Evaluation Of Parents Knowledge About The Dangerous Effect Of Excessive Use Of Antibiotics On Children With URTIs In Jeddah City

Received: 03 December 2016 Final Accepted: 30 December 2016 Published: January 2017 Background:Upper respiratory tract infections (URTIs) occur most commonly among children and most of these infections are selflimiting with a very low risk ofcomplications and its management consist of self-care and symptomatic treatment. Objectives:To examine assess parental knowledge about the antibiotic use in the treatment of childhood upper respiratory tract infections (URTIs), Saudi Arabia. Methods:A Pre-formed Self-administered questionnairewas conducted among the parents of children with URTIs of Jeddah City. Results:A total of 385parents from Jeddah City were included, of them 325 were females. Overall, 69 members of all interviewed parents had satisfactory knowledge on antibiotic use but 316 parents which represents the majority of subjects had poor knowledge.Univariate analysis showed that female was found to be the only variablethat associated with satisfactory knowledge. Conclusion:The knowledge of Parents in this study showed a poor knowledge on antibiotic use, which is significantly dependent on female gender.


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2741 the reasons associated with antibiotics overuse.These include: attitudes, beliefs, knowledge of antibiotic use (5,6) , behaviors (e.g. over-the-counter medication and self-medication) (7) .Patients' perceptions regarding patient-doctor interaction, patient satisfaction, and patients' experience with antibiotics (7) . It is important to assess the situation in order to solve the problem. In this paper our goal is to assess the parent's role in antibiotics misuse in children with URTIs in Jeddah city which is a big city in the WEST of Saudi Arabia. Measuring the parent's knowledge, attitudes, behaviors, and beliefs about antibiotics will help in the assessment of the situation burdens are attributable.
The overall aim of the present work was to study the parents' knowledge about the dangerous effect of excessive use of antibiotics on children with URTIs in Jeddah City.

Rational:-
The intervention of antibiotics has marked an important milestone in the history of medicine. The role of antibiotics in reducing the mortality and morbidity of diseases caused by bacteria is beyond any doubt. The challenge to the medical community is to maintain the effectiveness of antibiotics. When used inappropriately, antibiotics may lose its healing power as bacteria develop resistance.
Objectives:-General objectives: 1-To decrease the overuse of antibiotics in Jeddah city 2-To decrease the incidence of super-infections in Jeddah city 3-To decrease the incidence of hospital Acquired infections in Jeddah city Specific objective: 1-To access the parent's knowledge, attitudes, behaviors, and beliefs about antibiotics in Jeddah.

Methods:-
Study design:-It is community based, descriptive study.
Setting and data collection:-This survey analysis among community population was conducted in Jeddah city. A pre-formed self-administered questionnaire was distributed to Parents of children with UTRIs.
Sample size:-Subjects were chosen according to geographical and sex distribution. Sample size was calculated based on web-site calculator, taking the total size of Jeddah population (3,976,000), confidence level (95%) and margin error (5%) to be 385 (8) .
Study population:-Parents in Jeddah cityand their children had URTIs were included.

Study tools:-
The tool used wasPre-formed Self-administered questionnaire that requires information about. 1-Demographics including age, gender, education level. 2-Self-administrated questionnaire: To assess the knowledge of parents regarding tothe antibiotic use, including the basic concepts of antibiotics and indications for their use, methods of administration, and side effects. In the questionnaire patients' knowledge of anti-biotic abuse was assessed using 12 questions relating to the prescriber, course, and need of use. Then scored by assigning one point for each correct response. The antibiotic abuse knowledge score was calculated as a continuous variable by summing the participant's number with a maximum obtainable correct score of 12 for each respondent.

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-This study was carried out on only 385 parents, and limitations to generalizability are inevitable. -Samples readiness in participating. Ethical considerations:-Informed consent was obtained from all the participating parents in the study. Participants were made aware that they could withdraw at any time.

Statistical analysis:-
Data were entered into the Statistical Package for Social Sciences (SPSS, version 24, SPSS, Chicago, IL, U.S.A.) and descriptive analysis conducted. The results were reported as percentage (95% confidence interval) .The internal consistency was assessed using Cronbach's α test. Association of respondents' characteristics with about anti-biotic abuse anti-biotic abuse hazard, was evaluated using univariate logistic regression. Results were reported showing odds ratio (OR) and 95% confidence interval. Statistical significance was accepted at p < 0.05. The dependent variables: knowledge of anti-biotic abuse risk (1 = Poor knowledge and 0= good knowledge). The following independent variables were included: (1) age: ≤ 30 years,

