Knowledge and practice of anti-antibiotic use among mothers of children under 5 years with acute respiratory infection in Dong Hung Hospital - Thai Binh province
RESEARCH ARTICLE
KNOWLEDGE AND PRACTICE OF ANTI-ANTIBIOTIC USE AMONG MOTHERS
OF CHILDREN UNDER 5 YEARS WITH ACUTE RESPIRATORY INFECTION IN DONG
HUNG HOSPITAL - THAI BINH PROVINCE
Vu Thi Hai1, Vu Van Thanh2, Tang Thi Hao3, Nguyen Thi Dung4
1Dong Hung General Hospital, 2,4Nam Dinh University of Nursing,
3Thai Binh University of Medicine and Pharmacy,
ABSTRACT
Objective: To examine the knowledge
and practice of antibiotic use among
mothers of children under 5 years old with
acute respiratory infection at Dong Hung
General Hospital - Thai Binh province in
2020. Method: Cross-sectional descriptive
study was conducted on 97 mothers of
children under 5 years old with acute
respiratory infections treated at Dong Hung
General Hospital from March to June 2020.
Results: The proportion of mothers having
knowledge of using antibiotics was 34%.
Average score of knowledge on using
antibiotics of mothers was 7.85 ± 4.05 out
of the total score of 18. The rate of mothers
who practiced using antibiotics was 43.3%.
The mothers’average score of antibiotic use
was 6.3 ± 2.09 out of a total score of 12. The
results of mother knowledge indicated that
only 22.7% knew antibiotics were not used
to treat viral infections. 28.5% reported that
not all cases of fever should use antibiotics,
60.8% of mothers indicated that they should
give antibiotics to their children according to
the previous prescription if the child got sick
with the same symptoms as the previous
one. 85.6% of the participants reported that
they bought antibiotics according to the
sellers’ suggestion and shared antibiotics
with their relatives. Conclusion: Mothers’
knowledge and practice on antibiotic use
were limited. Therefore, it is essential to
promote maternal health education on the
proper use of antibiotics, which health care
providers were main responsible.
Keywords: Use of antibiotics; antibiotic
resistance; acute respiratory infections.
1. INTRODUCTION
Antibiotics are the one of the most
important therapies for treating illnesses,
allowed microorganisms to adapt to the
drug, causing many types of bacteria to
become resistant [1]. The burden of drug
resistance is increasing due to the increased
cost of treatment, prolonged treatment
days, affected the patient’s health, the
community and the general development
of the society. Currently, the synthesis of
new antibiotics does not keep up with the
antibiotic resistance of bacteria strains.
Antibiotic resistance has become an urgent
issue, requiring a concerted effort to help
mankind avoid the danger of returning to
the era without antibiotic [1].
effectively
treating
life-threatening
infections and preventing infectious
complications from common medical and
surgical interventions. However, overuse
of antibiotics in the healthcare, animal
husbandry and agricultural industries has
Cor. author: Vu Thi Hai
Email: vuthihaitbh@gmail.com
Received: Jan 06, 2021
Revised: Jan 13, 2021
Accepted: Mar 05, 2021
There are many causes of drug
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RESEARCH ARTICLE
resistance; in which, inappropriate use Dong Hung General Hospital, Thai Binh
of antibiotics is the most important factor province in 2020
stemming from the limited awareness of
2. RESEARCH METHOD
antibiotic use [1]. Buying the medicine
doctor’s prescription is quite common in Viet
Nam as well as in many countries around the
2.1. Participants:
Theparticipantswere mothersofchildren
under 5 years old with acute respiratory
infections at Dong Hung General Hospital,
Thai Binh province from March to June
2020. The participants were collected
using the following five inclusion criteria:
Mothers of children under 5 years old with
acute respiratory infections who treated at
Dong Hung General Hospital, Thai Binh
province from March to June 2020; The
mother agreed to participate in the study;
The mothers had the ability to answer
questionnaires.
world. A higher probability of using antibiotic
without doctor’s prescription is common in
people with less knowledge of antibiotic [2].
