Hindawi

Advances in Pharmacological and Pharmaceutical Sciences

Volume 2022, Article ID 2306637, 10 pages
https://doi.org/10.1155/2022/2306637

Research Article
Antibiotic Use among Patients Visiting Primary Hospitals in
Northwest Ethiopia: A Multicenter Cross-Sectional Survey

Adeladlew Kassie Netere and Ashenafi Kibret Sendekie

Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar,
Gondar, Ethiopia

Correspondence should be addressed to Adeladlew Kassie Netere; [email protected]

Received 6 May 2022; Accepted 24 August 2022; Published 10 September 2022

Academic Editor: Benedetto Natalini

Copyright © 2022 Adeladlew Kassie Netere and Ashenafi Kibret Sendekie. This is an open access article distributed under the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.

Background. Antimicrobial medications are becoming ineffective because of the surge in antimicrobial resistance. Poor knowledge
and inappropriate beliefs combined with the misuse of antibiotics may be common in the community and public health in-
stitutions. This study assessed the knowledge, belief, and antibiotic use practice among patients visiting rural hospitals in
Northwest Ethiopia. Methods. A facility-based multicenter cross-sectional survey was conducted in Northwest Ethiopian primary
hospitals from August to September 2020. The data are presented as frequencies and means (±SD) of our findings. The in-
dependent samples T test and One-Way Analysis of Variance (ANOVA) were used to explore the mean knowledge differences of
antibiotic use among respondents. A pvalue of <0.05 with 95% CI was considered significant. Results. More than half of the
participants (57.2%) were males, and the mean age was 34.8 ± 13.4 years. The mean (±SD) knowledge score of the respondents was
3.69 (±1.7) (range: 0 to 10), and the majority (69.7%) had poor knowledge. The mean (±SD) belief score (acceptance towards
antibiotic use) of the respondents was 20.08 ± 4 (range: 7 to 35) and most (70.1%) of the respondents had moderate levels of
perception regarding antibiotic use. The majority (69.5%) of respondents took antibiotics over the past year. Participants practiced
inappropriate uses of antibiotics such as medication discontinuation (49.5%), keeping unused antibiotics for future use (35.5%),
and sharing medications with/from others (30.1%). Diploma holder participants had significantly higher mean knowledge scores
on antibiotic use than those who were unable to read and write (p  0.047). Similarly, students had higher mean knowledge scores
compared with farmers (p  0.024), merchants (p  0.031), and housewives (p  0.047). Conclusion. Our study showed a
widespread misuse of antibiotics in Northwest Ethiopia. Malpractice such as dose interrupting, sharing of antibiotics for/from the
others, and keeping leftover drugs for future use were common among the respondents. These findings suggest that a greater effort
is required in public education related to proper and safe uses of antibiotics and that greater efforts are needed to enforce the
control of antibiotic use to overcome the emergence of antibiotic resistance.

1. Introduction Studies in both industrialized and nonindustrialized

countries reported lack of basic knowledge on appropriate
The global increase in antimicrobial resistance (AMR), antibiotics use[8–10]. A study from Ethiopia revealed that
which frequently leads to unforeseen life-threatening the community knowledge and attitude towards antibiotic
complications [1, 2], is associated with the misunderstanding use were poor, and the nonprescription use of antibiotics
and malpractice of antibiotic use [3, 4]. Various reasons, was also common [11]. The existing misconceptions on the
including inadequate knowledge and misuse of antibiotics, effectiveness and indications of antibiotic use suggested that
contribute to increases in AMR [5, 6]. The global AMR public perceptions should be considered when efforts are
“superbug crisis” requires a multidimensional worldwide made to better inform the public and prescribers on the safe
approach [1, 7], with improved public knowledge and be- and effective use of antibiotics [12]. An important consid-
haviors [2]. eration is the patients’ expectation of prescriptions when
2 Advances in Pharmacological and Pharmaceutical Sciences

