The Research On The Evaluation About Effect Of Intervention To Promote The Rational Use Of Antibiotics Of Rural Residents In Shandong Province

BackgroundDue to the lack of scientific and reasonable guidance for the use of antibiotics,the phenomenon of antibiotics misuse has become more and more serious,which is a huge threat for global health.This problem is also serious in China,and it is common in all health service sectors.The main hazard caused by antibiotics misuse is the emergence of antibiotic resistance,resulting in prolonged treatment course and increase of healthcare expenditure and mortality.In recent years,the antibiotics resistance is growing in worldwide,and it is caused by numerous reasons concern all the stakeholders including healthcare providers,healthcare demanders and healthcare system regulators.To solve this serious global public health problem,a large number of researches for the rational use of antibiotics have been carried out in the world.At present,most of the objects of research in China are main body of antibiotics circulation,which are the healthcare providers.The effective intervention to promote the rational use of antibiotics in rural area will be the focus of our next research.MethodsAs the crowd part of 'Sino-Swedish Integrated Multisectorial Partnership for Antibiotic Resistance Containment',this research selected 12 villages in H township,ZC county,Shandong province based on economic development,healthcare service,ecological environment and animal farming industry.And 65 households were selected in each village to carry out questionnaire surveys.The baseline survey was conducted in 2015 to investigate basic characteristics and KAP on antibiotics use of research group.And then the 6 villages were selected as intervention group to implement health educational interventions including lectures,broadcasting,posters and handbooks for one year.After the end of intervention,the repeated survey was conducted in 2017.Finally,the Chi-square test and DID analysis(difference-in-differences model)to evaluate the actual effect of intervention.Results:Through the intervention,the level of antibiotics knowledge of villagers in intervention group has greatly increased,while the control groups basically had no significant changes.The overall antibiotic awareness rate of the intervention group has increased from 31.8%to 81.3%,and the number of people who could correctly identify the three antibiotics has increased from 10.3%to 53.6%.The accuracy of all questions on the daily use of antibiotics and resistance issues also had a significant increase.According to the analysis results of the DID model,interventions can effectively improve the 32.2%accuracy on antibiotic knowledge questions of villagers in the intervention group(t=14.13,P<0.001).About anticipation of the rational use of antibiotics,the increase in the expected proportion of rational use of antibiotics in the intervention group was 54.2%,44.3%,41.8%,39.6%and 43.9%in the common cold,sore throat,hypertension,diabetes,and diarrhea,and all of them were higher than the control group 15.2%,12.7%,16.3%,12.6%and 16.2%.DID analysis results showed that interventions could significantly increase 22.4%anticipation rate of rational use of antibiotics in the intervention group(t=8.47,P<0.001).In addition to the questions of usage attitudes,the intervention group has significantly improved on the other four issues,with growth rates of 37.4%,30.8%,31.8%,and 36.5%respectively.Overall,interventions can effectively improve the 17.7%accuracy rate of usage attitude questions in the intervention group(t=6.08,P<0.001).Interventions had a significant effect on reducing the rate of occurrence on two kinds of irrational antibiotics use behaviors including 'purchasing antibiotics without prescription' and 'using self-prepared antibiotics for treatment',which could reduce the rate of 15.4%and 8.75%,respectively.In the case of 'do not follow doctor's orders for taking antibiotics on a course of treatment',although the intervention measures actually reduced the 2.91%rate of occurrence,the difference was not significant.Conclusion and suggestions:Intervention for the rational use of antibiotics with health education as the main form can effectively raise the level of antibiotics awareness among residents in rural areas,thereby improving their rational use of attitudes,and ultimately reducing the misuse of antibiotics and emergence and spread of antibiotics resistance.The 'listening'Interventions such as health lectures and broadcast could produce better effects and be generally welcomed by the residents.The younger residents with higher level of education had a better degree of acceptance of interventions,and the improvement is more significant.Based on the above conclusions,we propose the following points:1.The government and related healthcare departments should carry out health education intervention to promote the rational use of antibiotics in rural areas.2.The design and choice of methods for the intervention should be targeted to the demographic characteristics of residents.3.In addition to health education interventions for residents,the prescription behavior of healthcare providers should be strengthened to establish a policy system to control the abuse of antibiotics.