Evaluation of Kabul university students’

attitudes and knowledge about

antibiotic and it’s usage
Objective

 The aim of this research is to assess and estimate the level of Kabul
students’ knowledge about antibiotic and its usage
 know misconceptions and bad attitudes related to antibiotics.
 Investigation to have awareness about rational use of antibiotic.
Why we do this research ?
Medicine

 Common method treatment

 Health Trade or (social and economic )
 In developmental country 10% to 20
 Non developmental country 20% - 40%
 Strategic , and rational use medicine wiled world subject
Result of irrational use

 Treatment prolongation
 Non effective or non safe treatment
 Stress ,injuries to the patient
 Interaction (poly pharmacy)
 Antimicrobial resistance
Effect of irrational use medicine

 Reduce believe patient to health care system

 Increases cost ( prolongation hospitalization)
 Increases cost treatment to the people and government lost source of
Money and human
 • 700,000
death

Con… • Evey year

• 2050 more
than every
cancer ,
every 4
paient 3 wil
die

• 21-25
thosunad
million $ in
America

• 3,2 million $
cost extra
day
hospitalizatio
n
• Thailand,
•
• 38481 death
 • 600 million $
• Half them
antibiotic

• 90% inpatient
• Take anti biotic

• 58% of first vistor

of health center
‘take antibiotic

Every
minute one
person
Primary health care

1978 RMU add to PHC

All people, every where , deserve the right care right in their community
 . Education concerning prevailing health problems and the methods of
identifying, preventing and controlling them
 2. Promotion of food supply and proper nutrition, an adequate supply of safe
water and basic sanitation
 3. Maternal and child health care including family planning
 4. Immunization against major infectious diseases
 5. Prevention and control of locally endemic diseases
 6. Treatment of common diseases and injuries
 7. Promotion of mental health
 8. Provision of essential drugs
Definition of rational use of medicines

P atients receive medications appropriate to their clinical needs, in

doses that meet their own individual requirements, for an adequate
period of time,and at the lowest cost to them and their community

WHO report : half of drug , prescribing , dispensing , sale , not needed

What we can do for Rational Use and
Prescription of antibiotic???
WHO's 12 Strategies for Rational Use and
Prescription of Drugs
 1. Establishment of a multidisciplinary national body to coordinate policies on medicine use
 2. Use of clinical guidelines
 3. Development and use of national essential medicines list
 4. Establishment of drug and therapeutics committees in districts and hospitals
 5. Inclusion of problem-based pharmacotherapy training in undergraduate curricula
 6. Continuing in-service medical education as a licensure requirement
 7. Supervision, audit and feedback
 8. Use of independent information on medicines

9. Public education about medicines

 10. Avoidance of perverse financial incentives
 11. Use of appropriate and enforced regulation
 12. Sufficient government expenditure to ensure availability of medicines and staff
Rational use of medicine cycle
Lack of knowledge …

 Un flow up (Half of treatment with right administration , may not success )

 Take low dose, mis dose over dose , t
Developing public and patient
education strategies
 Investigation ( what need ?) 
 Plane communication activates 
Communication tools
Presentation
Media
Poster and other printing material
 Research methodology
cross-sectional studies form 1-sep-2019 to 25-sep-2019 in Kabul university it
apply on 22 faculties
Data collection method
We composed a proper close ended questionnaire by using those questions
which its validity was confirmed in previous research , and they can leave a
comment at the end .
This questionnaire contains 17 questions which arranged in three following
categories:
 Access of antibiotic.
 Attitude and knowledge about usage of antibiotic .
 Knowledge about bacteria resistance cause.
Research methodology

 Population and sampling size

Kabul university student during 1398 year. The overall population size was
expected as 25000 individuals which after excluding 3% social burdens in
sampling by using (P=0.03) formula we set our actual sampling size by 1073
Research methodology

 Data analysis method

We classify questionnaires into three categories:
•Individuals who with less knowledge .
•Individuals who with average knowledge .
•Individuals who with enough knowledge .