visiting physicians or medical clinics [13]. The previous subjects were nominated through a systematic random
study disclosed that the patients who used antibiotics sampling method, where 102, 86, 101, 65, and 68 respon-
without guidance made inappropriate choices about the dents were involved in Addis Zemen, Chilga, Debark,
antibiotics due to insufficient knowledge [7]. Besides, many Kolladiba, and Wogera, respectively (Figure 1). Respondents
patients believe that antibiotics can improve outcomes from were allocated proportionally as per the number of patients
both bacterial and viral infections [14, 15]. served in the outpatient departments in all hospitals, which
Several studies on antibiotic misuse recommended issues were initially selected by a simple random sampling method.
related to poor patient knowledge, attitudes and practices on
the appropriate use of antibiotics [16, 17], with suggestions
towards adhering improved guidelines on rational antibiotic 2.3. Data Collection Instruments and Procedures. The English
use practices [18, 19]. This tradition may assist both patients version of the questionnaire was translated in to Amharic,
and prescribers with customized innovations given that safe which is the official local language, and which was then
and effective use of antibiotics has improved [20]. The irra- translated back to English again to maintain consistency. A
tional use of antibiotics by both patients and healthcare pretest was done on 5% of clients having similar character-
providers is common in developing nations such as Ethiopia, istics in one of the selected hospitals and excluded from the
where medication sharing and nonadherence are collective final analysis. Further, local specialists were involved in the
challenges. According to the Food, Medicine, and Healthcare evaluation of item validity. The questionnaire contains items
Administration and Control Authority of Ethiopia measuring the clients’ knowledge, beliefs, and practices re-
(FMHCA), 70% of patients who visited outpatient clinics lated to antibiotic use and were structured based on published
had ∼ 40% of irrational prescriptions for antibiotics [21]. Data articles with some modifications [22–25]. The questionnaire
on the rational uses of antibiotics and common practices are then underwent minor adjustments based on the pretest
more accessible [9, 10]. However, such information is scarce results prior to actual data collection. Two data collectors were
for developing nations like Ethiopia. This study assessed the trained for the objectives of the study and familiarized with
knowledge and use of antibiotics by patients visiting primary the data collection tool and approaches. Sequential steps of
hospitals in rural districts of Northwest Ethiopia. participant enrollment and consent procedures were provided
to the data collectors and used during the data collection
procedures. The interview was conducted in the respondents’
2. Methods
official language and lasted an average of 20 to 25 minutes.
2.1. Study Design and Setting. A facility-based multicenter The interview-based questionnaires included sociodemo-
cross-sectional survey was conducted from August to Sep- graphic characteristics, knowledge of antibiotic uses, allergies
tember 2020 in primary hospitals in Northwest Ethiopia. The and resistance, self-reported practices of antibiotics use, levels
study area included five randomly selected public primary of satisfaction with the medical services provided by health
hospitals called Addis Zemen, Chilga, Debark, Kolladiba, professionals, ability to differentiate different antibiotic and
and Wogera in the three Gondar zones, where there were ten the sources of information regarding antibiotic use.
primary hospitals. Based on the hospital’s annual records, Ten items assessed the knowledge of participants on
there were about 163,234 patients served by the year 2020 in antibiotics using “Yes”, “No”, and “Don’t know” responses.
their outpatient departments, given that Addis Zemen, Seven questions addressed the beliefs of the respondents. A
Chilga, Debark, Kolladiba, and Wogera were delivering five-point Likert scale was used (where 1, 2, 3, 4, and 5
services to 41,208, 27,472, 40,804, 26,260, and 27,472 clients, represented strongly disagree, disagree, uncertain, agree, and
respectively [22]. This institutional-based study involved strongly agree, respectively) to measure responses to belief
outpatients who were able to be interviewed. All volunteer questions. Items regarding practices of antibiotics use were
clients aged 18 and above and patients served in the out- started by dichotomized questions to assess experiences with
patient department were included in the study, whilst those antibiotic use, i.e., “Have you taken any antibiotics in the last
experiencing difficulties being interviewed with the ques- one year? (Yes/No)”. The “Yes” response was then verified by
tionnaire-based approaches or who were unable to provide asking open- and closed-ended questions. The questions
consent because of serious illness, cognitive impairments, used in the study are summarized in Table 1.
and communication problems were excluded. We assigned “No” as the correct response for Q1-7 and
“Yes” as right response for Q8-10. Those who scored below
50% in responses to these ten questions had poor knowledge,
2.2. Sample Size Determination. A sample size of 422 in- and those scored 50%–75% had moderate knowledge and
dividuals from the outpatient department (OPD) service those who scored more than 75% had adequate knowledge
users was included by assuming 50% of the maximum [26]. For “Belief” items, we considered “disagree” as the
correct responses to questions on knowledge, belief, and correct response. Scores of 1, 2, 3, 4, and 5 were assigned for
practices of antibiotic use. A 5% absolute precision or strongly disagree, disagree, uncertain, agree, and strongly
margin of error, 5% significance, and 95% confidence level agree, respectively. A total score ranged from 7 to 35 for the
were used; and 10% of contingency for the nonresponses was seven “Belief” questions. Unlike knowledge scores, re-
applied. A multi-stage sampling strategy was employed in spondents scoring below 50% were designated as appro-
which the study participants were allocated proportionally priately believed, 50–75% as moderately believed, and those
from each randomly selected hospital. Finally, the study scoring above 75% as inappropriately believed [26].
Advances in Pharmacological and Pharmaceutical Sciences 3

