Main Article Content
Health Knowledge, Attitudes, Practice, Anti-Bacterial Agents, Drug Resistance, Bacterial, Patient Acceptance of Health Care, Surveys and Questionnaires, Kosovo
Background: Antimicrobial resistance is becoming a major public health challenge worldwide, caused primarily by the misuse of antibiotics. Antibiotic use is closely related to the knowledge, attitudes and behaviour of a population.
Objective: The objective of this study was to assess the level of knowledge, attitudes and practices about antibiotic use among the general public in Kosovo.
Methods: A cross-sectional face-to-face survey was carried out with a sample of 811 randomly selected Kosovo residents. The methodology used for this survey was based on the European Commission Eurobarometer survey on antimicrobial resistance.
Results: More than half of respondents (58.7%) have used antibiotics during the past year. A quarter of respondents consumed antibiotics without a medical prescription. The most common reasons for usage were flu (23.8%), followed by sore throat (20.2%), cold (13%) and common cold (7.6%). 42.5% of respondents think that antibiotics are effective against viral infections. Almost half of respondents (46.7%) received information about the unnecessary use of antibiotics and 32.5% of them report having changed their views and behaviours after receiving this information. Health care workers were identified as the most trustworthy source of information on antibiotic use (67.2%).
Conclusion: These results provide quantitative baseline data on Kosovar knowledge, attitudes and practice regarding the use of antibiotic. These findings have potential to empower educational campaigns to promote the prudent use of antibiotics in both community and health care settings.
2. Maragakis LL, Perencevich EN, Cosgrove SE Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther. 2008;6(5):751-763. doi: 10.1586/14787220.127.116.111
3. Goossens H. Antibiotic consumption and link to resistance. Clin Microbiol Infect. 2009;15(Suppl 3):12-5. doi: 10.1111/j.1469-0691.2009.02725.x
4. Bronzwaer SL, Cars O, Buchholz U, Mölstad S, Goettsch W, Veldhuijzen IK, Kool JL, Sprenger MJ, Degener JE; European Antimicrobial Resistance Surveillance System. A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis. 2002;8(3):278-282.
5. McNulty CA, Boyle P, Nichols T, Clappison P, Davey P. The public’s attitudes to and compliance with antibiotics. J Antimicrob Chemother. 2007;60(Suppl 1):i63-i68.
6. Emslie MJ, Bond CM. Public knowledge, attitudes and behaviour regarding antibiotics. Eur J Gen Pract. 2003;9(3):84-90.
7. Adriaenssens N, Coenen S, Versporten A, Muller A, Minalu G, Faes C, Vankerckhoven V, Aerts M, Hens N, Molenberghs G, Goossens H; ESAC Project Group. European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe (1997–2009). J Antimicrob Chemother. 2011;66 Suppl 6:vi3-vi12. doi: 10.1093/jac/dkr453
8. van Roosmalen MS, Braspenning JC, De Smet PA, Grol RP. Antibiotic prescribing in primary care: first choice and restrictive prescribing are two different traits. Qual Saf Health Care. 2007;16(2):105-109.
9. Buwa D, Vuori H. Rebuilding a health care system: war, reconstruction and health care reforms in Kosovo. Eur J Public Health. 2007;17(2):226-230.
10. Jakupi A. Report: Drug consumption in Kosovo 2011-2013. Kosovo Medicines Agency – Prishtina, 2014.
11. Versporten A, Bolokhovets G, Ghazaryan L, Abilova V, Pyshnik G, Spasojevic T, Korinteli I, Raka L, Kambaralieva B, Cizmovic L, Carp A, Radonjic V, Maqsudova N, Celik HD, Payerl-Pal M, Pedersen HB, Sautenkova N, Goossens H; WHO/Europe-ESAC Project Group. Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. Lancet Infect Dis. 2014;14(5):381-387. doi: 10.1016/S1473-3099(14)70071-4
12. Raka L, Goosens H, Mulliqi G, Versporten A, Krasniqi S, Kostyanev T, Kurti A, Lammens C, Kurti A, Paasch F, Uka V, Jakupi A, Loku A, Raka D. “Capacity building to implement state of the art surveillance systems for antibiotic consumption and resistance in Kosovo”: results of European Union research project in Kosovo. Antimicrob Resist Infect Control. 2015;4(Suppl 1):P178.
13. Gualano MR, Gili R, Scaioli G, Bert F, Siliquini R. General population's knowledge and attitudes about antibiotics: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2015;24(1):2-10. doi: 10.1002/pds.3716
14. Coenen S, Michiels B, Renard D, Denekens J, Van Royen P. Antibiotic prescribing for acute cough: the efect of perceived patient demand. Br J Gen Pract. 2006;56(524):183-190.
15. Kim SS, Moon S, Kim EJ. Public knowledge and attitudes regarding antibiotic use in South Korea. J Korean Acad Nurs. 2011;41(6):742-749. doi: 10.4040/jkan.2011.41.6.742
16. European Commission. Special Eurobarometer 407 ‘Antimicrobial resistance’. TNS Opinion &Social, at the request of the European Commission, Directorate-General for Health and Consumers. 2013. Available from: http://ec.europa.eu/public_opinion/archives/ebs/ebs_407_en.pdf (accessed Aug 6, 2016).