become between 1 and 5, it considers under first

between 6 and12, it goes under second category.
And if the total score of individuals exceed from 12 scores then it recognizes in 3rd category.
Better to mention we use last version of SPSS (V.25) with Chi-square software
to find out the relation between variables and conducting this research.
Result

 this study contain 22 faculties and 25000 student , we distributed 1073

questionnaire in Kabul university and categorize it to to section 1 social
science and 2 natural science .
 students age range divided in four category under 20 year, 20-25,25-30
and over 30 year. 57.5% students were male and 42.5% female.
 Result
Table 1
Demographic properties
Faculty no science Percentage Social science Percentage Gender
1 Pharmacy 48(4.4%) 9 Law and political 74(6.8%) Male618(57.6%)
science female 455(42.4%)
2 Veterinary 25(2.3%) 10 Economic 119(11.0%)
3 physic 27(2.3%) 11 Computer science 54(5%) Age
4 mathematic 25(2.3%) 12 information 16(1.5%) Under 20 571(53.2%)
technology 21-25 489(45.6%)
5 chemistry 27(2.5%) 13 Engineering 71(6.6%) 26-30 10 (0.9%)
6 biology 22(2%) 14 Journalism 48(4.4%) Over 30 3 (0.3%)

7 Agriculture 80 (7.4%) 15 Arts 59(5.5%) home town

8 Environment 27(2.5%) 16 Language and 64(5.9%) Kabul 935
science literature (in) (87.1%)
17 Language and 90(8.3%) Other province 138
literature (out) (12.9%)
18 Islamic studies 48(4.4%)
19 Social science 40(3.7%)
20 Psychology and 51(4.7%)
educational
science
21 Public policy 33 (3.0%)
22 Geology 34(3.1%)
Total 309(28.8%) Total 764(71.2%) Total = 1073(100%)
 ‫‪Home town‬‬

‫‪Result‬‬ ‫‪13%‬‬

‫‪87%‬‬
‫پوهنځی‬
‫‪12‬‬
‫کابل‬ ‫سایر والیات‬
‫‪10‬‬
‫‪Gender‬‬
‫‪8‬‬
‫‪Percent‬‬

‫‪famle‬‬
‫‪6‬‬
‫‪42%‬‬
‫‪male‬‬
‫‪4‬‬ ‫‪58%‬‬

‫‪2‬‬
‫ذکور‬ ‫اناث‬
‫‪0‬‬
‫زبان های‬ ‫زبان های‬ ‫هنرهای‬ ‫روان‬ ‫محیط‬ ‫زمین‬ ‫علوم‬ ‫کمپیوترسا‬ ‫تکنالوژی‬
‫زراعت‬ ‫حقوق‬ ‫اقتصاد‬ ‫شرعیات‬ ‫ژورنالیزیم‬ ‫پالیسی‬ ‫بیولوژی‬ ‫ریاضیات‬ ‫فزیک‬ ‫کیمیا‬ ‫وترنری‬ ‫فارمسی‬ ‫انجنیری‬
‫خارجی‬ ‫داخلی‬ ‫زیبا‬ ‫شناسی‬ ‫زیست‬ ‫شناسی‬ ‫اجتمتاعی‬ ‫ینس‬ ‫معلوماتی‬

‫‪Series1‬‬ ‫‪8.3179‬‬ ‫‪5.915‬‬ ‫‪5.4529‬‬ ‫‪7.3937‬‬ ‫‪6.8392‬‬ ‫‪4.7135‬‬ ‫‪10.998‬‬ ‫‪4.4362‬‬ ‫‪4.4362‬‬ ‫‪2.4954‬‬ ‫‪3.1423‬‬ ‫‪3.6969‬‬ ‫‪4.9908‬‬ ‫‪1.4787‬‬ ‫‪3.0499‬‬ ‫‪2.0333‬‬ ‫‪2.3105‬‬ ‫‪2.4954‬‬ ‫‪2.4954‬‬ ‫‪2.3105‬‬ ‫‪4.4362‬‬ ‫‪6.5619‬‬

‫پوهنځی‬ ‫‪29%‬‬

‫‪Faculty‬‬ ‫‪71%‬‬

‫علوم اجتماعی‬ ‫علوم طبیعی‬

 Result - Accessibility of antibiotics.
Table 2
Accessibility of antibiotics.
answers science social total p Value
Question
Do you KNOW Yes 253 (23.6%) 618 (57.6%) 871(81.2%) 0.293
antibiotic?
No 19 (1.8% ) 67 ) 6.2%( 86 (8.0%)
Unsure 37 (3.4% ) 79 (7.4% ) 116 (10.8%)
How do you get your Doctor’s prescription 137 (12.8%) 422 (39.3%) 559 (52.1%) 0.000
antibiotics? Pharmacist’s advice 143 (13.3%) 240 (22.4%) 383 (35.7%)
Non-medical person’s advice 9 (0.8%) 43 (4.0%) 52 (4.8% )
Personal choice 20 (1.9%) 59 (5.5%) 79 (7.4%)