Samples were Addis-Zemen: P=41,208; n1=102

proportionally
Debark: P=40,804;n2=101
allocated to all
Hospitals primary Chilga:P=34,744; n3=86 422
hospital OPDs
(total
Wogera: P=27,472; n4=68
clients=163,
234)
Kolladiba: P=26,260; n5=65

Figure 1: Schematic representation diagrams of the allocation of respondents per institution (P � number of patients visiting hospital site;
n � patients enrolled in the study).

Table 1: Knowledge and belief items on antibiotic use in interview-based questions to respondents in Northwest Ethiopia primary hospitals.
Items of knowledge questions
Q1. Antibiotics must be taken as soon as we have fever.
Q2. Antibiotics are indicated for treating sore throat.
Q3. Antibiotics are indicated for treating flu.
Q4. Antibiotics are indicated for treating cold.
Q5. Antibiotics can treat viral infections.
Q6. Antibiotics prepared for human could be used for animals.
Q7. Antibiotics can treat parasitic infections.
Q8. Antibiotics can treat bacterial infections.
Q9. People can be allergic to antibiotics.
Q10. Wrong indications of antibiotics could lead to antibiotic resistance.
Items of belief questions
Q1. I believe that antibiotics can cure any diseases.
Q2. I believe that antibiotics can prevent any illnesses from becoming worse.
Q3. I believe an injury to the skin can be cured quickly by pouring antibiotic powders onto the injury.
Q4. I believe that interrupting the course of antibiotic use will not affect the outcomes of treatment regimen
Q5. I believe that antibiotics are generally safe (do not have any side effects or ADRs).
Q6. I believe that antibiotics will cure me again for similar symptoms in the future
Q7. I believe that decisions regarding prescription of antibiotics should not be taken by physicians

2.4. Statistical Analysis. The data were entered and analyzed percent of those surveyed rated the healthcare services
using IBM SPSS Statistics for Windows, version 22.0. provided by health professionals as satisfactory. The largest
Sociodemographic characteristics with categorical variables (24.2%) and smallest (15.4%) groups of participants were
were described by frequency and percentage. The mean and recruited from Addis-Zemen and Kolladiba primary hos-
standard deviation (SD) were used for continuous variables. pitals, respectively (Table 2).
Independent-samples T-test and one-way ANOVA were
employed to explore mean knowledge differences in anti-
biotic use among respondents. A p-value of <0.05 with a 3.2. Knowledge of Antibiotic Use. More than half (57.1%) of
95% CI was considered significant. the respondents reported that they might be allergic to
antibiotics (Figure 2). Moreover, most study participants
indicated bacterial infections could be treated by antibiotics
2.5. Ethical Approval and Consent to Participate. This study (54.7%), while more than half (55.7%) responded incorrectly
was approved by the School of Pharmacy Research Ethics that antibiotics must be taken as soon as a fever develops.
Review Committee, University of Gondar (Approval Further, nearly half (46.7%) of the respondents wrongly
Number: UoG-SOP157/2018). We also obtained both verbal reported that antibiotics for the treatment of humans could
and written informed consent from all the respondents also be used in animals. The mean (±SD) knowledge score
before the start of each interview after explaining the pur- was 3.69 (±1.7) (range: 0 to 10). The question items related to
pose of the study. The information obtained from the study knowledge of antibiotic use indicated that 69.7% of study
was not disclosed to any third party, and code numbers were participants had poor levels of knowledge, 28.7% had
used to identify study participants. moderate levels of knowledge, and only 1.7% had adequate
levels of knowledge.
3. Results
3.1. Socio-demographic Characteristics of the Participants. 3.3. Beliefs of Antibiotic Use. The overall mean (±SD) belief
A total of 422 subjects completed and returned the survey score of the respondents was 20.08 (±4), with a range of 7 to
questionnaire; with the majority (57.2%) being males aged 35 (potential ranges from 7 to 30), of which 23.9% held
34.8 ± 13.4 years. Farmers represented about 33% of the appropriate beliefs. The majority of the study group (70.1%)
study participants. More than half visited the health facilities held moderate beliefs, while 5.9% held inappropriate beliefs
either once (25.4%) or twice (26.5%) within a year. Sixty about the use of antibiotics. Slightly more than half (51.4%)
4 Advances in Pharmacological and Pharmaceutical Sciences

