasizes the need of community based screening of pre-hypertension under National Rural Health Mission. It also provides apt information for the evidence based designing of interventions for lifestyle modifications among high risk young adults in the study area.
Project description:BACKGROUND/OBJECTIVES:In utero exposure to endocrine-disrupting compounds such as 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) may alter risk of obesity and related metabolic disease later in life. We examined the relationship of prenatal exposure to TCDD with obesity and metabolic syndrome (MetS) in children born to a unique cohort of TCDD-exposed women resulting from a 1976 explosion in Seveso, Italy. SUBJECTS/METHODS:In 2014, nearly 40 years after the explosion, we enrolled 611 post-explosion offspring, 2 to 39 years of age, in the Seveso Second Generation Study. In utero TCDD exposure was defined primarily as TCDD concentration measured in maternal serum collected soon after the explosion and alternately as TCDD estimated at pregnancy. We measured height, weight, waist circumference, body fat, blood pressure, and fasting blood levels of lipids and glucose, which were combined to assess body mass index (BMI) and MetS. RESULTS:Children (314 female, 297 male) averaged 23.6 (±6.0) years of age. Among the 431 children ?18 years, a 10-fold increase in initial maternal TCDD concentration was inversely associated with BMI in daughters (adj-??=?-0.99?kg/m2; 95% CI -1.86, -0.12), but not sons (adj-??=?0.41?kg/m2; 95% CI -0.35, 1.18) (p-int?=?0.02). A similar relationship was found in the younger children (2-17 years); a 10-fold increase in initial maternal TCDD was inversely associated with BMI z-score (adj-??=?-0.59?kg/m2; 95% CI -1.12, -0.06) among daughters, but not sons (adj-??=?0.04?kg/m2; 95% CI -0.34, 0.41) (p-int?=?0.03). In contrast, in sons only, initial maternal TCDD was associated with increased risk for MetS (adj-RR?=?2.09, 95% CI 1.09, 4.02). Results for TCDD estimated at pregnancy were comparable. CONCLUSIONS:These results suggest prenatal TCDD exposure alters cardiometabolic endpoints in a sex-specific manner. In daughters, in utero TCDD is inversely associated with adiposity measures. In sons, in utero TCDD is associated with increased risk for MetS.
Project description:BACKGROUND: Upper respiratory tract infections (URTIs) are common in children. The cause of URTIs is usually viral, but parents' attitudes often contribute to inappropriate prescription of antibiotics, promoting antibiotic resistance. The objective of this study was to document and analyse parental beliefs on antibiotic use for children with URTIs in Greece, a country with high levels of antibiotic use and antibiotic resistance. METHODS: A knowledge-attitude-practice questionnaire was developed and distributed to Greek parents caring for children who were 5-6 years old, between January and July of the same school year. The sample of the study contained parents from all geographic areas of Greece. RESULTS: The majority of Greek parents (80%) believed that UTRIs are mostly self-limited, although 74% of them expected to receive antibiotics when such a diagnosis was given. Earache was the most common reason for which parents expected antibiotics (45%). Greek parents rarely gave antibiotics to their children without medical advice (10%) and most (88%) believed that unnecessary antibiotic use drives antibiotic resistance and they were happy to receive symptomatic therapy if instructed by their physician. Almost 70% of parents confused antibiotics with other medicines used for symptomatic therapy for a child with URTI. CONCLUSION: Greek parents have a trusted relationship with their paediatrician and rarely give antibiotics without medical advice, indicating that parents contribute less than expected to antibiotic misuse. Parents also appreciate the benign course of most URTIs and the fact that unnecessary antibiotic use is harmful. More time needs to be invested in educating mostly physicians on the potential benefit from reducing antibiotic prescribing for children with URTI.