Reason for not Use self-experience 148(13.8%) 354 (33.0%) 502(46.8%) 0.823
consulting a doctor Friend & family suggestion 22 (2.1%) 67 (6.2%) 89 (8.3%)’
Money 44(4.1%) 105 (9.8%) 149 (13.9%)
No time 8 (0.7%) 30(2.8%) 38 (3.5%)
No need for a doctor 38 (3.5%) 102(9.5%) 140 (13.0%)
Scared 3 (0.3%) 8 (0.7%) 11 (1.0%)
Other reason 46 (4.3%) 98 (9.1%) 144 (13.4%)
‫‪Result and discussion‬‬
‫آیا شما انتی بیوتیک ها را می شناسید ؟‬

‫‪11%‬‬ ‫‪8%‬‬

‫نخیر‬
‫بلی‬
‫مطمین نیستم‬

‫‪81%‬‬
 ‫‪Result and discussion‬‬

‫به انتخاب خودم‬

‫‪%7‬‬ ‫چگونه انتی بیوتیک ها را می گیرید ؟‬
‫به توصیه‬
‫دوستان‬
‫‪%5‬‬

‫به توصیه داکتر‬

‫‪Lebanon 39%‬‬ ‫به توصیه فارمسست‬
‫به توصیه داکتر‬
‫‪Arabia 45%‬‬ ‫‪%52‬‬ ‫به توصیه دوستان‬
‫به انتخاب خودم‬

‫به توصیه‬
‫فارمسست‬
‫‪%36‬‬ ‫‪77.8% at same research in in‬‬
‫‪Riyadh university of Saudi Arabia‬‬
 ‫‪Result and discussion‬‬
‫‪46.8% of self-‬‬ ‫به کدام دلیل انتی بیوتیک ها را بدون نسخه خریداری میکنید؟‬
‫‪experience more‬‬
‫‪than half of‬‬
‫از تجربه قبلی خود در این مریضی‬
‫‪respondents do self-‬‬ ‫استفاده میکنم‬
‫‪medication so it’s‬‬ ‫به توصیه دوستان وفامیل خود استفاده‬
‫‪need to take‬‬ ‫‪13%‬‬ ‫میکنم‬
‫‪1%‬‬
‫‪awareness‬‬ ‫مشکالت مالی وهزینه بلند فیس داکتر‬

‫‪13%‬‬
‫‪47%‬‬ ‫وقت کافی برای مراجعه به داکتر ندارم‬

‫‪4%‬‬
‫مریضی ام به اندازه نیست که به داکتر‬
‫مراجعه کنم‬
‫‪14%‬‬
‫ترس از داکتر‬
‫‪8%‬‬
‫سایر موارد‬

‫‪Other research lack of time‬‬

Result- Attitude toward antibiotics use
Table 3
Attitude toward antibiotics use
Question Answers Science Social Total P value
I normally stop taking antibiotics when Yes 230 (21.4%) 598(55.7%) 828 (77.2%) 0.219
I start feeling well No 66 (6.2%) 129 (12.0%) 195 (18.2%)
Unsure 13 (1.2%) 37 (3.4%) 50 (4.7%)

Do you share antibiotic each other Yes 126 (11.7%) 349 (32.5%) 475 (44.3%) 0.034
No 161 (15.0%) 336 (31.3%) 497 (46.3%)
Unsure 22 (2.1% ) 79 (7.4%) 101 (9.4%)
I usually read the instructions label of Yes 226 (21.1%) 514 (47.9%) 740 (69.0%) 0.081
the No 69 (6.4%) 191(17.8%) 260 (24.2%)
antibiotics Unsure 14 (1.3%) 59 (5.5%) 73 (6.8%)

Injection is better than tablet and other Yes 127 (11.8%) 250 (23.3%) 377 (35.1%) 0.027
oral rout No 158 (14.7%) 435(40.5%) 593 (55.3%)
Unsure 24 (2.2%) 79 (7.4%) 103(9.6% )
Strong antibiotic is better than wake Yes 106 (9.9%) 246 (22.9%) 352(32.8%) 0.405
one No 138 (12.9%) 328 (30.6%) 466 (43.4%)
Unsure 65 (6.1%) 190 (17.7%) 255 (23.8%)
If the doctor prescribes antibiotic, I Yes 117 (10.9%) 310 (28.9%) 427 (39.8%) 0.429
will try to guide him to the antibiotic I No 160 (14.9%) 363 (33.8%) 523 (48.7%)
prefer Unsure 32 (3.0%) 91(8.5%) 123(11.5%)
The precious antibiotic better than Yes 162 (15.1%) 373 (34.8%) 535(49.9%) 0.065
cheap No 100 (9.3%) 227(21.2%) 327(30.5%)
Unsure 47 (4.4%) 164(15.3%) 211(19.7%)

