Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Questionnaire Instrument
2.3. Data Collection
2.4. Data Analysis
3. Results
3.1. Prior Experience and Practices in Antibiotic Use
3.2. Knowledge about Antibiotic Use and Resistance
3.3. Expectations for Antibiotic Treatment
3.4. Association between Knowledge, Expectations and Practice
3.5. Factors Associated with Knowledge of Antibiotics
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Respondents’ Characteristics | n (%) |
---|---|
Age (mean ± SD) | 67.72 ± 5.77 |
Gender | |
Male | 201 (50.0%) |
Female | 201 (50.0%) |
Ethnicity | |
Malay | 233 (58.0%) |
Chinese | 111 (27.6%) |
Indian | 55 (13.7%) |
Others | 3 (0.7%) |
Educational level | |
No formal education | 4 (1.0%) |
Primary education | 50 (12.4%) |
Secondary education | 228 (56.7%) |
Pre-university education | 44 (10.9%) |
Tertiary education | 76 (18.9%) |
Main occupation | |
Unemployed | 19 (4.7%) |
Employed for wages | 10 (2.5%) |
Self-employed | 23 (5.7%) |
Housewife/Househusband | 87 (21.6%) |
Retiree | 263 (65.4%) |
Occupation related to healthcare | |
Yes | 9 (2.2%) |
No | 393 (97.8%) |
Monthly income | |
None | 224 (55.7%) |
<RM 1000 | 21 (5.2%) |
RM 1000–RM 3999 | 115 (28.6%) |
RM 4000–RM 6999 | 31 (7.7%) |
RM 7000–RM 10,000 | 3 (0.7%) |
≥RM 10,000 | 8 (2.0%) |
n (%) | |
---|---|
Last take antibiotics (n = 402) | |
In the last month | 56 (13.9%) |
In the last 6 months | 75 (18.7%) |
In the last year | 41 (10.2%) |
More than a year ago | 85 (21.1%) |
Never | 12 (3.0%) |
Cannot remember | 133 (33.1%) |
Source of antibiotics (n = 257) | |
Prescribed after consultation with physician | 249 (96.9%) |
Prescribed after consultation with dentist | 4 (1.6%) |
Retail pharmacy/community pharmacy | 3 (1.2%) |
Leftover antibiotics (own/someone’s else) | 1 (0.3%) |
Reason(s) to take antibiotics (n = 257) | |
Fever | 56 (19.4%) |
Pain/inflammation | 41 (14.2%) |
Respiratory tract infection | 102 (35.4%) |
Urinary tract infection | 16 (5.6%) |
Skin problems/wounds/cuts | 21 (7.3%) |
Dental problem | 4 (1.4%) |
Diarrhoea/vomiting | 3 (1.0%) |
Others | 27 (9.4%) |
Do not know | 6 (2.1%) |
Cannot remember | 12 (4.2%) |
Get advice on how to take antibiotics (n = 257) | |
Yes | 246 (95.7%) |
No | 11 (4.3%) |
Source(s) of advice (n = 257) | |
Physician | 229 (74.6%) |
Dentist | 3 (0.9%) |
Pharmacist | 46 (15.0%) |
Nurse | 7 (2.3%) |
Friends/family/neighbours | 15 (4.9%) |
Patient information leaflet | 5 (1.6%) |
Mass media | 2 (0.7%) |
Inappropriate practice | |
Obtained antibiotics without a prescription (n = 402) | |
Yes | 14 (3.5%) |
No | 388 (96.5%) |
Used own/others’ leftover antibiotics without advice from healthcare profession (n = 402) | |
Yes | 14 (3.5%) |
No | 388 (96.5%) |
Not completed antibiotic course (n = 402) | |
Yes | 69 (17.2%) |
No | 333 (82.8%) |
Shared own leftover antibiotics to friends or family or neighbours (n = 402) | |
Yes | 10 (2.5%) |
No | 392 (97.5%) |
Engaged in at least one inappropriate practice (n = 402) | |
Yes | 83 (20.65%) |
No | 319 (79.35%) |
Respondents’ Answer, n (%) | |||||
---|---|---|---|---|---|
Correct | Incorrect | Not Sure | |||
Knowledge about antibiotic use | |||||
