| Objective Children across China are facing varying risks of inappropriate antibiotic use.This study aims to investigate parents’ knowledge about antibiotics and certain behaviors related to antibiotic use among children in both community and health institution contexts between regions with different development levels,to analyze the similarities and disparities of those knowledge,behaviors and their associations,then to propose universal and targeted suggestions for future interventions.Methods Parents whose children were at the age between 0-13 years were surveyed in kindergartens,primary schools and vaccination clinics in Zhejiang and Shaanxi province,which were selected to represents developed and less developed regions,using a multistage stratified cluster random sampling method between June,2017 and April,2018.The questionnaire was developed based on existing research scales at home and abroad,improved through qualitative interviews and tested by a pilot study.The questionnaire contains: 1)socio-demographic characteristics of parents and their children;2)three categories of antibiotic knowledge,including cognition of antibiotic efficacy,capacity of antibiotic identification,and awareness of antibiotic resistance,6 items respectively;3) behaviors related to antibiotic use among children,including self-medicating children with antibiotics,keeping antibiotics at home for children and giving children antibiotics for prophylaxis(referring to giving a child antibiotics who is not sick with the intention of preventing illnesses such as common cold)in community contexts,and requesting antibiotics during pediatric consultations and being prescribed with antibiotics in health institution contexts.After quality control of the data,chi-square tests were used to analyze the response of each item of antibiotic knowledge between the two regions;chi-square tests and multiple linear regressions were used to analyze the score level of each knowledge category between the two regions;chi-square tests and logistic regressions were used to analyze behaviors related to antibiotic use among children between the two regions;and logistic regressions were used to analyze the influence of antibiotic knowledge level on the behaviors in each region;data analyses were performed using IBM SPSS 24.0.Results Parents in Shaanxi had an overwhelming disadvantage on the response of every single item of antibiotic knowledge than those in Zhejiang(p<0.01);they also showed lower score levels in cognition of antibiotic efficacy,capacity of antibiotic identification,and awareness of antibiotic resistance(β=-0.50,95%CI-0.60~-0.41,p<0.001;β=-0.16,95%CI-0.25~-0.06.p<0.01;β=-0.16,95%CI-0.26~-0.06,p<0.01).However,parents in Zhejiang and Shaanxi shared the 3 items with the lowest score rates in the category of cognition of antibiotic efficacy,which were “antibiotics are effective for viral infections” “antibiotics can relieve the symptoms of a common cold” and “using antibiotics can speed up a common cold recovery”.In addition,parents in the two regions also shared the best capacity of antibiotic identification towards cephalosporin,penicillin and macrolides and the worst awareness of antibiotic resistance towards “the more frequently people use antibiotics,the harder it is to cure the bacterial infections” “there will be fewer and fewer effective antibiotics in the future if we don’t use antibiotics properly” and “excessive use of antibiotics can produce superbugs”.Common cold/sore throat was the most commonly reported discomforts among children in both Zhejiang and Shaanxi(86.7% vs.88.9%,p>0.05),and there were no significant difference in the proportions of parents who reported self-medicating children or taking children to health institutions(54.8% vs.53.8%;70.1% vs.69.5%,p>0.05).There were more parents who reported self-medicating children with antibiotics,keeping antibiotics at home for children,and giving children antibiotics for prophylaxis in Shaanxi than in Zhejiang(42.7% vs.18.8%;58.1% vs.45.6%;27.5% vs.16.7%,p<0.001),and parents in Shaanxi were more likely to engage in the behaviors above(a OR=2.83,95%CI 2.07-3.87;a OR=1.91,95%CI 1.70-2.15;a OR=1.83,95%CI 1.59-2.11,p<0.001).The antibiotics used for self-medicating children were mostly from home-stored antibiotics in Zhejiang(49.5%)and the secondary source was pharmacy purchase(38.1%),while in Shaanxi they were mostly purchased from pharmacies(51.2%)and then from home-stored antibiotics(38.7%);there was a significant difference in the source of home-stored antibiotics between the two regions – 79.7% from previous prescriptions and 18.6% from pharmacies in Zhejiang,while 61.8% from previous prescriptions and 36.8% from pharmacies in Shaanxi(p<0.001).There was no significant difference in the proportions of parents who reported requesting antibiotics during pediatric consultations in the two regions(6.8% vs.7.8%,p>0.05),but significantly more parents in Shaanxi were prescribed with antibiotics than in Zhejiang(56.6% vs.49.0%,p<0.01),and they were also more likely to receive antibiotic prescriptions(a OR=1.48;95%CI 1.18-1.87,p<0.01).Within either region,parents with better cognition of antibiotic efficacy were less likely to report self-medicating children with antibiotics,keeping antibiotics at home for children,giving children antibiotics for prophylaxis,requesting antibiotics during pediatric consultations and being prescribed with antibiotics(p<0.01).Parents with better capacity of antibiotic identification in Zhejiang were more likely to keep antibiotics at home for children(p<0.001),and their counterparts in Shaanxi were more likely to selfmedicate children with antibiotics,to keep antibiotics at home for children and to be prescribed with antibiotics during pediatric consultations(p<0.05).Parents with better awareness of antibiotic resistance in Zhejiang were more likely to keep antibiotics at home for children and to give children antibiotics for prophylaxis(p<0.01),and their counterparts in Shaanxi were more likely to keep antibiotics at home for children,to give children antibiotics for prophylaxis and to be prescribed with antibiotics during pediatric consultations(p<0.01).Conclusion In general,parents’ knowledge about antibiotics and the behaviors related to antibiotic use among children were better in Zhejiang than in Shaanxi.However,parents in the two regions had similar knowledge gap on the efficacy of antibiotics,the discrimination between antibiotics and anti-inflammatory agents as well as the threats of antibiotic resistance at individual level.Besides,there were also similar influences of antibiotic knowledge on related behaviors in the two regions,parents with better cognition of antibiotic efficacy were less likely to involve in inappropriate antibiotic use,while better capacity of antibiotic identification and awareness of antibiotic resistance showed no significant influence on the behaviors or could even be risk factors of antibiotic misuse.While over-prescription of antibiotics in health institutions bothered both regions,availability of non-prescription antibiotics was more problematic in a less developed region like Shaanxi.Future interventions should pay more attention to the regions with relatively lower socioeconomic levels.Health education needs to be delivered to parents on key weaknesses of antibiotic knowledge,and each region should take targeted strategies to reduce home-stored antibiotics,improve antibiotic prescriptions in health institutions and regulate antibiotic sales at retail pharmacies with adequate consideration on local adaptions. |
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