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Original Research (Original Article) 


Ghadah Abdulrahman Albalawi et al, 2020;4(3):753–758.

International Journal of Medicine in Developing Countries

Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections

Ghadah Abdulrahman Albalawi1, Sumayah abdulrahman Alzahrani2, Amal Abdulrahman Alotaibi2, Asmaa Salah Ghmaird2*

Correspondence to: Asmaa Salah Ghmaird

*Tabuk University, Tabuk Saudi Arabia.

Email: aghmaird [at] ut.edu.sa

Full list of author information is available at the end of the article.

Received: 16 January 2020 | Accepted: 21 January 2020


ABSTRACT

Background:

Pathogenic organisms are involved in the upper respiratory tract infections (URTIs) leading to nasal obstruction, sore throat, tonsillitis, otitis media, common cold, etc. and more prevalent in children. These URTIs may be mild and self-limiting, but the symptoms can cause fever and make children irritable and uncomfortable. To describe the knowledge, attitude, and practice of parents regarding the use of antibiotics for their children with URTIs in Tabuk, Saudi Arabia.


Methodology:

A cross-sectional study conducted in the Tabuk region, Saudi Arabia. Participants (n = 350) took part in the study from September 2018 to January 2019 by responding to a questionnaire. Chi-square and t-test were used to compare between dependents and independents variables. Statistical analysis was done using Statistical Package for the Social Sciences software.


Results:

93% of participants were familiar with antibiotics but only 22% knew that antibiotics are used against bacterial infections. Only 61% of participants were aware of antibiotic resistance and 50% of participants think that most of the URTIs can be treated with antibiotics. About 19% of participants gave antibiotics to the child without consulting any doctor. About 37% of participants did not complete the antibiotic course for their children once the condition improved.


Conclusion:

There were many misunderstandings regarding the use of antibiotics, following doctor’s instructions, time of usage, and use of antibiotics without prescription. The study concludes by stating the need for awareness among parents, action against handing antibiotics without prescription and all physicians following a common protocol for managing children with URTIs.


Keywords:

Antibiotics, upper respiratory tract infections, questionnaire, children.


Introduction

Upper respiratory tract infections (URTIs) are the most prevalent infectious diseases among the pediatric population with six to eight episodes per year [1]. In most cases, these infections are of viral etiology [25] and have specific seasonal occurrences [5]. Infections with these viruses exhibit symptoms of common cold, with coryza, cough, and hoarseness. Rhinitis and pharyngitis are also found and in some cases, symptoms and signs of otitis media may also occur [6]. These infections are known to be self-limiting with very few complications, their management consists of self-care and symptomatic treatment [7]. Furthermore, URTIs in children can become a burden on parents and the healthcare system, economically [5]. The diseases due to infections lead to low attendance of students in the school and unnecessary medical care, thus inflicting an unnecessarily high cost on society and healthcare services [1]. In pediatric cases of URTIs, prescription of antibiotics is the common practice [26] in spite of evidence supporting the fact that most infections are caused due to viruses [7]. Quite a few bacterial illnesses (such as otitis media and sinusitis) are usually self-limited making the antibiotic treatment unnecessary. The rise in antibiotic resistance worldwide can be mainly attributed to antibiotics abuse in children for the treatment of URTIs. Therefore, the judicious use of antibiotics in pediatric clinical practice is crucial in avoiding antibiotic resistance in patients [7,8]. The health economics takes its toll due to infections and bacterial resistance as this requires more specific and expensive antibiotics for their treatment [5,6]. The misuse of antibiotics will also lead to the development of side effects [5]. The main reason for the inappropriate antibiotic prescription is the lack of knowledge in parents and their neglectful attitudes. The pediatricians are coerced by the parents for prescriptions of more than the required antibiotics [911]. The awareness in the caregivers and parents about the effects of unnecessary antibiotics can lead to the right decisions regarding the correct use of antibiotics. The reasons for misuse of antibiotics can be due to the lack of the physicians’ knowledge and experience, wrong or uncertain diagnosis, and insufficient patient awareness. Unnecessary prescription of antibiotics may be due to reasons regarding the parents and physicians [3]. Parent related reasons involve beliefs, attitudes, and knowledge about antibiotic use and practice, leading to parents resorting to over-the-counter medication and self-medication [3]. Hence, it is expected by the parents that the physicians treat the illness in children by the prescriptions of antibiotics. Therefore, understanding parental knowledge, attitude, and practice (KAP) regarding antibiotics use for URTIs as the prime factor to decrease unjustified antibiotic prescriptions.