Therefore, raising awareness and changing
the behavior of using antibiotics for the
community is essential to reduce antibiotic
resistance.
Children are a group whose drug use
depends entirely on relatives, the most of
which are mothers of children. However,
mothers often using antibiotic without
doctor’s prescription when their babies
are sick [2]. Therefore, mothers’ good
knowledge of antibiotics and proper use of
antibiotics will help children use drugs safely
and effectively, contributing to reducing
drug resistance.
2.2. Setting and time of study:
The study was conducted at the
Department of Pediatrics and Department
of Ear - Nose - Throat, Dong Hung General
Hospital, Thai Binh province.
Dong Hung General Hospital examined
and treated about 2364 children under 5
years old with acute respiratory infections
eachyear.Inthefirst6monthsof2020,405
children infected with acute respiratory
infections (ARIs) with indications to test
antimicrobial susceptibility, in which 294
children were detected with antibiotic
resistant. The reseracher conducted the
study to join hands to work out in the
national action plan on combating drug
resistance, implement the slogan “No
action today means no cure tomorrow”
of the World Health Organization in
2011. The research will provide a basis
for the implementation of necessary
interventions to increase the proper use
of antibiotics. The study was conducted
with the aim to describe the knowledge
and practice of antibiotic use among
mothers of children under 5 years old
with an acute respiratory infection at
ThestudywasconductedfromDecember
2019 to June 2020. The data were collected
from March to June 2020.
2.3. Research design: The research
used the cross-sectional descriptive design
2.4. Sample size and sampling
* Sample size: The study used the total
sampling method to recruited 97 mothers
of children under 5 years old with acute
respiratory infections.
*Sampling:Allmothersofchildrenunder
5 years old with acute respiratory infection
treated at the Department of Pediatrics and
Ear - Nose - Throat, Dong Hung General
Hospital, Thai Binh province since March to
June 2020 who met the inclusion criteria.
The research team selected 97 eligible
mothers to participate in the study.
42
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RESEARCH ARTICLE
2.5. Instrumentations
2.6. Data analysis
The knowledge interview questionnaire
was adapted from the Antibiotic User Guide
issued together with Decision No. 708 / QD-
BYT dated March 2, 2015 of the Ministry
of Health [1] and the questionnaire was
developed by Vu Hong Nhung [3]. There
were 3 self-report questionnaires used for
data collection:
All data were analyzed by using a SPSS
20.0 program. Descriptive statistics were
used to describe characteristics of the
participants and compare means. Statistical
significance level was set at p < 0.05.
2.7. Protection of human subjects:
- The study was conducted at Dong
Hung General Hospital after getting the
approval and permission of the hospital’s
Board of Directors.
* A demographic questionnaire was
developed by the researcher
* The knowledge of antibiotic use
questionnaire: The measurement included
18 questions from B1 to B18. To assess
knowledge of using antibiotics, the
participants were asked to classify their
knowledge level into 02 levels of passed
and failed. Relying on the mothers’ answers
to assess their knowledge of antibiotic use.
Each correct answer got 1 point, each
incorrect or unknown answer got 0 point.
The total summed scores can range from 0
to 18. If the total score of knowledge were
more than 10 points, indicated that the
mother had knowledge of using antibiotics
and the knowledge score were under 10
points, indicated that the mother had no
knowledge of using antibiotics.
- All research participants were clearly
explained specifically about research
purposes, research contents and voluntarily
participation.
- All information about the research
participants were kept confidential.
3. RESULTS
3.1. Participant’s characteristics
The average age of mothers was 29.3 ±
9.7; The group of mothers with 2 children
accounted for the highest proportion with
43.3%. Mothers mainly lived in rural areas,
accounting for 92.8%. The proportion of
mothers with education from secondary
school or lower is quite high at 71.1%,
mothers with jobs as workers accounted
for the most with 36.1%. 70.1% of mothers
had information about antibiotic use.
However, there were still up to 29 mothers
(accounting for 29.9%) who did not have
an information source. Among sources
of information received, the majority of
information sources were from medical
staff, accounting for 56.7%. Health care
providers were the most reliable source of
information chosen by mothers the most,
accounting for 84.5%.
