Rural Residents’ Baseline Knowledge,Attitudes And Practices Of Antibiotics

BackgroundAntibiotic resistance is a great threat for global health and it has caused the increase of morbidity, mortality and healthcare expenditure. The dissemination of resistant bacteria among human and animal brings new global challenge for the containment of antibiotic resistance. Antibiotic misuse, which is the major cause of antibiotic resistance, is not uncommon in China. We consumed large amount of antibiotic both in human health care and farm industry with the consequence of high level of antibiotic resistance. The current situation of antibiotic resistance in China is likely caused by numerous reasons concern all the stakeholders in the health care system including administers, healthcare givers and healthcare consumers, among which the lack of common sense for antibiotic use especially the misunderstanding and misconception of antibiotic are the most important driving forces. To address the global crisis caused by antibiotic resistance, it is urgent to get a holistic understanding of the dissemination of resistant bacteria among different sections and contain this problem with a’one health’ approach.ObjectiveThe aim of the study is to get a holistic understanding of knowledge, attitudes and practice (KAP) toward antibiotic use both for human and animal healthcare among rural residents in Shandong Province. The findings in this thesis will be the basis of the model of transmission of resistant bacterial among human, animal and environment, the intervention toward the KAP of antibiotic use of participants will base on the evidence from this work as well.Methods12 villages were randomly selected in H Town, Z County, Shandong Province, according to the scale and number of pig farms both in household and commercial form, geographic location, environment, development level of healthcare system in this area.65 households were selected in each villages and data both regarding quantitative and qualitative were collected through various methods including household to household survey, focus group discussion, human nasal and faecal sample, pig nasal and facial sample, water and soil sample, etc. Results from household questionnaire survey will be presented in this thesis, the survey were conducted with self-designed semi-structured questionnaire, the questionnaire was developed first in English version with translation and back translation between Chinese and English to ensure consistency by our research group also pilot study was implemented to make sure the accuracy of the questionnaire. Data was entered in Microsoft Access 2007 database, data storage and data clean basic were performed in Microsoft Excel 2007, descriptive statistic data analysis and chi-square analysis were finished in SPSS 17.0Results769 responds answered the questionnaire in full, among them, only 29.52% know what antibiotics are and participants in men, younger and higher education group had a significantly higher awareness of antibiotic than their counterparts. More importantly and interestingly, we found though the health seeking experience of participants and their family members didn’t improve their knowledge of antibiotic use for household pigs, the experience they got from raising pigs did have positive impact regarding the general knowledge of antibiotic on the contrary. Among the 12 common consumed medicines, over half of all the participants didn’t recognize any one of antibiotics or anti-inflammatory drugs. Moreover, the four antibiotics mixed in the list were more often regarded as anti-inflammatory drugs rather than antibiotics.Participants had high over-expectation for antibiotic use for common diseases and symptoms which normally have viral causes, in our survey, common cold (40.8%), sore throat (26.7%) and diarrhea (22.0%) were most commonly over-expected for antibiotics by participants. Approximately 70% of participants didn’t know anything about antibiotic resistance, accordingly only 23.8% of participants stated that they were worried about antibiotic resistance. Over half of participants never purchased antibiotics with prescription and most of them stopped taking antibiotics for illness when the symptoms started to disappear and about half of participants have stored antibiotics and used these stored antibiotics without seeing a doctor.35.4% of participants had pigs in their household farms and 11.85% of non-pig-raising farmers had pigs in their household in the past five years. Among all the participants had pigs, only 35.2%knew that there was no need to use antibiotic when pigs stopped eating feed. Education level had significant impact on the awareness of this question and participants in illiterate/half illiteracy group had higher expectation for antibiotics for this symptom than high school and above group. In the practice of feeding pigs with antibiotics,52.1% of pig farmers only use antibiotics in pigs showing disease,28.8% of them used antibiotics for all pigs in the same pen, when some of the pigs in the pen were sick, meanwhile 18.5% of them stated that they used antibiotics in feed, to keep the pigs healthy and prevent disease. Although most of pig raising farmers stated that they trusted veterinarians, a pig proportion of them felt expensive to get advice from veterinarians and brought antibiotics for pigs. Accordingly, more than 70% of pig raising farmers stated that they knew when their pigs need medications and about a third of these farmers purchased antibiotics for pigs without speaking with a vet first and the most important reasons for this behavior is they knew when their pigs need medications.Conclusions and SuggestionsParticipants in our survey showed low awareness of antibiotics and high level of misuse of antibiotics regarding purchased antibiotics without prescriptions and took antibiotics interruptedly and self-treatment with antibiotics. Misuse and misunderstanding of antibiotics also detected among participants with pigs in their farms and the experience of using antibiotic for pigs which sometimes totally wrong could affect their knowledge and behavior of antibiotics when in human healthcare. Policy and intervention implications including education program initiated by government targeting at rural residents and focusing on basic knowledge of antibiotics and rational use of antibiotics both in local and national level are needed. Strict enforcement and supervisions on antibiotic prescription regulations with a rational and comprehensive subsidy system for doctors are needed as well.