The knowledge about antibiotics use in the parents, their attitudes and practices about antibiotic use in pediatric URTIs are of utmost importance. This information about the parents can be used to create awareness among the parents about antibiotic use. The present study was designed to assess the knowledge of parents and their attitudes toward antibiotics use in the treatment of childhood URTIs.


Subjects and Methods

This study was approved by the Institute Ethical Committee of Tabuk University. The participants were requested to respond to a questionnaire and no participants were obligated to respond. All personal information of the respondents was kept confidential. Informed consent was obtained from all the participants. This was a cross-sectional surveillance study conducted in the Tabuk region, Saudi Arabia. According to the previous study conducted Taif, Kingdom of Saudi Arabia in 2016, it was estimated that the parent’s knowledge of antibiotic use was 31.0% (12). Therefore, the sample size was calculated with the following equation:

n = z² p q/m²

where z = z value (1.96 for 95% confidence level)

p = assumed proportion = 31%

q = 1–p (complementary) = 69%

m = margin of error = 0.05

n = sample size

According to the equation, sample size (n) is (1.96)2 *0.31* 0.69/(0.05)2 = 329.

To increase the validity and for convenience of analysis, 350 subjects were selected for this study. The period of study was from the 21st of September 2018 till the 1st of January 2019. The data collection tool was a pre-tested close-ended self-administered online survey. The variables used were sociodemographic variables (e.g., age, sex, and education level) and variables related to KAP (e.g., level of knowledge, questions on practice). All data were statistically done using (Statistical Package for the Social Sciences, version 24) descriptive statistics, such as frequency and percentage for qualitative variables; mean and SD for quantitative variables were done for all data while advanced analysis, such as Chi-square and t-test were applied to compare between dependents and independent variables.


Results

This community based descriptive study was conducted at Tabuk region to describe the KAP of parents regarding the use of antibiotics among their children with URTIs. For this study, sample of 350 participants who fulfilled eligibility criteria and agreed to participate were included from September 2018 till January 2019.

Figure 1. Percentage of male and female participants.

Majority of participants were males (62%) (Figure 1), with Saudi nationality (98%), about 30% of participants within the age group of 20–30 years old (Figure 2), 31% within the age group of 31–40 years old and 30% within the age group of 41–50 years old. Most of the participants had a diploma or university degree (75%) (Figure 3). More than half of the participants (56%) were civil servants and about 49% of participants had a number of children from 1 to 3 child (Table 1). Majority of participants were familiar with antibiotics (93%); only 22% of participants correctly answered that antibiotics were mainly for treating bacterial infections; 86% of participants knew that antibiotics have side effects or allergic reaction; Only 61% of participants were aware of antibiotics resistance and 50% of participants thought that most of the URTIs (e.g., cold, flu, sore throats, and ear infections) can be treated with antibiotics (Table 2). About 70% of participants used antibiotics for their children in the last 12 months. Antibiotics were mainly used for the treatment of sore throat (43%), flu (19%), fever (16%), ear infections (9%), urinary tract infections (7%), and pneumonia (6%). About 19% of participants tended to give child antibiotics without consulting any doctor, 27% changed their doctor because he/she did not prescribe any antibiotics for their child. Only 15% of participants kept the remaining antibiotics for future use and 27% re-used an antibiotic which was used in the past when similar symptoms were present. About 37% of participants did not complete the antibiotic course for the child once the condition or symptoms improved (Table 3). Only 13% of participants always ask pediatrician if it’s necessary to prescribe an antibiotic, 6% always praise the pediatrician if he prefers not to prescribe antibiotics, 2% always follow the pediatrician’s instructions and advice, 5% of participants always agree that pediatrician explains about child’s condition and whether the child should take any antibiotics, and finally 52% of participants always think that the pediatrician prescribes antibiotics only because the parents to do so (Table 4).

Figure 2. The age group of participants.

Figure 3. The educational level of participants.

Table 1. Demographic data of the participants (n = 350).