1. | Antibiotics are medicines that can kill bacteria. | True | 283 (70.4%) | 25 (6.2%) | 94 (23.4%) |
2. | Antibiotics can be used to treat viral infections. | False | 76 (18.9%) | 215 (53.5%) | 111 (27.6%) |
3. | Antibiotics work on most colds and coughs. | False | 146 (36.3%) | 216 (53.7%) | 40 (10.0%) |
4. | Antibiotics can kill bacteria that normally live on the skin and gut (digestion tract). | True | 220 (54.7%) | 60 (14.9%) | 122 (30.3%) |
5. | Bacteria that normally live on the skin and in the gut are good for your health. | True | 229 (56.9%) | 97 (24.1%) | 76 (18.9%) |
6. | Antibiotics are the same as medications used to relieve pain and fever such as aspirin and paracetamol (Panadol). | False | 179 (44.5%) | 194 (48.3%) | 29 (7.2%) |
7. | Penicillin is an antibiotic. | True | 129 (32.1%) | 122 (30.3) | 151 (37.6%) |
8. | Antibiotics may cause allergy reactions. | True | 265 (65.9%) | 79 (19.7%) | 58 (14.4%) |
9. | All antibiotics do not cause side effects. | False | 223 (55.5%) | 114 (28.3%) | 65 (16.2%) |
10. | It is okay to stop taking antibiotic when symptoms are improving. | False | 320 (79.6%) | 72 (17.9%) | 10 (2.5%) |
11. | Taking less antibiotics than prescribed is healthier than taking the full course prescribed. | False | 333 (82.8%) | 54 (13.4%) | 15 (3.7%) |
12. | Overuse of antibiotics can cause the antibiotics to lose effectiveness in long term. | True | 261 (64.9%) | 71 (17.7%) | 70 (17.4%) |
Knowledge about antibiotic resistance | |||||
1. | Antibiotic resistance occurs when your body becomes resistant to antibiotics and they no longer work as well. | False | 60 (14.9%) | 273 (67.9%) | 69 (17.2%) |
2. | Many infections are becoming increasingly resistant to treatment by antibiotics. | True | 246 (61.2%) | 68 (16.9%) | 88 (21.9%) |
3. | If bacteria are resistant to antibiotics, it can be very difficult or impossible to treat the infections they cause. | True | 288 (71.6%) | 43 (10.7%) | 71 (17.7%) |
4. | Antibiotic resistance is an issue that could affect me or my family. | True | 195 (48.5%) | 124 (30.8%) | 83 (20.6%) |
5. | Antibiotic resistance is an issue in other countries but not here. | False | 240 (59.7%) | 40 (10.0%) | 122 (30.3%) |
6. | Antibiotic resistance is only a problem for people who take antibiotics regularly. | False | 72 (17.9%) | 251 (62.4%) | 79 (19.7%) |
7. | Bacteria which are resistant to antibiotics can be spread from person to person. | True | 167 (41.5%) | 143 (35.6%) | 92 (22.9%) |
8. | Antibiotic-resistant infections could make medical procedures like surgery, organ transplants and cancer treatment much more dangerous. | True | 180 (44.8%) | 56 (13.9%) | 166 (41.3%) |
n (%) | Mean Knowledge Score (±SD) | p-value | ||
---|---|---|---|---|
If I expect an antibiotic, I am less satisfied with the physician visit if I do not receive one. | Agree | 50 (12.44%) | 11.2 ± 3.245 | 0.030 * |
Disagree/ neutral | 352 (87.56%) | 10.05 ± 3.522 | ||
I would rather take an antibiotic that may not be needed than wait to see if I will get better without it. | Agree | 48 (11.94%) | 9.38 ± 3.751 | 0.086 |
Disagree/ neutral | 354 (88.06%) | 10.30 ± 3.462 | ||