* The mothers’ knowledge of practicing
antibiotic use: The measurement included
12 questions from questions B19 to B30. To
assess knowledge of of practicing antibiotic
use, the participants were asked to classify
their knowledge of practicing antibiotic use
into 02 levels of passed and failed. Each
correct answer got 1 point, each incorrect
answer got 0 point. The total summed
scores can range from 0 to 12. If the total
score of knowledge of practicing antibiotic
use were more than 7 points, indicated that
the mother had knowledge of practicing
antibiotic use and the score were under 7,
indicated that the mother had no knowledge
of practicing antibiotic use.
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RESEARCH ARTICLE
3.2. Mother knowledge and practice of antibiotic use
Table 1. General mother knowledge and practice of antibiotic use (n=97)
Pass
Percentage
Not pass
Percentage
Contents
n
n
Knowledge of antibiotic use
Practice of antibiotic use
33
42
34
64
55
66,0
56,7
43,3
Table 2. Mother knowledge and practice of antibiotic use (n=97)
Mother response
Contents
Right response
Wrong response
n
Percentage
n
Percentage
Antibiotics are not anti-inflammatory drugs
Antibiotics are not used to treat viral infections
16
22
16,5
22,7
81
75
83,5
77,3
Scientists are not always able to produce new
antibiotics
10
10,3
87
89,7
In most cases of the common cold, antibiotic
treatment is not necessary
59
25
60,8
25,8
38
72
39,2
74,2
Not all cases of fever should use antibiotics
Acough, runny nose or sore throat is not always
treated effectively with antibiotics as soon as 30
possible.
30,9
44,3
48,5
67
54
50
69,1
55,7
51,5
Do not stop taking antibiotics when the illness has
decreased
43
When a child refuses to take antibiotics, the dose
should not be divided into several meals to take 47
gradually throughout the day
Combining multiple antibiotics is not always
more effective than using just one
44
45,4
32,0
53
66
54,6
68,0
Usually oral antibiotics are better than an
injection antibiotic
31
Antibiotics should only be used with a doctor’s
prescription
78
80,4
72,2
50,5
19
27
48
19,6
27,8
49,5
Antibiotics have side effects
70
49
Overuse of antibiotics increases the risk of
antibiotic resistance
Antibiotic-resistant bacteria can be spread from
person to person
19
19,6
78
80,4
44
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RESEARCH ARTICLE
A large proportion of mothers mistakenly thought that antibiotics were anti-inflammatory
drugs, accounting for 83.5%; Only 10.3% of mothers knew that scientists cannot always
produce new antibiotics. Up to 69.1% of mothers said that antibiotics help to cure quickly
when suffering from a cough, runny nose or sore throat; Only 25.8% of mothers answered
correctly, not all cases of fever used antibiotics. More than half of mothers, accounting for
55.7%, had incorrect knowledge when they think that antibiotics should be stopped when
the disease has decreased. The majority of mothers, accounting for 80.4%, answered
correctly when they said that antibiotics should only be used with a doctor’s prescription.
More than half of mothers (50.5%) answered that overuse of antibiotics increases the risk
of antibiotic resistance. Only 19.6% of mothers reported that antibiotic-resistant bacteria
could spread from person to person.
