Self-medication with antibiotics is common among students of medical and non-medical disciplines.
In Sudan, the prevalence of self-medication with antibiotics among undergraduate students in Khartoum State is high.(2)
Results of another Sudanese study showed that
the prevalence of self-medication with antibiotics during the 6 month prior to the study was 41%, so this is confirming that self-medication with antibiotics is a frequent problem in Sudan and thus interventions are urgently required to reduce the frequency of antibiotics misuse.(5)
Worldwide, misuse of antibiotic is one of the most important challenges to health care system, because reduction of antibiotic resistance is achieved by controlled use of antibiotics.(1) This is a major health problem that emphasize the urgent need of adding some courses on rational antibiotic use in University curricula.(7)
In this online cross-sectional study,725 students from all over Sudan were included, three quarters of our study participants were studying medicine-related fields. Up to 35% of participants’ parents have medical background and this may contribute to antibiotics misuse in a way of skipping doctor visit and go directly to direct antibiotics consumption. In contrast, in a Chinese study most of students’ parents had limited or no college education and with no medical background.(8)
Assessment of antibiotics misuse revealed that many participants didn’t have adequate behavior toward antibiotics use may be due to decreased awareness about the adverse effects of unnecessary antibiotic use. Similar to Chinese study that showed medical students have high rates of antibiotic self-medication for self-limiting illnesses, symptom relief and prophylaxis; and this might be higher than the reported number since they may not report these behaviors because they were medical students and know this is inappropriate .
In our study eastern and middle states have comparably high level of antibiotic misuse unlike the Chinese study which showed that the less developed region(Guizhou Province) was significantly associated with higher antibiotic misuse behaviors.(9)
In Nigeria, there was good theoretical knowledge of antibiotic use and resistance, however, practice levels were poor since only 8.2% of respondents always consulted a doctor before starting an antibiotic.(4)
Similarly, in a study conducted in Sudan during 2019, participants had shown 44.44%, 34.3%, 20.3% and 1% good, poor, very good and excellent knowledge on resistance, respectively. About 34.3% of respondents have poor knowledge which was a huge number. However, only 24.8% of them had a good attitude; thus the attitude was average, which is not enough in a population of students who are studying health related fields and having good knowledge.(3)
In another Sudanese study, surprisingly despite respondents higher level of education, the majority of those who practiced self medication with antibiotics were university graduates and university students.(5)
In United Arab Emirates , medical students scored remarkably better than non-medical students on KAP of antibiotic use.(7)
In Saudi study, 67% of the respondents were unaware of the meaning of ABs resistance. 24% believed that ABs worked on viruses, 31% on cold and 21% can cure cough. Only 33% of them understand the meaning of ABs resistance, 45.8% agreed that ABs resistance is caused by using unwarranted ABs, and 55.4% agreed that it caused by incomplete course of Abs. (6)
Only 48% of our participants stated that they will visit a doctor when feel diseased. In a study done in Jordan, 61.4% of the medical students reported that they had seen physicians at least 1 time in the past 6 months from the time of the study, which was comparable to that of the nonmedical students (68.6%) and cold was one of the major reasons for visiting physicians among Jordan participants (26.4%). Both groups of students reported that they highly adhered to doctor instruction.(1)
In Chinese study.. 29% medical students reported at least one self-limiting illness in the prior month of the study time. Of those,21% went to see a doctor, of which 58% were prescribed antibiotics . Of the students reporting illness of cold, 16.8% only went to see a doctor.(8)
37% of our participants stop taking medication when they feel better. When comparing antibiotic misuse between types of our study groups.. those who study a non medical field stop their antibiotic course when feel better more than those who study a medical field (P value <.001). While the majority of Jordan participants (65.3%) reported that they stopped using the medicine and saw physicians whenever the drug had no effect. Another study done in south Jordan revealed that half the participants used the antibiotic for three days or less depending mainly on the symptoms. In study done in Nigeria, 41% of their respondents never stopped taking their antibiotics when they felt better, 36.6% sometimes and 13.1% usually stopped taking their antibiotics when they felt better . .(4)
In Sudanese study during 2006, when a noticeable improvement in the illness occurred during self-treatment, respondents reported continuing treatment until the medication was gone is 71.8% which is a good percentage. Those who stopping treatment immediately after experiencing noticeable improvement were 28.2%.(2)
Another Sudanese study showed that the majority of those who self-medicated used antibiotics for a short duration of less than 5 days. (5)
In Saudi study, 58% respondents discontinued using ABs after completing the course while 42% discontinue ABs on alleviation of symptoms. (6)
In our study, 79% use antibiotics as prophylaxis and this is common among non medical ( p value < 0.001) and 21% take antibiotics when they feel common cold symptoms. In study done in Sudan, 41% of those who self-medicated used antibiotics to treat cough and common colds.(5)
In china, of the students reporting illness of cold, 59.2% of them were self-medicated and one in seven participants used antibiotics for preventing a cold.(8)
In Saudi, almost 51% used ABs without physician prescription.(6)
In Jordan, the most predominant medicine classes that were self-used by all students in the past 6 months were variable and the antibiotics used by
21% of the participants.(1)
Moreover, taking antibiotics for the common cold was more common in our students outside medical fields similar to Jordan study where cold was an indication for which students take medications on their own with percent of 58.3%.(1)
In our study, taking antibiotics for common cold common among those whose parents work in the medical fields. This is inappropriate but may be that working in medical fields not nessecitae good knowledge and good delivery of right information to the families. In china, Logistical regression showed that students whose fathers had a higher education level, whose mothers had medical background, were more likely to stock antibiotics and self-medicate with antibiotics.(8)
Adjusted regression models in our study showed significant association between using antibiotics without prescription and gender as females use more antibiotics than males 1.6 times. In Chinese study, female students had significantly higher rates of stocking antibiotics.(8)
In Nigeria, more male respondents had a better knowledge of antimicrobial use and resistance than their female counterparts (70.4% vs. 55.1%; P=0.035) and this is statistically significant.(4) In Sudanese study, self-medication was slightly higher among females.(5) This is related to our finding that getting medication from the pharmacy was associated with gender as female use new pharmacy medications more than males.
In our study, completing antibiotics course was significantly associated with both type of study and age. So medical students do the right practice of completing the antibiotic course more than the non medicals, also higher age group practice better. In contrast, older age students in Chinese study had significantly higher rates of stocking antibiotics.(8)
In study done in Sudan 2006 , self medication with any of the antibiotics and/or antimalarials was shown to be significantly associated with age group (p = 0.008).(2) Another Sudanese study showed that the prevalence of self-medication was found to be inversely proportional to age. It was highest among those aged between 18 to 24 years.(5)
None of the variables such as gender, age, and education level showed statistical significance when compared with knowledge response regarding AB resistance in Saudi study. (6)
similarly, In study done in Sudan2019, students characteristics like age, gender have negligible impact on the students knowledge and attitude.(3)
limitations :
1/ physical distribution of questionnaire wasn’t achievable due to Covid-19 lockdown. 2/ distribution of questionnaire in western and northern states was suboptimal, we think in addition to the lack of physical distribution , the number of universities is less compared to eastern and middle states .