Knowledge, attitudes and practices of parents towards antibiotic use in rural communities in Peru: a cross-sectional multicentre study

Abstract

Background The inappropriate use of antibiotics significantly contributes to the development of antibiotic resistance. There is limited information about the use of antibiotics among parents from rural areas in Peru. This study aimed to describe the knowledge, attitudes and practices towards antibiotics among parents of children < 5 years of age from rural communities in Peru; to explore the association between knowledge and attitudes towards antibiotics and to explore determinants of low knowledge and self-medicating his/her child with antibiotics. Methods Cross-sectional study in six rural primary health centres in Peru using a self-administered survey. Crude and adjusted Prevalence Ratios (PR), and 95% Confidence Intervals (95% CI) were calculated to explore determinants of low knowledge and of having self-medicated his/her child with antibiotics. Linear regression was used to explore the association between knowledge and attitudes. Results A total of 231 parents were included. The largest gap in knowledge was among 183 parents (79%) who did not know that antibiotics cannot cure viral infections. The largest gap in attitudes was among 185 participants (80%) that did not disagree with “If I want my child to receive antibiotics, I would not be satisfied if the doctor refuses to prescribe them”. More than half of parents (n = 120, 52%) reported having self-medicated his/her child with antibiotics. A positive correlation was found between knowledge and attitudes (Coefficient 0.53, 95% CI 0.38–0.68) after adjusting for the age and the education of the parent. Parents who were < 20 years old were more likely to have low knowledge about antibiotics (crude PR 2.39, 95% CI 1.32–4.34) compared to those aged > 40 years. Parents who had self-medicated his/her child with antibiotics (n = 120, 52%) were more likely to have purchased antibiotics without prescription (aPR 2.70, 95% CI 1.74–4.19) and to have received antibiotics after the recommendation of a pharmacist (aPR 1.79, 95% CI 1.13–2.82). Conclusions Knowledge about antibiotics among parents from rural settings in Peru is limited and highlights the need for educational interventions. Public health policies to limit the acquisition of antibiotics without prescription should be implemented.

Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis

“…The degree of heterogeneity between groups for this subgroup was also statistically significant (P = 0.035). However, disregarding the one study from Latin America [58], subgroup analysis by region of the study reports found no difference between the Asian and African countries. Besides, the subgroup analysis by the children's age was also not significant.…”

“…Antibiotic access sources for children in six of the remaining studies were mainly leftovers of home-stored drugs from previous prescriptions or uses [38,60,63,[66][67][68] and private clinics in the other two studies [44,59]. Eighteen of the included studies were conducted in uppermiddle-income countries [24,25,38,39,48,49,52,58,[60][61][62][63][64][65][66][67][68][69], while the remaining twelve [21-23, 40, 44-47, 50, 51, 54, 57] and nine [20, 41-43, 53, 55, 56, 59, 70] studies were conducted in lower-middle-income and low-income countries, respectively. The children in 14 studies used non-prescribed antibiotics for acute diarrhea [20, 21, 23, 24, 39, 40, 43, 49-52, 54, 57, 70]; the children in nine studies used them for acute upper respiratory tract infections [25,41,42,55,[59][60][61][62][63]; and the children in the remaining 16 studies used them for mixed-types of childhood illnesses [22, 38, 44-48, 53, 56, 58, 64-69].…”

“…The risk of bias was judged as of low level for the 26 studies we included [20, 21, 23-25, 38-42, 44-48, 51, 52, 54, 57, 59, 61-63, 66, 67, 69]. It was moderate (i.e., some concerns) and high levels in 11 [22,43,50,53,55,56,58,60,64,65,70] and two [49,68] of the remaining studies, respectively. Most studies had a low or moderate risk of participant selection bias, while this was of a high level in nine studies [20, 21, 23, 49, 52, 58, 62, [53,55,56,60,64,68,69,71].…”

Household-level risk factors for water contamination and antimicrobial resistance in drinking water among households with children under 5 in rural San Marcos, Cajamarca, Peru

“…In a study of primary care physicians in peri-urban Lima, Peru, trimethoprim-sulfamethoxazole was found to be the most frequently preferred antibiotic to treat childhood dysentery [ 44 ]. Antibiotics are widely available in rural Peru and often given by parents to children without a prescription [ 45 ], which may be both a response to diarrheal disease and a contributing factor to AMR carriage. Kristiansson et al (2009) found that child or family members' recent antibiotic use was associated with a greater odds of resistance among multiple antibiotics in a study of urban communities in Amazonian Peru (Kristiansson et al, 2009) [ 46 ].…”

Reliability and validity evaluation of the appropriate antibiotic use self-efficacy scale for Chinese adults

“…Existing studies have found that inappropriate antibiotic is associated with the following reseasons: antibiotic prescribing by non-infectious disease physicians [25], antibiotic dispensing in pharmacies [26,27], and public knowledge, attitude and practice of antibiotic use [28]. The factors determining the appropriate use of antibiotics by individuals are influenced by several aspects, including consumers' lack of knowledge about the appropriate use of antibiotics and their adverse effects [29][30][31], as well as their beliefs, expectations and personal experiences with antibiotics [32,33]. Knowledge, attitudes and practice (KAP) studies are often a preferred method to achieve this [34][35][36][37].…”