Introduction
Methods
Study design and participants
Sampling process
Development of data collection instruments
Data collection
Data management and statistical analysis
Results
Characteristics | Total (n = 539) | Feuang (n = 274, 51%) | Vangvieng (n = 265,49%) | P-value |
---|---|---|---|---|
Age (mean SD) | 24.7 ± 6.1 | 23.9 ± 6.0 | 25.5 ± 6.0 | < 0.01 |
Household size (median number of people, IQR) | 5 (4–7) | 6 (4–8) | 5 (4–7) | 0.10 |
Incomea (Lao Kips) (median, IQR) | 2000,.000 (1000,000-3,000,000) | 1,200,000 (600,000-2,500,000) | 2000,000 (1,500,000-3,500,000) | < 0.01 |
Ethnic-group | < 0.01 | |||
Lao-Tai (main ethnic group) | 247 (45.8) | 106 (38.6) | 141 (53.2) | |
Other ethnic groups | 292 (54.1) | 168 (61.3) | 124 (46.7) | |
Education | < 0.01 | |||
Illiterate | 61 (11.3) | 36 (13.1) | 25 (9.4) | |
Primary | 164 (30.4) | 107 (39.0) | 57 (21.5) | |
Lower secondary and higher | 314 (58.2) | 131(47.8) | 183 (69.0) | |
Occupation | < 0.01 | |||
Farmer | 254 (47.1) | 147 (53.6) | 107 (40.3) | |
Housewife/work without pay | 190 (35.2) | 89 (32.4) | 101 (38.1) | |
Work with pay | 95 (17.6) | 38 (13.8) | 57(21.5) | |
Number of pregnancies | ||||
1 | 181 (33.5) | 88 (32.1) | 93 (35.0) | 0.27 |
2 | 126 (23.3) | 59 (21.5) | 67 (25.2) | |
> =3 | 232 (43.0) | 127 (46.4) | 105 (39.6) | |
ANC visits during pregnancy | 0.04 | |||
< =1 | 33 (6.1) | 14 (5.1) | 19 (7.1) | |
2–3 | 50 (9.2) | 18 (6.5) | 32 (12.0) | |
> =4 | 456 (84.6) | 242 (88.3) | 214 (80.7) | |
Delivery mode | 0.37 | |||
Vaginal | 512 (94.8) | 258 (94.1) | 254 (95.8) | |
Assisted or c-section | 27 (5.2) | 16 (5.8) | 11(4.1) |
Knowledge about antibiotics and antibiotic resistance
Knowledge Questions | Total (n = 539) | Feuang (n = 274, 50.8%) | Vangvieng (n = 265, 49.2%) | P | |
---|---|---|---|---|---|
Section 1. Knowledge about effectiveness of antibiotics | |||||
Q1. Antibiotics are effective against bacterial infections | Yes | 129 (23.9) | 52 (19.0) | 77 (29.1) | < 0.01 |
No | 36 (6.7) | 4 (1.5) | 32 (12.1) | ||
I don’t know | 374 (69.4) | 218 (79.6) | 156 (58.9) | ||
Q2. Antibiotics are effective against viral infections | Yes | 125 (23.2) | 41 (15.0) | 84 (31.7) | < 0.01 |
No | 39 (7.2) | 13 (4.7) | 26 (9.8) | ||
I don’t know | 375 (69.6) | 220 (80.3) | 155 (58.5) | ||
Q3. Common cold is normally caused by bacteria | Yes | 96 (17.8) | 34 (12.4) | 62 (23.4) | < 0.01 |
No | 76 (14.1) | 17 (6.2) | 59 (22.3) | ||
I don’t know | 367 (68.1) | 223 (81.4) | 144 (54.3) | ||
Q4. Common cold is normally caused by viruses | Yes | 127 (23.6) | 39 (14.2) | 88 (33.2) | < 0.01 |
No | 45 (8.4) | 13 (4.7) | 32 (12.1) | ||
I don’t know | 367 (68.1) | 222 (81.0) | 145 (54.7) | ||
Q5. Antibiotics are used to stop fever | Yes | 163 (30.2) | 86 (31.4) | 77 (29.1) | < 0.01 |
No | 153 (28.4) | 58 (21.3) | 95 (35.9) | ||
I don’t know | 223 (41.4) | 130 (47.5) | 93 (35.1) | ||
Q6. Antibiotic use may cause side effects | Yes | 131 (24.3) | 43 (15.7) | 88 (33.2) | < 0.01 |
No | 71 (13.2) | 50 (18.3) | 21 (7.9) | ||
I don’t know | 337 (62.5) | 181 (66.1) | 156 (58.9) | ||
Q7. I decide myself when to stop antibiotics | Yes | 256 (47.5) | 146 (53.3) | 110 (41.5) | 0.02 |
No | 169 (31.4) | 77 (28.1) | 92 (34.7) | ||
I don’t know | 114 (21.2) | 51 (18.6) | 63 (23.8) | ||
Section 2. Knowledge about antibiotic resistance | |||||
Q1. Have you heard the term ABR | Yes | 89 (16.5) | 37 (13.5) | 52 (19.6) | 0.11 |
No | 348 (64.6) | 187 (68.3) | 161 (60.8) | ||
