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Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia.

ABSTRACT: INTRODUCTION:Low-income and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains under-represented in AMR research. OBJECTIVE:To (1) Describe antibiotic-related knowledge, attitudes and practices of the general population in two LMICs. (2) Assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers. DESIGN:Observational study: cross-sectional rural health behaviour survey, representative of the population level. SETTING:General rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018. PARTICIPANTS:2141 adult members (?18 years) of the general rural population, representing 712?000 villagers. OUTCOME MEASURES:Antibiotic-related knowledge, attitudes and practices across sites and healthcare access channels. FINDINGS:Villagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p<0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p<0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like 'anti-inflammatory medicine' in Chiang Rai (87.6%; 95% CI 84.9% to 90.0%) and 'ampi' in Salavan (75.6%; 95%?CI 71.4% to 79.4%). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95%?CI 0.01 to 0.23) and 0.53 in Salavan (95%?CI 0.16 to 0.90). CONCLUSIONS:Locally specific conceptions and counterintuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming 'knowledge deficits' alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards 'AMR-sensitive interventions' that address context-specific upstream drivers of antimicrobial use (eg, unemployment insurance) and complement education and awareness campaigns. TRIAL REGISTRATION NUMBER:Clinicaltrials.gov identifier NCT03241316.

SUBMITTER: Haenssgen MJ

PROVIDER: S-EPMC6707701 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia.

Haenssgen Marco J MJ Charoenboon Nutcha N Zanello Giacomo G Mayxay Mayfong M Reed-Tsochas Felix F Lubell Yoel Y Wertheim Heiman H Lienert Jeffrey J Xayavong Thipphaphone T Khine Zaw Yuzana Y Thepkhamkong Amphayvone A Sithongdeng Nicksan N Khamsoukthavong Nid N Phanthavong Chanthasone C Boualaiseng Somsanith S Vongsavang Souksakhone S Wibunjak Kanokporn K Chai-In Poowadon P Thavethanutthanawin Patthanan P Althaus Thomas T Greer Rachel Claire RC Nedsuwan Supalert S Wangrangsimakul Tri T Limmathurotsakul Direk D Elliott Elizabeth E Ariana Proochista P

BMJ open 20190820 8

<h4>Introduction</h4>Low-income and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains under-represented in AMR research.<h4>Objective</h4>To (1) Describe antibiotic-related knowledge, attitudes and practices of the general population i ...[more]

PMID: 31434769

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Project description:BACKGROUND:Despite rapid upscale of insecticide-treated nets (ITNs) and indoor residual spraying (IRS), malaria remains a major source of morbidity and mortality in Zambia. Uptake and utilization of these and novel interventions are often affected by knowledge, attitudes and practices (KAP) amongst persons living in malaria-endemic areas. The aims of this study were to assess malaria KAP of primary caregivers and explore trends in relation to ITN use, IRS acceptance and mosquito density in two endemic communities in Luangwa and Nyimba districts, Zambia. METHODS:A cohort of 75 primary caregivers were assessed using a cross-sectional, forced-choice malaria KAP survey on ITN use, IRS acceptance and initial perception of a novel spatial repellent (SR) product under investigation. Entomological sampling was performed in participant homes using CDC Miniature Light Traps to relate indoor mosquito density with participant responses. RESULTS:Ninety-nine percent of participants cited bites of infected mosquitoes as the route of malaria transmission although other routes were also reported including drinking dirty water (64%) and eating contaminated food (63%). All caregivers agreed that malaria was a life-threatening disease with the majority of caregivers having received malaria information from health centers (86%) and community health workers (51%). Cumulatively, self-reported mosquito net use was 67%. Respondents reportedly liked the SR prototype product but improvements on color, shape and size were suggested. Overall, 398 mosquitoes were captured from light-trap collections, including 49 anophelines and 349 culicines. Insecticide treated nets use was higher in households from which at least one mosquito was captured. CONCLUSIONS:The current study identified misconceptions in malaria transmission among primary caregivers indicating remaining knowledge gaps in educational campaigns. Participant responses also indicated a misalignment between a low perception of IRS efficacy and high stated acceptance of IRS, which should be further examined to better understand uptake and sustainability of other vector control strategies. While ITNs were found to be used in study households, misperceptions between presence of mosquitoes and bite protection practices did exist. This study highlights the importance of knowledge attitudes and practice surveys, with integration of entomological sampling, to better guide malaria vector control product development, strategy acceptance and compliance within endemic communities.

