Changes in public knowledge and perceptions about antibiotic use and resistance in Jordan: a cross-sectional eight-year comparative study

Abstract

Background: Resistance to antibiotics is a growing problem, worldwide and particularly in developing countries like Jordan. Raising public awareness on appropriate antibiotic use is crucial to combat this problem. The current study describes the change in public Knowledge and attitudes towards the use of antibiotics over a period of 8 years.

Methods: Two cross-sectional studies were performed 8 years apart on Jordanians of different age groups, and social settings, residing in Amman, Jordan. Convenience non-probability sampling techniques were used. In 2010, a questionnaire was distributed in paper form, whereas in 2018 snowball sampling was used to disseminate an identical electronic questionnaire. Chi-square test and post hoc analysis were done using the z-test to compare column proportions, adjustment for multiple testing using the Bonferroni method. Multiple logistic regression was used to adjust for case mix for each survey. Comparisons were made across the two studies and within each study.

Results: A total of 711 participants in 2010 and 436 participants in 2018 were surveyed. Over the 8-year period, there was a significant improvement in the beliefs regarding the use of antibiotics such as disagreeing to keeping left over antibiotics for later use from 57 to 70% (p < 0.05) and disagreeing to buying antibiotics without physicians' consent increased from 80 to 89% (P value < 0.001). There was no significant change in the beliefs that support self-medication such as: using antibiotics from a friend (72 to 77%) buying antibiotics without a prescription (42 to 45%), and getting information about medication use from leaflet without referring to a health care professional (60 to 63%). There were some areas of confusion regarding antibiotic range of effectiveness, and origin of resistance. Agreement about antibiotic resistance being a problem in Jordan increased significantly from 44 to 60% (p < 0.001). In addition, there was a significant increase in the percentage of participants who said that they don't request antibiotics from physicians (56 to 75% (P ≤ 0.001) and who said they would trust physicians' decisions about the necessity of antibiotics (70 to 83% P < 0.05).

Conclusion: Findings indicate the need for better suited, and more inclusive, public educational campaigns.

Keywords: Antibiotic; Awareness; Beliefs; Comparison study; Knowledge; Perception; Resistance.

Fig. 1

Change in Knowledge about range of antibiotics effectiveness. a: 2010, b: 2018. P values * < 0.05. < 0.001**

Fig. 2

Changes in the Knowledge about antibiotics use. The following statements were presented to participants: a. Antibiotics accelerate recovery from common cold. b. “Runny nose accompanied by a colored discharge requires antibiotic therapy”. P values * < 0.05. < 0.001**

Fig. 3

Perceptions about indications for antibiotics use

Fig. 4

Knowledge about antibiotic resistance. a Origin of antibiotic resistance. b. Excessive use of antibiotics increase the chance of creating resistance. c Consequences of antibiotic resistance. d Antibiotic resistance is a problem in Jordan. P values * < 0.05. < 0.001**

Fig. 5

Patient -Physician relationship. The following statements were presented to participants. a I ask a doctor to prescribe an antibiotic for me if he does not prescribe one. b The Doctor who does not prescribe antibiotic, when the patient believe he should, is an incompetent doctor. c I trust the Doctor’s decision whether he/she prescribes an antibiotic or not. P values * < 0.05. < 0.001**