If your antibiotic not effective Use new 40 (3.7%) 92 (8.6%)] 132) 12.3%( 0.169
antibiotic
Stop use of
antibiotic 127 (11.8%) 360(33.6%) 487 (45.4%)
Reject to your
doctor
142(13.2%) 312(29.1%) 454 (42.3%)
 Result and discussion

‫معمو ًلا زمان که فکر میکنید که خوب شده اید آیا استفاده‬
bad attitude increases the risk of ‫انتی بیوتیک ها را متوقف میکنید ؟‬
resistant bacterial strains and,
unfortunately, only 18.2% of our
respondents knew that.
5%
Accordingly, the shortage of 18%
knowledge was behind this bad ‫بلی‬
attitude ‫نخیر‬
77% ‫مطمین نیستم‬
 ‫‪Result and discussion‬‬

‫‪• Sultan Alghadeer et al 26.2%‬‬

‫آیا انتی بیوتیک ها که برای شما تجویز شده را به‬
‫‪• show that rate of self-medication is so‬‬ ‫دوستان تان پیشنهاد میکنید ؟‬
‫‪high‬‬

‫‪10%‬‬

‫بلی‬
‫‪44%‬‬
‫نخیر‬
‫مطمین نیستم‬
‫‪46%‬‬
 ‫‪Result and discussion‬‬

‫آیا معلومات وهدایت که در بروشور و پشت ‪.‬‬

‫‪it’s positive point for us than 57% student‬‬
‫بسته بندی دوا است را میخوانید؟‬
‫‪Own language‬‬
‫نخیر‬ ‫بلی‬ ‫مطمین نیستم‬

‫‪0%‬‬
‫‪7%‬‬
‫‪24%‬‬

‫‪69%‬‬
 Result and discussion

‫انتی بیوتیک ها را )پیچکاری ( آیا شکل زرقی‬

a bad attitude injectable, ‫ کپسول( نسبت به شکل فمی‬، ‫را ترجیح ) تابلیت‬
vice versa oral form or more ‫میدهید ؟‬
safe then injectable form ‫بلی‬ ‫نخیر‬ ‫مطمین نیستم‬
that can make the field
conducive of infection and 10%0%
other diseases that carried
35%
by syringe and also adverse
effect of this form is
irreversible.
55%
 Result and discussion

49% of the respondents ‫آیا کوشش میکنید به داکتر توصیه کنید انتی بیوتیک‬
never try to guide the doctor ‫که شما میخواهید را برای تان تجویز کند ؟‬
to the antibiotic they prefer,
‫بلی‬ ‫نخیر‬ ‫مطمین نیستم‬
so they follow the doctor’s
selection of an appropriate 11%
antibiotic. And same
statistics (37.4%) in studies in
Riyadh Neda et al[7]. 40%

49%
Result and discussion

It’s wrong idea that is ‫انتی بیوتیک که قیمت است نسبت به انتی‬
expensive , is better ‫بیوتیک که ارزان است بهتر است ؟‬
and effective
Namei et l 22 brand
Price not belong to
efficacy , 20%
‫بلی‬
50% ‫نخیر‬
‫مطمین نیستم‬
30%
Result and discussion
Table 4
Antibiotics efficacy and resistance
P value
Question ANSWERS Sciences Social Total
Antibiotics is Kill bacteria 94(8.8%) 166(15.5%) 260(24.2%) 0.002

Kill viruses 95 (8.9%) 299(27.9%) 394 (36.7%)

Reduce pain 67 (6.2%) 198 (18.5%) 265(24.7%)

Cure all disease 53 (4.9%) 101 (9.4%) 154(14.4%)

Amoxicillin 150(14.0%) 307(28.6%)

Which of them is 457(42.6%) 0.012
Aspirin 58(5.4%) 184(17.1%)
antibiotic? 242(22.6%)
Paracetamol 71(6.6%) 219(20.4%) 290(27.0%)
Ibuprofen
30(2.8%) 54(5.0%) 84(7.8%)

