Utilization Of Antibiotics And The Influencing Factors In Rural Area Of Jiangxi Province

Part1Insights into residents’ behaviors of antibiotic purchasing from medicinal sales data of retail pharmacies in rural ChinaObjective:This study analyzes and compares the sales data of4categories of medicines in retail pharmacies and gains some insights into the residents’ purchasing behaviors of antibiotics as well as compound cold medicine, cough suppressants and antipyretics. Methods:From September1,2011to May31,2012, the daily sales data of36compound cold medicines,36cough suppressants,18antibiotics and9antipyretics was collected from8retail pharmacies, and the correlation coefficients among the4drug categories were evaluated by means of working-related matrix based on Generalized Estimating Equations (GEE) model. Results:Antibiotics shared a highest average sales volume of single medicine; the correlation coefficients between antibiotics and compound cold medicine, cough suppressants and compound cold medicine, antibiotics and cough suppressants were0.5912,0.4735and0.3845, respectively; the sales volume of antibiotics, compound cold medicine and cough suppressants increased significantly during the promotion period. Conclusions:Non-prescription purchase of antibiotics in pharmacies is common among residents who bear some misperception to antibiotics use in counties and towns. It is necessary and imminent to strengthen the supervision on illegal antibiotic sales in pharmacies and health education of populace on proper antibiotic use.Part2Parents’ knowledge, attitudes and practice regarding use of antibiotics in children in rural ChinaObjectives:To assess parents’ knowledge and attitudes towards antibiotic use, their interaction with physicians for the treatment of children, and the self-medication behavior with antibiotics to children and its influencing factors. Methods:Parents from two rural counties of China were interviewed face-to-face using a structured questionnaire in this cross-sectional study. Fourteen questions were used to assess parents’knowledge level of antibiotic use. Multiple logistic regression models were applied to identify factors contributing to parents’ knowledge of antibiotic use and their behavior of self-medicating antibiotics to children. Results:Of the854parents finishing the survey,61%were at a low level of knowledge on antibiotics. Parents with higher education were more knowledgeable on appropriate use of antibiotics. More than40%of parents had purchased antibiotics without prescription, and62%had self-medicated their children with antibiotics. Risk of self-medication with antibiotics to children was significantly associated with living in villages, raising more than one child, increasing age of child, experiences of antibiotic purchase without prescription and having stored antibiotics at home. Parents with better adherence to physicians’ advice were less likely to self-medicate their children with antibiotics. Conclusions:Health education of parents about appropriate use of antibiotics is necessary and urgent in rural China. Interventions aimed at preventing self-medication with antibiotics to children need multilateral efforts including improving parents’ awareness, enforcing regulations regarding the sale of antibiotics in retail pharmacy, and decreasing antibiotic leftovers. Physicians should be trained to effectively communicate with patients and refrained from unnecessary prescription of antibiotics.Part3Attitudes of physicians towards antibiotic overuse and resistance in rural ChinaObjective:To gain insights into physicians’ attitudes and practices on antibiotic prescription, overuse and resistance in rural China. Methods:Jiangxi Province is located in middle China with Gross Domestic Product ranking21st among34provincial level divisions. Fifteen towns in two counties of Jiangxi Province were selected as study sites. Physicians eligible for the survey included internists and pediatricians at township hospitals and general practitioners at village health stations. A self-administered, anonymous questionnaire was used to explore physicians’ attitudes and practices. Results:Thirty-six physicians from township hospitals and114from village health stations completed the questionnaire. Nearly one-third of respondents recalled that in the past week, more than half of their prescriptions included antibiotics. Most physicians (85.3%) believed antibiotic overuse is a serious national problem, and evaluated the severity with a median score of seven (zero represents least serious and nine most); however, only57.4percent perceived the same problem existing in their own clinics, with a median score of four. Similarly, more physicians (72.0%) considered antibiotic resistance as a national problem but less significant locally (45.3%).Insufficient knowledge on antibiotic use among public, lack of access to diagnostic laboratories and government’s neglect of regulation were chosen most frequently as the main causes of antibiotic overuse in China. Forty-two percent of respondents acknowledged that the request from patients is an important consideration of their prescription of antibiotics, and in practice,26percent of physicians sometimes or even more frequently satisfied patients’ request of antibiotics. Conclusions:An apparent disparity was found from physicians’ opinion about antibiotic overuse and resistance nation-wide and locally, indicating that some physicians possibly fail to realize their own inappropriate behavior of antibiotic prescription. Furthermore, request of antibiotics from patients indeed exerted an influence on physicians’ prescribing practice.