Determinants of misuse of antibiotics among parents of children attending clinics in regional referral hospitals in Tanzania

Abstract

Parents are the important implementers on appropriate/inappropriate use of antibiotics, especially in the pediatric population. Limited studies have associated poor knowledge, attitude, and practice (KAP) among parents with antibiotics misuse. Therefore, this study was conducted to determine the parents' KAP and factors associated with inappropriate use of antibiotics among Tanzanian children. A hospital-based cross-sectional study was conducted in 14 regional referral hospitals (RRHs) in Tanzania between June and September 2020. KAP was estimated using a Likert scale, whereas KAP factors were determined using logistic regression models. A total of 2802 parents were enrolled in the study. The median age (interquartile range) of parents was 30.0 (25-36) years where 82.4% (n = 2305) were female parents. The majority of the parents had primary education, 56.1% (n = 1567). Of 2802 parents, only 10.9% (n = 298) had good knowledge about antibiotics, 16.4% (n = 455) had positive attitude whereas 82.0% (n = 2275) had poor practice on the appropriate use of antibiotics. Parents' education level, i.e., having a university degree (aOR: 3.27 95% CI 1.62-6.63, p = 0.001), good knowledge (aOR: 1.70, 95% CI 1.19-2.23, p = 0.003) and positive attitudes (aOR: 5.56, 95% CI 4.09-7.56, p < 0.001) were significantly associated with the appropriate use of antibiotics in children. Most parents had poor knowledge, negative attitude, and poor practice towards antibiotics use in children. Parents' education level, employment status, knowledge on antibiotic use, and good attitude contributed to the appropriate use of antibiotics in children attending clinics at RRHs.

Figure 1

Knowledge on rational use of antibiotics in children among parents attending clinic at RRHs in Tanzania. In assessing the knowledge, 2726 participants responded to different questions whereby 42.3% and 40.1% knew that magnesium and paracetamol are not antibiotics, respectively. Few participants, 11% had the knowledge that misuse of antibiotics can lead to AR while 21.4% had adequate knowledge on AR.

Figure 2

Parents’ attitude toward rational use of antibiotics among children. Among 2772 parents assessed for their attitude towards appropriate antibiotic use in children, 56.0% had a negative attitude to non-antibiotics prescriptions and were ready to seek another doctor who would prescribe an antibiotic for their children. The majority (63.8%) were ready to give their children antibiotics without a doctor’s prescription. Additionally, 44.1% could provide antibiotics for their children, even without an indication.

Figure 3

Parental practice on the appropriate use of antibiotics in children. Of 2775 responded to the practice questions, 67.0% like to take medicine from pharmacies than doctors. Some parents (30.3%) were ready to stop giving antibiotics to their children when there were improvements. About 33% of parents gave antibiotics to their children when they had a cough. Regarding the expiry date, 41.7% reported that they don’t check the expiring dates of antibiotics before giving to their children.

Figure 4

Parents’ source(s) of information about antibiotics. Of 2802 respondents, majority of the parents obtained their information from dispensers 85.6% followed by prescriber 77.1%) then nurses 76.1%. Few parents obtained the information about antibiotics from social media 26.0%, colleague 25.5% and university courses 15.6%.