Abstract
Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6–4.4)], versus secondary education (8–10 grade) [AOR = 1.8 (95% Cl = 1.0–3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.
Highlights
Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics
The survey was conducted in collaboration with National Public Health Laboratory (NPHL) and the hospitals, data on AMR in different settings were collected from available reports which were tracked through laboratory registers/Laboratory Management Information System (LMIS) and were analyzed to assess AMR patterns
This study explored knowledge, attitude and practice related to antibiotics uses among patients, healthcare workers, and farmers; using quantitative methods alone constrained us to understand the deeper reasons behind the responses including extent and nature on how they affect the use of antibiotics in Nepal
Summary
Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. Infection with drug resistant microbes increases the morbidity, mortality, length of hospitalization and treatment cost of patients[7,8]. Such scenario will continue to affect low- and middle- income countries as they suffer from high overuse and misuse of antibiotics[9,10]. Increasing food and environmental links has facilitated the rapid transfer of drug-resistant pathogens[11] In response to these challenges, a holistic ‘One Health’ approach has been advocated in recent years that aims to include the health of human, animal and the environment[12]. One health approach can be utilized to enhance risk analysis on emergence, spread and control strategies of AMR at the human-animal-local environment interfaces[13]
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