Table 3. Mother practice of antibiotic use (n=97)
Mother response
Contents
Right response Wrong response
n
Percentage
n
Percentage
Use an antibiotic without a doctor’s prescription
31
32,0
66
68,0
Buy antibiotics according to the seller’s
recommendation
5
5,2
92
94,8
Use the remaining antibiotic from the previous
treatment
54
58
46
55,7
59,8
47,4
43
39
51
44,3
40,2
52,6
Buy and store antibiotics for prevention
Use antibiotics as suggested by relatives,
neighbors (not medical staff)
Give your child a full immunization according to
the instructions
61
51
66
14
62,9
52,6
68,0
14,4
36
46
31
83
37,1
47,4
32,0
85,6
Regularly clean your child’s hands
Ask your pediatrician to prescribe more
antibiotics
Share antibiotics with loved ones
The results indicated that most mothers (94.8%) and (85.6%) incorrectly answered
the content of buying antibiotics as suggested by drug sellers and sharing antibiotic drugs
with loved ones. A not small percentage, accounting for 32% of mothers, answered that
they asked the pediatrician to prescribe more antibiotics. 37.1% and 47.4% of mothers
did not have proper knowledge about the contents of vaccination to their children fully
according to the instructions and regularly sanitize their hands to help good practice in
using antibiotics and prevention of antibiotic resistance
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RESEARCH ARTICLE
Table 4. Average score of knowledge and practice of antibiotic use by mothers
Score
Min
Max
± SD
X
Knowledge of antibiotic use
Practice using antibiotics
0
1
17
11
7,85 ± 4,05
6,30 ± 2,09
Average score of mothers’ knowledge about antibiotic use was only 7.85 ± 4.05; The
lowest score was 0 and the highest score was 17 out of the total score of 18. The practical
average score on antibiotic use was only 6.30 ± 2.09 with the lowest score of 1 and the
highest score of 11 out of the total score of 12
4. DISCUSSION
to the study of Chu Thi Dao with the rate of
22.1% [4]. Higher results were found in the
study of Al-Ayed M.S.Z with 38.6% [5]. This
rate is not the same in the studies due to the
different research locations, the education
background as well as the educational level
of the research participants (MSM) in each
location.
4.1. Mother general knowledge and
practice of antibiotic use
The results from Table 3.1 indicated
that mothers’ knowledge and practice of
using antibiotics were low. The proportion
of mothers with knowledge of using
antibiotics was lower than the practice
of using antibiotics (34% compared to
42.3%). The research results were similar
to those of Vu Hong Nhung with 32.9%
of the participants having knowledge of
antibiotic use [3]. Lower than Chu Thi Dao’s
study with 37.4% of mothers had correct
knowledge of antibiotic use [4]. This result
was due to the fact that in our study location
the proportion of mothers who lived in rural
areas with a college or university education
or higher is 92.8% and 28.9% respectively.
The corresponding rates in Chu Thi Dao’s
study were 61% and 65.7%, respectively
[4]. On the other hand, in the study, 29.9%
of mothers did not receive information on
antibiotic use from any source while this
rate in Chu Thi Dao’s study was lower with
5.1% [4].
Most mothers, 60.8%, reported that
antibiotics were not necessary for most
common colds and 64.9% answered that
antibiotics were not used to prevent colds for
their children. This result is similar to the study
of Vu Hong Nhung with the rates of 59.3%
and 61% respectively [3]. The lower results
was found in the study of Al-Ayed M.S.Z
with the rate of 65% and 82.9%, respectively
[5]; In the study of Yu M et al. 70.4% of
respondents reported that antibiotics are not
necessary for most common colds but only
56.9% answered that antibiotics are not used
to prevent colds in children [6].
The results of our study showed that up to
69.1% of mothers did not know that antibiotics
do not always cure a cough, runny nose or
sore throat. However, this rate also found in
the study of the author Vu Hong Nhung was
63.7% [3]; Yu M et al. 49.9% [6]. In Chu Thi
Dao’s study, 37.7% of mothers knew that
antibiotics should not be used for children
with upper respiratory tract infections (caused
by the virus, only 22.1% of mothers knew that
antibiotics could not prevent complications of
upper respiratory tract infections caused by
viruses [4].