17. Ivanovska V, Zdravkovska M, Bosevska G, Angelovska B. Antibiotics for upper respiratory infections: Public knowledge, beliefs and self-medication in the Republic of Macedonia. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2013;34(2):59-70.
18. Ilhan MN, Durukan E, Ilhan SO, Aksakal FN, Ozkan S, Bumin MA. Self-medication with antibiotics: Questionnaire survey among primary care center attendants. Pharmacoepidemiol Drug Saf. 2009;18(12):1150-1157. doi: 10.1002/pds.1829
19. Ling Oh A, Hassali MA, Al-Haddad MS, Syed Sulaiman SA, Shafie AA, Awaisu A. Public knowledge and attitudes towards antibiotic usage: a cross-sectional study among the general public in the state of Penang, Malaysia . J Infect Dev Ctries. 2011;5(5):338-347.
20. Vanden Eng J, Marcus R, Hadler JL, Imhoff B, Vugia DJ, Cieslak PR, Zell E, Deneen V, McCombs KG, Zansky SM, Hawkins MA, Besser RE. Consumer attitudes and use of antibiotics. Emerg Infect Dis. 2003;9(9):1128-1135.
21. You JHS, Yau B, Choi KC, Chau CTS, Huang OR, Lee SS. Public knowledge, attitudes and behavior on antibiotic use: A telephone survey in Hong Kong. Infection. 2008;36(2):153-157. doi: 10.1007/s15010-007-7214-5
22. Lee SS, Bernard Yau, Joe Q Huang and Joyce H S You. Determinants of appropriate antibiotic use in the community - a survey in Sydney and Hong Kong. Br J Infec Control 2008;9(6):6-9.
23. McNulty CA, Boyle P, Nichols T, Clappison P, Davey P. Don’t wear me out—The public’s knowledge of and attitudes to antibiotic use. J Antimicrob Chemother. 2007;59(4):727-738.
24. Alzoubi K, Al-Azzam S, Alhusban A, Mukattash T, Al-Zubaidy S, Alomari N, Khader Y. An audit on the knowledge, beliefs and attitudes about the uses and side-effects of antibiotics among outpatients attending 2 teaching hospitals in Jordan. East Mediterr Health J. 2013;19(5):478-484.
25. Grigoryan L, Burgerhof JG, Degener JE, Deschepper R, Lundborg CS, Monnet DL, Scicluna EA, Birkin J, Haaijer-Ruskamp FM; SAR consortium. Attitudes, beliefs and knowledge concerning antibiotic use and self-medication: A comparative European study. Pharmacoepidemiol Drug Saf. 2007;16(11):1234-1243.
26. Awad AI, Aboud EA. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS One. 2015;10(2):e0117910. doi: 10.1371/journal.pone.0117910
27. Kim SS, Moon S, Kim EJ. Public knowledge and attitudes regarding antibiotic use in South Korea. J Korean Acad Nurs. 2011;41(6):742-749. doi: 10.4040/jkan.2011.41.6.742
28. McNulty CA, Nichols T, Boyle PJ, Woodhead M, Davey P.The English antibiotic awareness campaigns: Did they change the public’s knowledge of and attitudes to antibiotic use? J Antimicrob Chemother. 2010;65(7):1526-1533. doi: 10.1093/jac/dkq126
29. Azevedo MM, Pinheiro C, Yaphe J, Baltazar F. Assessing the impact of a school intervention to promote students’ knowledge and practices on correct antibiotic use. Int J Environ Res Public Health. 2013;10(7):2920-2931. doi: 10.3390/ijerph10072920
30. Goossens H, Guillemot D, Ferech M, Schlemmer B, Costers M, van Breda M, Baker LJ, Cars O, Davey PG. National campaigns to improve antibiotic use. Eur J Clin Pharmacol. 2006;62(5):373-379.
31. Abbo LM, Cosgrove SE, Pottinger PS, Pereyra M, Sinkowitz-Cochran R, Srinivasan A, Webb DJ, Hooton TM. Medical students’ perceptions and knowledge about antimicrobial stewardship: how are we educating our future prescribers? Clin Infect Dis. 2013;57(5):631-638. doi: 10.1093/cid/cit370
32. Fejza A, Kryeziu Z, Kadrija K, Musa M. Pharmacy students' knowledge and attitudes about antibiotics in Kosovo. Pharm Pract (Granada). 2016;14(1):715. doi: 10.18549/PharmPract.2016.01.715
33. Dyar OJ, Pulcini C, Howard P, Nathwani D; ESGAP (ESCMID Study Group for Antibiotic Policies). European medical students: A first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother. 2014;69(3):842-846. doi: 10.1093/jac/dkt440
34. World Health Organization: Central Asian and Eastern European Surveillance of Antimicrobial Resistance. Annual report 2016. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/publications/2016/central-asian-and-eastern-european-surveillance-of-antimicrobial-resistance.-annual-report-2016 (accessed Aug 6, 2016).