Perception of health-care staff's knowledge, attitudes, and practices and of potential barriers toward containing antibiotic resistance in public health-care facilities of Tumkur district (South India)

Abstract

Background: India faces a major public health problem of antibiotic resistance. The rational prescription practices with behavioral change of health-care staff are one of the potential interventions for containment of antibiotic resistance at the health centers level. Yet, not much is known about the perceptions of health workers. Methodology: The present study evaluated the knowledge, attitude, practices, and barriers around antibiotic usage and resistance among the government health staff by a quantitative survey of 118 health-care providers (60 physicians and 58 pharmacists) across Tumkur district of Karnataka – 53 government health facilities from all levels – 1 district hospital (DH), 4 taluk hospitals, and 48 primary health centers. Results: Antibiotic resistance was perceived as an important problem globally, nationally, and locally by 81.3% (n = 96) and 83.8% (n = 99) and 54.2% (n = 64), respectively. About 86% (n = 52) of doctors were not aware of top three resistant organisms prevalent in their center. Only 38% (n = 23) sought microbiologist's input for antibiotic recommendations. Unavailability of antibiotics was quoted a major barrier to practice (78%, n = 47), followed by unregulated over-the-counter sale (OTC) (62%, n = 37) and high work-load (56.6%, n = 34). About 87% (n = 52) of the physicians and 98% (n = 57) of pharmacists expressed their interest for a potential educational program in antibiotics and resistance. Microbiology record (July–December 2013) from DH revealed only 22 isolates from 54 processed samples and resistance data were not recorded. Conclusions: While issues around antibiotics unavailability and OTC sales are being addressed at the center, the perceptions of the public health center's staff seem to have been overlooked. The laboratory support is grossly underutilized by the staff-culture seeking behavior of the practicing physicians needs to be enhanced, and laboratory strengthening at DH is imperative. The District seems ready for the implementation of Antibiotic stewardship programs, which may be introduced by the state as an educational intervention to address the gaps in knowledge, attitude, and practices of the staff.