4.2. Mother knowledge of antibiotic
use
Although antibiotics are common, there
are not many people who know their target
for action. Only 22.7% of mothers in the
study knew that antibiotics were not used to
treat viral infections. This result was similar
46
Journal of Nursing Science - Vol. 04 - No. 01
RESEARCH ARTICLE
Fever is an increase in body temperature there is a considerable mistake when up
for a variety of reasons, antibiotics are to 60.8% of mothers responsed that they
not always used when there is a fever. should give antibiotics to their children
However, the number of mothers who according to the previous prescription if the
knew that was very small proportion of
25.8%. The results were similar to other
research of Al-Ayed M.S.Z (27%) [5]; Yu
M (30.6%) [6]. The lower results in Chu
Thi Dao’s study with 54.8% of mothers
mistakenly believed that antibiotics should
be used for their children when the fever
starts [4]. The explanation for this is a lack
of knowledge and parents’ concern about
the consequences of fevers. The above
results indicated that there was a large gap
that needs to be supplemented in mothers’
child gets sick with the same symptoms
as the previous illness. Despite the use
of prescripted antibiotics, this was the
significant mistake that contributed to drug
resistance stemming from confidence in
personal experience in caring for a sick
child and inadequate understanding of
mothers about children’s diseases as well
as knowledge about antibiotic use. The
mistake is common in many countries,
especially lower income ones. The results
of the WHO multinational survey showed
mixed results for each country Nigeria
(56%), India (52%), Indonesia (51%), Viet
Nam (45%), Sudan (34%). ), Mexico (26%)
[7].
knowledge of antibiotic indications
.
Like any other medicine, the antibiotic
can cause side effects for the user.
However, not everyone knew the exact
side effects of antibiotics. Out of 544
respondents in the Al-Ayed M.S.Z study,
up to 466 people incorrectly answered
questions regarding antibiotic side effects
[5]. Chu Thi Dao’s study had similar results
while only 17.9% of mothers reported that
antibiotics had side effects. The result in
the study was 72.2% which is quite similar
to the study of Vu Hong Nhung (68.5%)
[3] and Yu M (70.2%) [6]. Knowing the
possible side effects of antibiotics correctly
may help mothers to be more cautious
about using antibiotics for their children,
however, due to inadequate knowledge,
mothers stopped antibiotics as the disease
got a little bit improvement. This in turn
Proper use of antibiotics contribute
to
reducing
antibiotic
resistance,
while understanding the causes and
consequences of antibiotic resistance is
likely to help users consider the benefits
and risks of using antibiotics. However,
many people were unfamiliar with the
term antibiotic resistance and when
heard, not everyone knew the causes and
consequences of it. The WHO multinational
survey found that 70% of respondents in
all surveyed countries answered that they
had heard the term antibiotic resistance [7].
Perhaps this is the reason why many people
are unaware that antibiotic resistance is
largely driven by antibiotic overused. Only
half of mothers (50.5%) in our study knew
that overuse of antibiotics increased the
risk of antibiotic resistance.
contributed to antibiotic resistance
.
To ensure effective use of medicine, limit
antibiotic resistance when the medicine is
overused, antibiotics have been included
in the list of prescription medicine. A good
proportion of 80.4% of mothers in the study
answered that antibiotics should only be
used with a doctor’s prescription. This result
is similar to research of WHO [7]. However,
4.3. Mother practice of antibiotic use
In order to limit the misuse of antibiotics,
it is important to have a good knowledge
of antibiotic practice. Especially using
antibiotics prescribed by a doctor. However,
Journal of Nursing Science - Vol. 04 - No. 01
47
RESEARCH ARTICLE
the research results indicated that mothers’ results indicated the knowledge gap in
practice of using antibiotics was very many countries, especially in lower income
deficient.
countries [7]. Health education is needed to
improve the knowledge gap.
Although the percentage of mothers
knowing that they need to use prescription
Proper use of antibiotics does not
antibiotics was quite high, 94.8% of mothers just stop at using the correct antibiotics.
incorrectly answered in buying antibiotics Preventing diseases in children, especially
as suggested by the drug sellers. Over-trust diseasesthatareacquiredinthecommunity,
in pharmacists and a lack of understanding keeping healthy children will help children
of antibiotics had created huge holes in limit their exposure to antibiotics, in which
antibiotic use. This leads to mothers using adequate vaccination on time and hand
the drug without a doctor’s prescription. hygiene are effective measures. However,
As high as 86% of respondents have ever the reserch result indicated that there were
bought antibiotics directly at the pharmacy 52.6% of mothers who knew the benefits
under the consultation of the seller [8]. In and regularly sanitize their hands. This
Chu Thi Dao’s study, 51.7% of mothers was a low practice rate of mothers in child
wanted to give their children antibiotics as care. 68% of mothers would not ask their
suggested by the pharmacist [4].
pediatrician to prescribe more antibiotics,
showing trust in their doctor. This was a
favorable result for doctors to advise and
prescribe antibiotics. However, 32% of
mothers still needed to be equipped with
more knowledge, because this lack of
knowledge not only made mothers use
antibiotics inappropriately but also created
pressure and made doctors prescribe
unnecessary and increase antibiotic
overusing.