If a physician does not prescribe an antibiotic when I think one is needed, I will visit another physician. | Agree | 75 (18.66%) | 10.95 ± 3.238 | 0.0928 |
Disagree/ neutral | 327 (81.34%) | 10.02 ± 3.546 | ||
I expect the physician to discuss with me regarding the need of an antibiotic for my symptoms, rather than just giving me a prescription. | Agree | 335(83.40%) | 8.95 ± 4.307 | 0.053 |
Disagree/ neutral | 67 (16.60%) | 10.33 ± 3.381 |
Expectations to be Prescribed Antibiotic for Their Cold, Flu or Cough, n (%) | χ2, p-value | |||
---|---|---|---|---|
Yes | No | |||
Antibiotics can be used to treat viral infections. | Answered correctly | 6 (8.1%) | 68 (91.9%) | χ2 = 15.576, p < 0.001* |
Answered incorrectly/ not sure | 100 (30.5%) | 228 (69.5%) | ||
Antibiotics work on most colds and coughs. | Answered correctly | 8 (5.4%) | 139 (94.6%) | χ2 = 52.267, p < 0.001* |
Answered incorrectly/ not sure | 98 (38.4%) | 157 (61.6%) |
Inappropriate Practice of Not Completing Antibiotics Prescribed, n (%) | χ2, p-value | |||
---|---|---|---|---|
Yes | No | |||
It is okay to stop taking antibiotics when symptoms are improving. | Answered correctly | 26 (8.1%) | 294 (91.9%) | χ2 = 90.153, p < 0.001* |
Answered incorrectly/ not sure | 43 (52.4%) | 39 (47.6%) | ||
Taking less antibiotics than prescribed is healthier than taking the full course prescribed. | Answered correctly | 40 (12.0%) | 293 (88.0%) | χ2 = 36.221, p < 0.001* |
Answered incorrectly/ not sure | 29 (42.0%) | 40 (58.0%) |
Factors | n (%) | χ2, p-value | |
---|---|---|---|
Adequate Knowledge (≥10) | Inadequate Knowledge (<10) | ||
Age | |||
60–69 years old | 163 (61.7%) | 101 (38.3%) | χ2 = 9.979, p = 0.007* |
70–79 years old | 68 (58.6%) | 48 (41.4%) | |
≥80 | 6 (27.3%) | 16 (72.7%) | |
Gender | |||
Male | 124 (61.7%) | 77 (38.3%) | χ2 = 1.244, p =0.265 |
Female | 113 (56.2%) | 88 (43.8%) | |
Ethnicity | |||
Malay | 140 (60.1%) | 93 (39.9%) | χ2 = 2.289, p = 0.318 |
Chinese | 68 (61.3%) | 43 (38.7%) | |
Indian and others | 29 (50.0%) | 29 (50.0%) | |
Educational level | |||
No formal education and primary education | 23 (42.6%) | 31 (57.4%) | χ2 = 16.07, p < 0.001* |
Secondary education | 127 (55.7%) | 101 (44.3%) | |
Pre-university and tertiary education | 87 (72.5%) | 33 (27.5%) | |
Last receipt of antibiotics within the past 6 months | |||
Yes | 73 (55.7%) | 58 (44.3%) | χ2 = 0.838, p = 0.360 |
No | 164 (60.5%) | 107 (39.5%) | |
Last receipt of antibiotics within the past 1 year | |||
Yes | 103 (59.9%) | 69 (40.1%) | χ2 = 0.107, p = 0.743 |
No | 134 (58.3%) | 96 (41.7%) |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Kong, L.S.; Islahudin, F.; Muthupalaniappen, L.; Chong, W.W. Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey. Geriatrics 2019, 4, 61. https://doi.org/10.3390/geriatrics4040061
Kong LS, Islahudin F, Muthupalaniappen L, Chong WW. Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey. Geriatrics. 2019; 4(4):61. https://doi.org/10.3390/geriatrics4040061
Chicago/Turabian StyleKong, Lai San, Farida Islahudin, Leelavathi Muthupalaniappen, and Wei Wen Chong. 2019. "Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey" Geriatrics 4, no. 4: 61. https://doi.org/10.3390/geriatrics4040061