Variable Sub Variable n %
Gender Female 132 37.7
Male 218 62.3
Nationality Saudi 344 98.3
Non Saudi 6 1.7
Age group 20–30 110 31.4
31–40 109 31.1
41–50 106 30.3
>50 25 7.1
Educational level illiterate 8 2.3
Secondary school or less 81 23.1
Diploma or university degree 261 74.6
Occupation Unemployed 135 38.6
Civil servant 196 56.0
Private sector 19 5.4
Self-employed. 0 0
Number of children 1–3 170 48.6
4–6 121 34.6
>7 59 16.9

Discussion

URTIs are the most prevalent infectious diseases among the pediatric population with six to eight episodes per year [1]. An antibiotic is a type of antimicrobial substance active against bacteria which may either kill or inhibit the growth of bacteria. Undesirable use of antibiotics for diseases such as URTIs caused by microorganisms other than bacteria is common all over the world. Our study indicated that majority of participants were familiar regarding antibiotics (93%), but only 22% of participants who correctly answered that antibiotics were mainly for treating bacterial infections; 86% of participants knew that antibiotics have side effects or allergic reaction; only 61% of participants heard of antibiotics resistance; 50% of participants think that most of the URTIs (e.g., cold, flu, sore throats, and ear infections) can be treated with antibiotics. This study also stated that about 70% of participants used antibiotics for their children in the last 12 months; 19% of participants tended to give children a course of antibiotics without consulting any doctor, 27% changed their doctor because he/she did not prescribe any antibiotics for their child. Only 15% of participants kept the remaining antibiotics for future use and 27% re-used an antibiotic which was used in the past when similar symptoms were present; about 37% of participants did not complete the antibiotic course for the child once the child’s conditions improved. Parent’s knowledge and attitudes toward antibiotics play a vital role in the success of the treatment process. Only 13% of participants always ask physician if it’s necessary to prescribe an antibiotic, 6% always praise the physician if he prefers not to prescribe antibiotics, 2% always follow all the physician’s instructions and advice, 5% of participants always agree that physician explained about the condition of the child and whether or not to receive any antibiotic drugs, and finally, 52% of participants always think that the physician prescribes antibiotics only if they request them to do so. Our findings were supported by the previous study conducted in 2018 by Hammour et al. [13], which concluded that 50% of respondents wrongly believed that antibiotics are void of side effects. It was commonly believed by more than two-thirds (72.4%) that the antibiotics should be administered once the children develop a fever. But, awareness about the misuse of antibiotics was shown by 68.3% of respondents, and more than 62% of the parents confessed to coercing the pediatrician to prescribe antibiotics. A similar study conducted in Pakistan in 2017 revealed that 92 (23%) of the respondents had poor knowledge, 252 (63%) had moderate knowledge [14]. According to a study conducted in Malaysia in 2016, it was found that about two-thirds (69.1%) of the parents were negligent about the right antibiotic use. About 31.6% were unaware of the requirement of a prescription to buy antibiotics and about two-third (67.5%) confessed to having not followed instructions from the doctors. A study by Koh Chee et al and Al-Ayed et al [15,16] and the recent study conducted in Saudi Arabia, in 2019 demonstrated that parents’ KAP on antibiotics for their children are poor.

Table 2. The attitude of participants to antibiotics.

Variable Sub variable n %
Do you know what Antibiotics are? Yes 327 93.4
No 23 6.6
what do you think antibiotic treat? Bacterial infections 78 22.3
Viral infections 58 16.6
Fungal infections 7 2.0
All of the above 174 49.7
I don’t know 33 9.4
Do you think that antibiotics have side effects or an allergic reaction? Yes 301 86.0
No 21 6.0
I don’t know 28 8.0
Have you heard of antibiotics resistance? Yes 215 61.4
No 98 28.0
I don’t know 37 10.6
Do you think the efficiency and effectiveness of the antibiotics are better when it is? Newer 162 46.3
More costly 26 7.4
Both 55 15.7
I don’t know 107 30.6
Do you think that most of the upper respiratory tract infections (Like cold, flu, sore throats, and ear infections) should treat with antibiotics? Yes 175 50.0
No 141 40.3
I don’t know 34 9.7

Table 3. Wrong practices related to the use of antibiotics for children.

Variable Sub variable n %
In the last 12 months did you use antibiotics for your children? Yes 234 66.9
No 103 29.4
I don’t know 13 3.7
What is the cause of the antibiotic given to the child? Ear infections 33 9.4
Pneumonia 20 5.7
Sore throat 151 43.1
Urinary tract Infections 23 6.6
Wound infections 0 0
Flu 66 18.9
Fever 57 16.3
Would you give your child antibiotics without a previous doctor consult? Yes 66 18.9
No 278 79.4
I don’t know 6 1.7
Would you change your doctor because you think he/she not prescribed antibiotics for your child? Yes 96 27.4
No 229 65.4
I don’t know 25 7.1
Do you keep the remaining antibiotics for future use? Yes 54 15.4
No 284 81.1
I don’t know 12 3.4
Would you re-use an antibiotic that you had used in the past if your child presents similar symptoms? Yes 96 27.4
No 229 65.4
I don’t know 25 7.1
Do you complete a complete antibiotic prescription for the child even if the child’s condition or symptoms improve? Yes 194 55.4
No 130 37.1
I don’t know 26 7.4

Table 4. Attitude towards physician.