Stockpiling of antibiotics for prevention
not only increased the use of antibiotics
without doctor’s prescription, but also
resulted wastage of antibiotics. This was
the cause of antibiotic resistance when the
storekeeper did not know how to handle
expired antibiotics. However, stockpiling
of antibiotics and the use of remaining
antibiotics were common in many parts
of the world. Only 35.1% of participants
never stored antibiotics [3], 32% of those
who gave their children antibiotics without
advice admitted using the remained
antibiotics for treatment [6]. 38.7% of
mothers wanted and 24.2% of mothers
gave their children antibiotics for the rest of
the previous period [4]. The study results
reached up to 40.2% of mothers with
wrong practice in this issue. The mistake
significantly contributed to the proliferation
of antibiotic-resistant bacteria.
5. CONCLUSION
Knowledge and practice of antibiotic use
of mothers of children under 5 years old
with acute respiratory infections at Dong
Hung General Hospital, Thai Binh province,
by 2020 was limited. The proportion of
mothers with knowledge of using antibiotics
was 34%, the average score of mothers with
antibioticuseknowledgewas7.85±4.05out
of a total score of 18. Proportion of mothers
who practiced antibiotic use. Antibiotic use
A serious mistake was when 85.6% of was 43.3%, the mothers’ average score of
mothers were willing to share antibiotics antibiotic use was 6.3 ± 2.09 out of a total
with their relatives and 52.6% of mothers score of 12. The research results suggested
had used antibiotics as suggested by their that the health care providers should plan
relatives or neighbors. The WHO survey and provide educational interventions to
48
Journal of Nursing Science - Vol. 04 - No. 01
RESEARCH ARTICLE
improve knowledge of antibiotics use to help
mothers acquire knowledge and practice in
the appropriate use of antibiotics, helping to
limit and prevent antibiotic resistance.
8. Ngo Thao Nguyen, Nguyen Thi Thu
Thuy (2017). Knowledge, attitude and
behavior of antibiotic use among pharmacy
customers in the inner districts of Ho Chi
Minh City. Medpharmres Journal, 21(1),
341-349.
REFERENCES
1. Ministry of Health (2015). Decision
No. 708 / QD-BYT dated 2 March 2015 on
the issuance of the professional document
“Instructions for the use of antibiotics”. [In
VietNamese]
2. Nguyen Van Kinh, Luong Ngoc Khue
and Truong Quoc Cuong (2010). Analysis
of the current situation of antibiotic use and
antibiotic resistance in Viet Nam, CDDEP,
Washington DC- New Delhi.
3. Vu Hong Nhung (2018). Factors
related to knowledge, attitude and practice
of using antibiotics of the primary caregiver
of children at Nam Dinh Children’s Hospital,
2018, Master Thesis in Nursing, Nam Dinh
University of Nursing [In VietNamese].
4. Chu Thi Dao (2018). Knowledge,
attitudes and practices on antibiotic use
in the treatment of upper respiratory tract
infections among mothers with children
under 5 years old in Hoai Duc district, Hanoi,
2018, Master Thesis in Nursing, Nam Dinh
University of Nursing [In VietNamese].
5. Al-Ayed M.S.Z (2019). Parents’
knowledge, attitudes and practices on
antibiotic use by children. Saudi Journal of
Medicine & Medical Sciences, 7(2), 93-99.
6. Yu M, Zhao G, Lundborg C.S et al
(2014). Knowledge, attitudes, and practices
of parents in rural China on the use of
antibiotics in children: a cross-sectional
study. BMC Infectious Diseases, 14, 112.
7. World Health Organization (2015).
Antibiotic resistance: Multi-country public
awareness survey.
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