Table 2: Sociodemographic characteristics of participants at the primary hospitals of Northwest Ethiopia (N � 422).
Variables Frequency (%)
Male 244 (57.2)
Sex
Female 178 (42.8)
Age in years Mean (±SD) 34.79 ± 13.41
Urban 211 (50)
Location
Rural 211 (50)
Single 134 (31.8)
Marital status Married 248 (58.8)
Ever married 40 (9.5)
Unable to read and write 138 (32.7)
Read and write only 55 (13)
Primary education (1–8 grades) 56 (13.3)
Educational status
Secondary education (9–12 grades) 57 (13.5)
Diploma and vocational training 75 (17.8)
Degree and above/University 41 (9.7)
Farmer 136 (32.2)
Merchant 38 (9)
Occupational status Employee 99 (23.5)
Student 75 (17.8)
Housewife 774 (17.5)
Not at all 28 (6.6)
Once 107 (25.4)
Twice 112 (26.5)
Healthcare visits/year
Three time 59 (14)
Four times 41 (10.7)
Five or more times 71 (16.8)
Unsatisfied 93 (22)
Satisfaction levels with health professionals Indifferent 76 (18)
Satisfied 253 (60)
Addis zemen 102 (24.2)
Debark 101 (23.9)
Hospital location Chilga 86 (20.4)
Wogera 68 (16.1)
Kolladiba 65 (15.4)

Participants response to knowledge questions of antibiotics use

Wrong indications of antibiotics could lead to antibiotic resistance. 33.2 36 30.8
People can be allergic to antibiotics. 19.9 57.1 23
Knowledge question items

Antibiotics can treat bacterial infections. 14.2 54.7 31

Antibiotics can treat parasitic infections. 30.8 40.5 28.7
Antibiotics prepared for human could be used for animals. 46.7 22.7 30.6
Antibiotics can treat viral infections. 41.2 23.7 35.1
Antibiotics are indicated for treating cold. 14.7 46.4 38.9
Antibiotics are indicated for treating flu. 10.4 53.6 36
Antibiotics are indicated for treating sore throat. 16.1 43.1 40.8
Antibiotics must be taken as soon as we have fever. 55.7 32.2 12.1
0 10 20 30 40 50 60 70 80 90 100
(%)

No
Yes
I don’t know
Figure 2: Study participants’ antibiotic use knowledge levels for each question item.
Advances in Pharmacological and Pharmaceutical Sciences 5