Variable Sub variable n %
In case the physician prescribes an antibiotic, how often do you ask him if it’s necessary? Always 45 12.9
Often 116 33.1
Sometimes 106 30.3
Never 83 23.7
How often do you praise the physician if he prefers not to prescribe antibiotics? Always 22 6.3
Often 91 26.0
Sometimes 134 38.3
Never 103 29.4
How often do you follow all the physician instructions and advice? Always 7 2.0
Often 51 14.6
Sometimes 176 50.3
Never 116 33.1
How often does the physician explain to you about your child’s condition and if it should or shouldn’t receive antibiotics? Always 19 5.4
Often 136 38.9
Sometimes 109 31.1
Never 86 24.6
How often do you think that the physician prescribes antibiotics only because you asked him to? Always 181 51.7
Often 116 33.1
Sometimes 15 4.3
Never 38 10.9

Conclusion

This study concluded that parents’ KAP on antibiotics use for their children were poor, and there were many misunderstandings regarding the use of antibiotics, following doctors’ instructions, usage of antibiotics without prescription and when to use antibiotics. Hence, all healthcare providers should increase parents’ awareness related to antibiotics use for children and action exercised to ban the handing of antibiotics without prescription and all physicians should follow one protocol for managing children with URTIs.


List of Abbreviations

DR Diabetic retinopathy
FBS Fasting blood sugar
HbA1c Hemoglobin A1C
T2DM Type 2 Diabetes Mellitus
Vit D Vitamin D

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

This study was approved by Institute Ethical Committee of Tabuk University. The research was approved by College of Medicine, Tabuk University, Ref # READ0022, dated: 7/10/2019.


Author details

Ghadah Abdulrahman Albalawi1, Sumayah abdulrahman Alzahrani2, Amal Abdulrahman Alotaibi2, Asmaa Salah Ghmaird2

  1. Hail University, Al Hail, Saudi Arabia
  2. Tabuk University, Tabuk, Saudi Arabia

References

  1. Cotton MF, Innes S, Jaspan H, Madide A, Rabie H. Management of upper respiratory tract infections in children. South Afr Fam Pract. 2008;50(2):6–12. https://doi.org/10.1080/20786204.2008.10873685
  2. Wang H, Zheng Y, Deng J, Wang W, Liu P, Yang F, et al. Prevalence of respiratory viruses among children hospitalized from respiratory infections in Shenzhen, China. Virol J. 2016;13:39. https://doi.org/10.1186/s12985-016-0493-7
  3. Ji W, Chen Z, Zhou W, Sun H, Li B, Cai L, et al. Etiology of acute respiratory tract infection in hospitalized children in Suzhou from 2005 to 2011. Zhonghua Yu Fang Yi Xue Za Zhi [Chin J Prev Med]. 2013;47(6):497–503.
  4. Bezerra PG, Britto MC, Correia JB, Duarte Mdo C, Fonceca AM, Rose K, et al. Viral and atypical bacterial detection in acute respiratory infection in children under five years. PLoS One. 2011;6(4):e18928. https://doi.org/10.1371/journal.pone.0018928
  5. Denny Jr FW. The clinical impact of human respiratory virus infections. Am J Respir Crit Care Med. 1995;152(4):S4. https://doi.org/10.1164/ajrccm/152.4_Pt_2.S4
  6. Tregoning JS, Schwarze J. Respiratory viral infections in infants: causes, clinical symptoms, virology, and immunology. Clin Microbiol Rev. 2010;23(1):74–98. https://doi.org/10.1128/CMR.00032-09
  7. Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD, et al. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ. 2013;347:f7027. https://doi.org/10.1136/bmj.f7027
  8. Nyquist A-C, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA. 1998;279(11):875–7. https://doi.org/10.1001/jama.279.11.875
  9. Huang N, Morlock L, Lee C-H, Chen L-S, Chou Y-J. Antibiotic prescribing for children with nasopharyngitis (common colds), upper respiratory infections, and bronchitis who have health-professional parents. Pediatrics. 2005;116(4):826–32. https://doi.org/10.1542/peds.2004-2800
  10. Nash DR, Harman J, Wald ER, Kelleher KJ. Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Arch Pediatr Adolesc Med. 2002;156(11):1114–9. https://doi.org/10.1001/archpedi.156.11.1114
  11. Alumran A, Hurst C, Hou X-Y. Antibiotics overuse in children with upper respiratory tract infections in Saudi Arabia: risk factors and potential interventions. Clin Med Diagn. 2011;1(1):8–16. https://doi.org/10.5923/j.cmd.20110101.02
  12. Elbur A, Albarraq A, Abdallah M. Saudi Parents’ knowledge, attitudes and practices on antibiotic use for upper respiratory tract infections in children: a population-based survey; Taif, Kingdom of Saudi Arabia. J Med Res. 2016;2(4):99–103. https://doi.org/10.21276/sjmps.2016.2.6.3
  13. Hammour KA, Jalil MA, Hammour WA. An exploration of parents’ knowledge, attitudes and practices towards the use of antibiotics in childhood upper respiratory tract infections in a tertiary Jordanian Hospital. Saudi Pharm J. 2018;26(6):780–5. https://doi.org/10.1016/j.jsps.2018.04.006
  14. Atif M, Sadeeqa S, Afzal H, Latif S. Knowledge, attitude and practices regarding antibiotics use among parents for their children. Int J Pharm Sci Res. 2018;9(5):2140–8.
  15. Teck KC, Ghazi HF, Bin Ahmad MI, Binti Abdul Samad N, Ee Yu KL, Binti Ismail NF, et al. Knowledge, attitude, and practice of parents regarding antibiotic usage in treating children’s upper respiratory tract infection at primary health clinic in Kuala Lumpur, Malaysia: pilot study. Health Serv Res Manag Epidemiol. 2016;3:2333392816643720. https://doi.org/10.1177/2333392816643720
  16. Al-Ayed MSZ. Parents’ knowledge, attitudes and practices on antibiotic use by children. Saudi J Med Med Sci. 2019;7(2):93. https://doi.org/10.4103/sjmms.sjmms_171_17