Humans can become Yes 184(17.1%) 397(37.0%) 581(54.1%) 0.056

169(15.8%)
resistant to antibiotics No 63 (5.9%) 232(21.6%)
198 (18.5%)
Unsure 62 (5.8%) 260(24.2%)

Bacteria can become Yes 131(12.2%) 252(23.5%) 383(35.7%) 0.01

342(31.9%)
resistant to No 138(12.9%) 480(44.7%)
170(15.8%)
antibiotics Unsure 40(3.7%) 210(19.6%)

Antibiotic overuse Yes 175(16.3%) 337(31.4%) 512(47.7%) 0,000

217(20.2%)
leads to antibiotic No 87(8.1%) 304(28.3%)
210(19.6%)
resistance Unsure 47(4.4%) 257(24.0%)

Not completing the full Yes 197(18.4%) 483(45.0%) 680(63.4%) 0.457

131(12.2%)
course of antibiotic may No 60(5.6%) 191(17.8%)
150(14.0%)
cause resistance Unsure 52(4.8%) 202(18.8%)
 ‫انتی بیوتیک ها دوا های هستند که‬
‫؟‬
Result and discussion
‫باکتری را از بین‬
14% ‫میبرد‬
Lack of knowledge 24%
‫ویروس ها را از بین‬
Wrong believe ‫میبرد‬
25%
This confusion about pain killer ‫برای کاهش درد‬
‫است‬
versus antibiotic can explain
37% ‫برای تمام امراض‬
the incorrect selection of ‫است‬
medications when a patient
has pain or infection
43% amoxicillin
all of these response show may ‫دوای ذیل انتی بیوتیک است ؟‬
be they know the name of
antibiotic but they have
misconceptions and bad 0%
8%
‫آموکسی سیلین‬
attitudes
27% 43% ‫آسپرین‬
‫پرستامول‬
‫ایبوبروفین‬
22%
 Result and discussion
We found 54% of respondents believe that human become
resistance to antibiotic and 35% response that bacteria become
resistance . so more than half of them have wrong attitudes .

‫در مقابل (میکروب ها)باکتری ها‬ . ‫انسان در مقابل انتی بیوتیک ها‬
‫انتی بیوتیک ها مقاوم میشود ؟‬ ‫مقاوم میشود ؟‬

19% 24%
‫نخیر‬ ‫بلی‬
45% ‫نخیر‬
‫بلی‬ 54%
‫مطمین نیستم‬ ‫مطمین نیستم‬
22%
36%
 ‫استتفاده بیش از حد انتی بیوتیک ها می تواند سبب‬
‫مقاومت میکروبی شود ؟‬
Result and discussion ‫نخیر‬ ‫بلی‬ ‫مطمین نیستم‬

24%
48% agreed that Antibiotic overuse 28%

leads to antibiotic resistance it’s

higher percentage then 35% 0f
Riyadh
‫تداوی )پروسه (تکمیل نه نمودن کورس‬
63% of respondents know
that Not completing the ‫سبب مقاومت میکروب ها می شود ؟‬
48%
full course of antibiotic
may cause resistance it
may be a positive point
19% 18%
and also same to 64% 0f
Riyadh ‫نخیر‬
‫بلی‬
‫مطمین نیستم‬

63%
Knowledge score
 Conclusion

 This survey noticed a bad attitude related to antibiotics use associated with many
misconceptions and poor knowledge So it’s necessary to take awareness related antibiotic
rational use
 We recommend support performing a similar study involving other universities or other
educational center like school etc .. to achieve a comprehensive understanding of the
knowledge's of university students or other student regarding to the use of antibiotics.
 The next step should be initiating community campaigns during every university semester
to educate this sector of the population about the indications, efficacy, resistance of
antibiotics. pharmacists, and other health professionals should participate in the education
of patients. Understanding the complications of antibiotics use, or about antibiotic
resistance, may convince individuals to change their bad behaviors
Acknowledgements

 We would like to express our high appreciation and deep gratitude to the
ass professor Ahmad Farid Habibyar, professor Qand Aqa Nzari, ass
professor Shafiq Mashal,ass professor Raihan, ass professor Sadiah, professor
Bbak and all directors and supervisors of pharmacy of K.U, and data
collectors and respondents from all the ten health regions of K.U, for their
cooperation and contribution towards the success of this work.
Team member

Zaman nowruzi
Zohra majidi
M.Nasir movahedi
Parwana nazir formuli
Ateka bashary
Mortaza abullahi
Bahara sadat
Moqadesah Mohseni
Guide teacher A.farid habibyar
Zolf Ali Dawlatpor
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