Project description:The worldwide use of medicinal plant products has been steadily increasing over the past few decades, whereas the traditional knowledge and practices of these botanical medicines appears to be diminishing. Considering the need to conserve and document these traditions, the objective of this study was to understand the knowledge, attitudes, and practices of people who are familiar with botanical medicines, as well as any factors that may influence the perceptions and behaviours associated with the use of medicinal plants. A previously validated survey instrument assessing knowledge, attitudes, and practices on the use medicinal plants was randomly administered to residents of three rural Barbadian communities. The data was analyzed using descriptive statistics and cross tabulations (Chi-Square Test, Fisher's Exact Test), with a confidence level of 95% and significance level of p < 0.05. One hundred and fifty-four participants completed the survey with a response rate of 96%. From participant responses we found that over 75% of the study population used botanical medicines. Key findings included a diverse repertoire of traditional knowledge on the use of medicinal plants, which included a total of 29 medicinal applications cited across 69 different plant species and 39 families. The most popular species among respondents (irrespective of use) were Pimenta racemosa (Mill.) J.W. Moore (FC = 30, RFC = 0.26), Momordica charantia L. (FC = 28, RFC = 0.24), Zingiber officinale Roscoe (FC = 22, RFC = 0.19) and Annona muricata L. (FC = 21, RFC = 0.18). The findings also show the persistence of medico-cultural concepts such as cleansing and cooling, and identified significant associations between the use of botanical medicines and related practices with demographic variables such as education (p = 0.05; Fisher's Exact Test) and health insurance, χ2 (1, n = 152) = 4.645, p = 0.003. The findings of this study can be used in the identification and archiving of the medicinal plant practices in Barbados and the wider Caribbean, as well as for the larger purposes of biocultural exploration, preservation and further scientific assessment of botanical medicine practices.

Project description:ObjectiveThe aim of this study was to explore inequities in knowledge, attitudes and practices regarding tuberculosis (TB) among the urban and rural populations.DesignA cross-sectional study was conducted in two districts of Pakistan's Punjab province. The 1080 subjects aged 20 years and above, including 432 urban and 648 rural respondents, were randomly selected using multistage cluster sampling and interviewed after taking verbal informed consent. Logistic regression was used to calculate the crude odds ratio (OR) with 95% confidence interval (CI) for the urban area. The differences in knowledge, attitudes, practices and information sources between the urban and rural respondents were highlighted using Pearson chi-square test and Fisher's exact test.ResultsThe study revealed poor knowledge regarding TB. The deficit was greater in the rural areas in all aspects. The knowledge regarding symptoms (OR 2.03, 95% CI 1.59-2.61), transmission (OR 1.93, 95% CI 1.44-2.59), prevention (OR 2.24, 95% CI 1.70-2.96), duration of standard treatment (OR 1.88, 95% 1.41-2.49) and DOTS (OR 1.84, 95% CI 1.43-2.38) was significantly higher in the urban areas (all P < 0.001). Although a majority of the subjects (urban 83.8%, rural 81.2%) were aware of the correct treatment for TB, less than half (urban 48.1%, rural 49.2%) were aware of the availability of the diagnostic facility and treatment free of cost. The practice of seeking treatment at a health facility (P = 0.030; OR 2.01, 95% CI 1.06-3.82), as soon as they realized that they had TB symptoms (P < 0.001; OR 1.72, 95% CI 1.26-2.35), was significantly higher in the urban areas. People in the urban areas were more likely to feel ashamed and embarrassed being a TB patient (P < 0.001; OR 2.03, 95% CI 1.50-2.76); however, they seem to be supportive in case their family member suffered from TB (P = 0.005; OR 1.53, 95% CI 1.13-2.06). Nearly half of the respondents, irrespective of the area of residence, believed that the community rejects the TB patient (urban 49.8%, rural 46.4%). Television (urban 80.1%, rural 68.1%) and health workers (urban 30.6%, rural 41.4%) were the main sources for people to acquire the TB related information.ConclusionRespondents' knowledge regarding TB was deficient in all aspects, particularly in the rural areas. Intended health seeking behavior was better in the urban areas. Television and health workers were the main sources for TB related information in both the urban as well as the rural areas. Therefore, the area of residence should be considered in tailoring communication strategies and designing future interventions for TB prevention and control.

Project description:BackgroundHypertension contributes significantly to cardiovascular and renal diseases. It can be controlled by lifestyle modifications, however in poor communities there is lack of awareness, and treatment and control of hypertension is often poor. The aim of this study was to determine hypertension knowledge, attitudes and practices in a disadvantaged rural community in Matebeleland South province of Zimbabwe.MethodsWe conducted a descriptive cross-sectional survey on hypertensive patients in the community. A pre-tested and validated interviewer-administered questionnaire was used to collect demographic, awareness, treatment and control data among consenting hypertensive patients.Results304 respondents were enrolled into the study (mean age, 59 years), and a majority were women (65.4%). The treatment default rate was 30.9%, and 25% of respondents on medication did not know their blood pressure control status. Knowledge on hypertension was poor, with 64.8% of respondents stating that stress was its main cause, 85.9% stated that palpitations were a symptom of hypertension and 59.8% of respondents added salt on the table. The more education respondents had received, the more likely they were knowledgeable about hypertension (odds ratio for secondary education, 3.68 [95% CI: 1.61-8.41], and for tertiary education, 7.52 [95% CI: 2.76-20.46], compared to those without formal education). Those who believed in herbal medicines (50.7%) and those who used traditional medicines (14.5%) were 53% (95% CI: 0.29-0.76) and 68% (95% CI: 0.29-0.76) less likely to be knowledgeable about hypertension compared to those who did not believe in or use traditional medicines, respectively.ConclusionMembers of the community had poor knowledge on hypertension. This was associated with a lack of education and with strong beliefs in herbal and traditional medicines in the community, which influenced attitudes and practices on hypertension. Dietary risk factors were linked to poor knowledge. Hypertensive medicine shortages at the clinic resulted in worsened hypertension care and poor hypertension outcomes in the community.

Dataset Information

Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia.

Publications

Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia.

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