I don’t know | 102 (18.9) | 50 (18.3) | 52 (19.6) | ||
Q2. Antibiotic use can cause ABR | Yes | 117 (21.7) | 50 (18.3) | 67 (25.3) | < 0.01 |
No | 72 (13.4) | 29 (10.6) | 43 (16.2) | ||
I don’t know | 350 (64.9) | 195 (71.2) | 155 (58.5) | ||
Q3. The more antibiotics we use in society, the higher risk that the resistance develops and spread | Yes | 142 (26.4) | 51 (18.6) | 91 (34.3) | < 0.01 |
No | 38 (7.1) | 17 (6.2) | 21 (7.9) | ||
I don’t know | 359 (66.6) | 206 (75.2) | 153 (57.7) | ||
Q4. Bacteria can become resistant to antibiotics | Yes | 85 (15.8) | 32 (11.7) | 53 (20.0) | < 0.01 |
No | 39 (7.24) | 10 (3.7) | 29 (10.9) | ||
I don’t know | 415 (77.0) | 232 (84.7) | 183 (69.1) | ||
Q5. People can become resistant to antibiotics | Yes | 132 (24.5) | 51 (18.8) | 81 (30.6) | < 0.01 |
No | 70 (13.0) | 39 (14.2) | 31(11.7) | ||
I don’t know | 337 (62.5) | 184 (67.2) | 153 (57.7) | ||
Q6. Unnecessary use of antibiotics can make them ineffective in long term | Yes | 170 (31.5) | 61 (22.3) | 109 (41.1) | < 0.01 |
No | 45 (8.4) | 21 (7.7) | 24 (9.1) | ||
I don’t know | 324 (60.1) | 192 (70.1) | 132 (49.8) | ||
Q7. ABR can spread from animals to humans | Yes | 85 (15.8) | 37 (13.5) | 48 (18.1) | 0.01 |
No | 80 (14.8) | 31 (11.3) | 49 (18.5) | ||
I don’t know | 374 (69.4) | 206 (75.2) | 168 (63.4) | ||
Q8. Today ABR is a big problem in Lao PDR | Yes | 121 (22.5) | 47 (17.2) | 74 (27.9) | < 0.01 |
No | 48 (8.9) | 13 (4.7) | 35 (13.2) | ||
don’t know | 370 (68.7) | 214 (78.1) | 156 (58.9) | ||
Q9. Today, ABR is a big problem in the world | Yes | 91 (16.9) | 37 (13.5) | 54 (20.4) | < 0.01 |
No | 45 (8.4) | 8 (2.9) | 37 (14.0) | ||
don’t know | 403 (74.8) | 229 (83.6) | 174 (65.7) |
Attitudes towards antibiotic use
Attitude Questions | Woman during pregnancy | Woman after birth (six months follow up) | p value |
---|---|---|---|
Q1 When ill e.g., having a runny nose, sore throat, fever or cough but without difficulties in breathing I would use antibiotics to get better quickly | < 0.01 | ||
Disagree | 411 (76.2) | 366 (67.9) | |
Agree | 92 (17.0) | 156 (28.9) | |
I don’t know | 36 (6.6) | 17 (3.1) | |
Q2. If one of my family members is ill with the above symptoms I would advise them to take antibiotics without seeing a healthcare provider | < 0.01 | ||
Disagree | 282 (52.3) | 341 (63.2) | |
Agree | 225 (41.7) | 181 (33.5) | |
I don’t know | 32 (5.9) | 17 (3.1) | |
Q3. I expect antibiotics being prescribed by the doctor/ assistant doctor when suffering from a common cold | < 0.01 | ||
Disagree | 341 (63.2) | 316 (58.6) | |
Agree | 141 (26.1) | 192 (35.6) | |
I don’t know | 57 (10.5) | 31 (5.7) | |
Q4. I prefer to be able to buy antibiotics directly from a pharmacy without prescription | < 0.01 | ||
Disagree | 396 (73.4) | 445 (82.5) | |
Agree | 119 (22.0) | 84 (15.5) | |
I don’t know | 24 (4.4) | 10 (1.8) | |
Q5. If I would have left over antibiotics, I would prefer to store them at home, just in case I need them later | < 0.01 | ||
Disagree | 384 (71.2) | 452 (83.8) | |
Agree | 137 (25.4) | 77 (14.2) | |
I don’t know | 18 (3.3) | 10 (1.8) | |
Q6. I would use leftover antibiotic from previous prescription for treating similar symptoms | < 0.01 | ||
Disagree | 428 (79.4) | 471 (87.5) | |
Agree | 90 (16.7) | 59 (10.9) | |
I don’t know | 21 (3.9) | 8 (1.4) | |
Q7. When getting a cold I will use antibiotics to prevent symptoms from getting worse | < 0.01 | ||
Disagree | 382 (70.8) | 404 (74.9) | |
