Knowledge, prevalence and associated factors for antibiotic non-adherence among adult outpatients in public health facilities in South-south Nigeria

Abstract

Background: Poor adherence to prescribed antibiotics leads to sub-optimal concentrations in vivo and is a recognized cause of antibiotic resistance. Most studies on antibiotic adherence focus on healthy population groups. The study assessed knowledge and attitude towards antibiotics and antibiotic use, and associated factors for non-adherence amongst adult general out-patient clinic attendees. Methods and materials: Using a cross-sectional study design, 800 consenting attendees at adult general outpatient clinics of 5 secondary and tertiary hospitals in Edo central senatorial district, Edo State, Nigeria were interviewed using pretested questionnaires following ethical approval to conduct the study. Independent variables were sociodemographic, knowledge (good/fair/poor), attitude (positive/negative), perceived doctor's support and perceived family support. The dependent variable was antibiotic non-adherence. Data were analysed using Statistical Package for Social Sciences. Chi-square test was used for bivariate analysis and significant variables analyzed with multivariate logistic regression, with statistical significance, p, set as <0.05. Results: Response rate was 100%. Majority, 360 (45.0%), had poor knowledge and 74 (50.3%) had poor attitude towards antibiotics use. Majority, 608 (85.0%) opined that antibiotics were effective against bacteria, 175 (21.9%) that antibiotics can be used to treat common colds, and 471 (58.9%) that antibiotics can be stopped when symptoms cleared. Factors negatively associated with poor knowledge were higher educational level, age > 30 years and being of occupational skill level 3. Duration of residence > 40 years was positively associated with poor knowledge. Poor attitude was negatively associated with average monthly income and duration of residence 40–49 years. Attitude was also significantly associated with respondent's knowledge level (p < 0.001). One hundred and forty-seven respondents (18.4%) had received an antibiotic prescription in the last 4 months, of which 75 (51.0%) did not complete the dose, with the most common reason given as remission of symptoms (65.3%). In multivariate analysis, attitude, perceived support from doctor and family members were negatively associated with non-adherence. Conclusion: Interventions to improve antibiotic adherence should be centred around public health education and behaviour change communication on appropriate antibiotic use, building clinician-patient interactions and fostering family support for the sick patient.