Demographics of the studied subjects:-
The socio-demographic characteristics were shown in Table. 1. This study included total of 385 subjects who approved to answer the questionnaire. The range of age was from 12 to 60 years with a mean 31 years old. About 6.4% of subjects were less than 20 years old, 48.1% of participants were from 21-30 years old, 30.1% were from 31-40% years old, 12.2% ranged from 41-50 years old and 3.2% were more than 51 years old. Thisstudy included 85.5% females and only 14.5% were males. The study population represents a highly educated group of people, with 75.5% have completed college, 19.2% completed high school, 3.7% completed middle school and 1.6% have been to elementary school.
Responses to questions of knowledge assessment questionnaire (Table. 2& Figure. 1):   Overall, 70.4% of the parents in the study didn't give their children antibiotic without advice from doctors as well as 66.2% didn't rate fever or high temperature as a motivation for using antibiotics.
Of the 385 parents responding, 69.0% of them usually complete the antibiotic course and 64.4% of parents believed that they had good knowledge on antibiotic resistance of bacteria, and 69.0% of them thought that non completion of the antibiotic course may lead to antibiotic resistance of bacteria. The main source for parents to obtain information on antibiotic use was from physicians (71.1%), and followed by pharmacy staff (15.4%), 9.8% was self-described and 3.7% take antibiotics according to person who used it before.
In addition, when parents were asked specifically about the most serious symptoms that would have to be present in order for them to buy a certain antibiotic in the case of URTIs, 63.3 and 28.3 % of symptoms were tonsillitis and fever, respectively, often accompanied by other symptoms.
The majority of subjects depend on the doctor's advice (72.2%) to buy antibiotic followed by 13.0% depend on pharmacist. Price, the persons who used antibiotic before and commonly used antibiotics were the least percentages of dependence when buying antibiotics.
If treatment failed, 88.0% of participants go to seek doctor's advice. Also most of parents define the failure period to be 1 week (47.4%), followed by 30.3% of them thought that the treatment failure period was 4-6 days and 22.4% was from 1-3 days.
Only 30.9% of parents thought that antibiotics did not cause any harmful side effects, while 69.1% were certain that antibiotics might cause many harmful adverse effects and also the majority (76.1%) know about the interference of antibiotics with other drugs.

Assessment of knowledge of participants regarding to the risks of excessive use of antibiotics:
The mean knowledge score was 7.8 out of 12 for all subjects and it as considered as poor knowledge (Table. 3). Also, 316 parents which represents the majority of subjects had poor knowledge however, only 69 had good knowledge ( Figure.2).    Table. 4 showed theassociation between knowledge and subject's demographics. This study showed that there was no significant association between neither age nor educational level with demographic variables of the participants (P >0.05). On the other hand, the female gender was associated with higher levels of knowledge than males and achieved statistical significance (p <0.0001) association. Remarkably, females had higher levels of knowledge due to their higher interaction with their children (Figure. 3).  Figure 3:-Forest plot illustrating the odd ratios with 95% confidence intervals of the different socio-demographic predictors for Respondent's Knowledge about antibiotic use.

Discussion and Conclusion:-
The study assessed the parents knowledge thatinfluence theuse of antibiotics in children. Knowledge and beliefs of parents were assessed using a questionnaire to study the behaviors,antibiotics adherence, seeking information, and awareness about antibioticsresistance. All of these aspects were tested in this study against a set of demographicand child health-related aspects.
Antibiotics are helpful in treating bacterial infections, but have been widely used inappropriately to treat viral infections such as most Upper Respiratory Tract Infections (URTIs) otherwise known as the common cold infection, the most common infections around the world (9)(10)(11)(12) .
This study showed that the majority of population had poor knowledge however prevalence of higher levels of educations. This study was in agreement with a recent study that was conducted at Taif City, Saudi Arabia where they found that had poor parents knowledge on antibiotic use however it was significantly dependent on parents' level ofeducation (13) .
Comparatively, otherresearchers reported high level of knowledge among 60% of caregiversinterviewed to assess their KAP on the same topic (14) . Also, in contrast study in Saudi Arabia showed that most parents in the study show good-to-moderateawareness about antibiotic resistance (15) ; similar results have been documented in other studies (16,17) .
The parents here in this study trusted both thephysician and the pharmacist as top sources of information about antibiotic use and the least were the common use and self-administrated antibiotics. In consistence with these results, this was apositive finding that parents seek physician and pharmacist advice and this can be utilized for the distribution of healtheducation in the future (13) .
Respondents in this research ranked tonsillitis and fever as the most common symptoms that enhance them to use antibiotics. In agreement with this result,the fever was the most common symptom (80.5%) that the child suffers and make them to visit the doctors (13) . Also, other researchers reported that the main symptoms considered important and would drive parents to visit the doctor were earache (84%) and fever (81%) (18) . These findings may be highly attributed to the parents' fear of the complication associated with fever beside their lack of knowledge about fever. Parents in Taifwere interviewed about their knowledge about fever, which was found to be suboptimal and nearly 38% correctly determined the threshold for defining fever (19) .
There was a significant association between good knowledge and female gender also fathers in the current study appear to have lower knowledge and beliefsabout the appropriate use of antibiotics in children. This result is consistent withother studies which foundthat males provided more incorrect information regarding the appropriate use ofantibiotics than females (20,21) . Belongiaet al. (2002) also found that females have betterknowledge and beliefs about the appropriate use of antibiotics in children (22) .
The univariate analysis showed no association between the age and knowledge score of the participants. In contrast with our findings, Belongia (2002) found that older parents havebetter knowledge and beliefs about antibiotics use. Which could be associated witholder parents having more years of experience with antibiotics compared to youngerparents, and experience leads to better knowledge and beliefs (22) .
During this study the knowledge about antibiotic resistance and complications associated with overuse of antibiotics were good despite low knowledge score achieved by the included parents. In agreement, the antibiotics resistance is currently one of the most important growing publichealth issues worldwide, mainly caused by antibiotics overuse (23) . Antibiotic resistance places both the community andthe individual at risk (24) . Teng et al. (2004) assert that the inappropriate use orthe overuse of antibiotics to treat viral URTIs is one of the main reasons for thedevelopment of antibiotic resistance (9) .

In conclusion:-
providing patients and parents with this information will help doctors to give better medical treatment without prescribing unnecessarily antibiotic treatment for URTI. Further research should focus on evaluation of parents' expectations and effective ways to educate the parent about appropriate use of antibiotics in treatment for URTI.