Pilot Survey of Knowledge, Attitudes and Perceptions of Hajj Deployed Health Care Workers on Antibiotics and Antibiotic Prescriptions for Upper Respiratory Tract Infections: Results from Two Hajj Seasons.

Hamid Bokhary,Grant A Hill-Cawthorne,Osamah Barasheed,Harunor Rasheed,Moataz Abd El Ghany,Ameneh Khatami

doi:10.3390/tropicalmed5010018

Abstract

Antimicrobial resistance (AMR) is a global public health issue. Upper respiratory tract infections (URTIs) are common illnesses during Hajj, for which antibiotics are often inappropriately prescribed. Hajj healthcare workers’ (HCW) knowledge, attitudes and perceptions (KAP) about AMR and antibiotic use for URTIs are not known. We conducted a survey among HCWs during Hajj to explore their KAP regarding antibiotic use for URTIs in pilgrims. Electronic or paper-based surveys were distributed to HCWs during the Hajj in 2016 and 2017. A total of 85 respondents aged 25 to 63 (median 40) years completed the surveys. Most participants were male (78.8%) and were physicians by profession (95.3%). Around 85% and 19% of respondents claimed to have heard about AMR and antimicrobial stewardship programs, respectively, among whom most had obtained their knowledge during their qualification. Implementation of URTI treatment guidelines was very low. In conclusion, HCWs at Hajj have significant knowledge gaps regarding AMR, often do not use standard clinical criteria to diagnose URTIs and display a tendency to prescribe antibiotics for URTIs.

Highlights

Antimicrobial resistance (AMR) is a growing global concern affecting human health
5.0% (1/20) of those who knew of the Centor criteria provided responses to demonstrate correct use of such criteria, whereas 6.9% (2/29) of healthcare workers’ (HCW) who claimed not to have heard of the Centor criteria were practicing the guideline correctly. This survey demonstrates a substantial gap in knowledge about antibiotics, AMR and antibiotic treatment protocols for Upper respiratory tract infections (URTIs) among HCWs deployed during Hajj
This may not reflect a true lack of knowledge about antibiotics but could be due to lack of clarity about the questions since several conflicting results were identified that suggest some HCWs were confused with the use of English terms such as ‘antimicrobial’ and ‘antibacterial’

Summary

Introduction

Antimicrobial resistance (AMR) is a growing global concern affecting human health. The World Health Organization (WHO) has addressed AMR on several levels: surveillance [1], action plans [2] and guidelines including antimicrobial uses other than for medical purposes [3]. Tackling AMR requires a multi-disciplinary effort, including reducing unnecessary antimicrobial prescriptions by healthcare workers (HCWs) [5]. Assessing HCWs’ knowledge, attitudes and perceptions (KAP) on AMR is important to formulate an action plan to tackle drug resistance. This is crucially important in settings like travel, mass migration and during mass gatherings such as the Hajj pilgrimage in Makkah, Saudi Arabia

Methods

Discussion

Conclusion