How to Cite this Article
Pubmed Style

Albalawi GA, Alzahrani SA, Ghmaird AS, Alotaibi AA. Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections. IJMDC. 2020; 4(3): 753-758. doi:10.24911/IJMDC.51-1579174920


Web Style

Albalawi GA, Alzahrani SA, Ghmaird AS, Alotaibi AA. Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections. http://www.ijmdc.com/?mno=82286 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1579174920


AMA (American Medical Association) Style

Albalawi GA, Alzahrani SA, Ghmaird AS, Alotaibi AA. Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections. IJMDC. 2020; 4(3): 753-758. doi:10.24911/IJMDC.51-1579174920



Vancouver/ICMJE Style

Albalawi GA, Alzahrani SA, Ghmaird AS, Alotaibi AA. Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections. IJMDC. (2020), [cited March 29, 2020]; 4(3): 753-758. doi:10.24911/IJMDC.51-1579174920



Harvard Style

Albalawi, G. A., Alzahrani, . S. A., Ghmaird, . A. S. & Alotaibi, . A. A. (2020) Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections. IJMDC, 4 (3), 753-758. doi:10.24911/IJMDC.51-1579174920



Turabian Style

Albalawi, Ghadah Abdulrahman, Sumayah Abdulrahman Alzahrani, Asmaa Salah Ghmaird, and Amal Abdulrahman Alotaibi. 2020. Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections. International Journal of Medicine in Developing Countries, 4 (3), 753-758. doi:10.24911/IJMDC.51-1579174920



Chicago Style

Albalawi, Ghadah Abdulrahman, Sumayah Abdulrahman Alzahrani, Asmaa Salah Ghmaird, and Amal Abdulrahman Alotaibi. "Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections." International Journal of Medicine in Developing Countries 4 (2020), 753-758. doi:10.24911/IJMDC.51-1579174920



MLA (The Modern Language Association) Style

Albalawi, Ghadah Abdulrahman, Sumayah Abdulrahman Alzahrani, Asmaa Salah Ghmaird, and Amal Abdulrahman Alotaibi. "Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections." International Journal of Medicine in Developing Countries 4.3 (2020), 753-758. Print. doi:10.24911/IJMDC.51-1579174920



APA (American Psychological Association) Style

Albalawi, G. A., Alzahrani, . S. A., Ghmaird, . A. S. & Alotaibi, . A. A. (2020) Knowledge, attitude, and practices of parents regarding the use of antibiotics among their children with upper respiratory tract infections. International Journal of Medicine in Developing Countries, 4 (3), 753-758. doi:10.24911/IJMDC.51-1579174920