Agree | 116 (21.5) | 124 (23.0) | |
I don’t know | 41 (7.6) | 11 (2.0) | |
Q8. I think it is good to be able to acquire antibiotics from relatives or acquaintances without seen by a healthcare provider | 0.13 | ||
Disagree | 458 (84.9) | 480 (89.0) | |
Agree | 62 (11.5) | 46 (8.5) | |
I don’t know | 19 (3.5) | 13 (2.4) | |
Q9. I would change the doctor/assistant doctor if according to my opinion they do not prescribe antibiotics enough | 0.03 | ||
Disagree | 402 (74.5) | 428 (79.5) | |
Agree | 95 (17.6) | 88 (16.3) | |
I don’t know | 42 (7.7) | 22 (4.0) | |
Q10. Doctor/assistant doctor always conduct an examination regardless if patient needs antibiotic or not | 0.29 | ||
Disagree | 41 (7.6) | 32 (5.9) | |
Agree | 485 (89.9) | 499 (92.5) | |
I don’t know | 13 (2.4) | 8 (1.4) | |
Q11. Doctor/assistant doctor prescribe antibiotics when patient expects it | < 0.01 | ||
Disagree | 337 (62.5) | 335 (62.1) | |
Agree | 161 (29.8) | 192 (35.6) | |
I don’t know | 41 (7.6) | 12 (2.2) | |
Q12. When antibiotics are prescribed, the doctor/assistant doctor takes time to provide information on how they should be used, in an understandable manner | 0.08 | ||
Disagree | 28 (5.2) | 18 (3.3) | |
Agree | 500 (92.9) | 517 (95.9) | |
I don’t know | 10 (1.8) | 4 (0.7) | |
Q13. Pharmacy staff take their time to inform me on how antibiotics should be used | 0.12 | ||
Disagree | 27 (5.0) | 14 (2.6) | |
Agree | 505 (93.8) | 519 (96.2) | |
I don’t know | 6 (1.1) | 6 (1.1) | |
Q14. A doctor/assistant doctor who does not prescribe antibiotics when patient thinks that they are needed, is not a good doctor | < 0.01 | ||
Disagree | 388 (71.9) | 381 (70.6) | |
Agree | 102 (18.9) | 135 (25.0) | |
I don’t know | 49 (9.0) | 23 (4.2) | |
Q15. I am confident in a doctor’s/assistant doctor’s decision if she/he does not prescribe antibiotics | < 0.01 | ||
Disagree | 38 (7.0) | 60 (11.1) | |
Agree | 480 (89.0) | 471 (87.3) | |
I don’t know | 21 (3.9) | 8 (1.4) |
Reported practice of participants regarding antibiotic use during pregnancy and for their children
Most commonly reported symptoms/illness episodes | ||||||
---|---|---|---|---|---|---|
Common cold n (%) | Pneumonia n (%) | UTI n (%) | RTI n (%) | Fever n (%) | ||
Pregnant women who reported symptoms/illness during pregnancy (n = 96) | 37 (40.2) | 7 (7.6) | 5 (5.4) | 19 (20.6) | 24 (26.0) | |
Children with reported symptoms/illness (n = 324) | 243 (75.5) | 19 (5.8) | 16 (4.9) | – | 72 (22.2) | |
Got medicine for this symptom | ||||||
Pregnant women | 23 (62.0) | 1(14.0) | 0 | 7(37.0) | 20 (83.0) | |
Child | 229 (94.0) | 15 (79.0) | 12 (75.0) | – | 67 (93.0) | |
Antibiotic used | ||||||
Pregnant woman | 7 (19.0) | 0 | – | 5 (26.0) | 2(8.0) | |
Child | 112 (46.0) | 15 (79.0) | 8 (50.0) | – | 11 (15.0) | |
If antibiotic was used, who suggested it? | ||||||
Pregnant woman | Self-decision | 1 (14.3) | – | – | 1 (20.0) | 0 |
Healthcare providers | 6 (86.0) | – | – | 4 (80.0) | 2 (100.0) | |
Child | Self- decision | 2 (2.0) | 1 (7.0) | 0 | – | 0 |
Healthcare providers | 110 (98.0) | 14 (93.0) | 8(100.0) | – | 11(100.0) | |
If antibiotics was used, where did you get it? | ||||||
Pregnant woman | Private pharmacy or drug store | 1 (14.0) | – | – | 1(20.0) | 0 |
Health facilities | 6 (86.0) | – | – | 4 (80.0) | 2 (100.0) | |
Child | Private pharmacy or drug store | 21 (19.0) | 1(7.0) | 4 (50.0) | – | 2 (18.0) |
Health facilities | 91 (81.0) | 14 (93.0) | 4 (50.0) | – | 9 (82.0) |