of the study subjects held appropriate beliefs that the pre- use of antibiotics in low- and middle-income countries such
scription of antibiotics must be provided by physicians, as Ethiopia has increased during the last twenty years
whereas more than one-third (35.1%) held inappropriate [28, 29]. We investigated the knowledge, beliefs, and
beliefs given that antibiotics will prevent similar symptoms practices regarding the antibiotic use of patients in resource-
in the future. On the other hand, more than one-third limited settings. Our findings suggest that most study
(34.8%) of the surveyed subjects were uncertain about participants had poor levels of knowledge and moderate
whether antibiotics could prevent any illnesses from be- levels of belief, combined with widespread misuse of
coming worse or if an injury could be cured more quickly by antibiotics.
pouring antibiotic powder onto the injury site (Figure 3). The findings of this study demonstrated that just fewer
than three-quarters of study participants had poor levels of
knowledge of antibiotic use, with an overall mean score of
3.4. Antibiotic Use Practices. More than two-thirds (64.7%) 3.7 out of 10 points. The knowledge levels in this study are
of those interviewed commented that they had taken anti- similar to previous findings [11, 30–32]. This insufficient
biotics in the past year. Among these, amoxicillin (36.3%) knowledge of antibiotic uses in the low- and middle-income
was the single most used medication, followed by ampicillin countries (LMICs) might be related to limited resources on
and metronidazole (8.8% for each medication). Cough antibiotic prescriptions and lower levels of professional and
(19.4%), wounds (10.7%), and diarrhea diseases (10.2%) were authority monitoring. Moreover, in relation to antibiotic
the primary reasons for using antibiotics. Nearly, a third resistance, just under two-thirds of the study participants
(30.1%) of respondents shared medications for/from were unaware of antibiotic resistance, as also reported by
somebody else. Almost half (49.5%) of the study participants others [33, 34]. This poor awareness of the appropriate use of
discontinued antibiotic medications once their symptoms antibiotics has been identified as a major cause of antibiotic
subsided, while more than a third (35.5%) of participants resistance [35–37]. This finding is in contrast to an earlier
kept unused antibiotics for future use. Moreover, about study conducted in Hara city, in the eastern part of Ethiopia,
eleven percent of the participants replied that they took where the participants had better information on antibiotics
antibiotics without a prescription (Table 3). resistance [11]. This inconsistency might be related to dif-
ferences in study settings and is likely because the residents
3.5. Antibiotics Awareness. Amoxicillin and ampicillin were of Harar city were better informed about the consequences
the most known antibiotics to 36.7% and 14% of partici- of antibiotic misuse. Significant numbers of the study
pants, respectively. Despite almost one-fourth (24.9%) of the participants (40–56%) believed that antibiotics could be
surveyed being capable enough to differentiate between four taken regardless of fever type and could be used to treat flu,
and above antibiotics displayed, a significant number sore throats, and parasitic infections. This is in good
(59.5%) were unaware of their importance. Most (83.6%) of agreement with the previous studies [11, 33, 38]. The results
the participants responded that appropriate antibiotic use of this study suggest that patients dwelling in rural districts
should be determined by physicians (Table 4). could be with insufficient knowledge regarding the appro-
priate use of antibiotics. The likelihood reason might be the
patients do lack resources and have limited public awareness
3.6. Knowledge Difference among Participants on Antibiotic of the appropriate use of antibiotics. Our study also suggests
Uses. A one-way ANOVA test indicated that there were that hospital healthcare providers, the supporting zonal
significant differences in the mean knowledge scores of health bureaus, and others could provide improved health
participants regarding their educational levels they held education and resources, and promote the appropriate use of
(F � 2.3, p � 0.043) and occupational types (F � 3.3, antibiotics by people living in rural districts of resource-
p � 0.011). The Tukey posthoc test also revealed that di- limited settings.
ploma-graduated participants had significantly higher Our study also indicates that significant numbers of the
knowledge scores (mean � 3.95) than those who were unable study participants had moderate levels of belief in antibiotic
to read and write (mean � 3.3) (p � 0.047) about antibiotic use. Almost more than two-thirds of study participants
use. Concerning the occupational types of study partici- believed that interruption of the antibiotic treatment could
pants, students had significantly higher mean knowledge affect the therapeutic outcomes, and most participants
scores (mean � 4.3; p � 0.024) than farmers (mean � 3.5; agreed and/or strongly agreed that the prescription of an-
p � 0.031), merchants (mean � 3.3; p � 0.05), and house- tibiotics must be taken by physicians. These findings are in
wives (mean � 3.5; p � 0.047) (Table 5). complete agreement with a previous report from Ethiopia
[11] which concluded that interrupting antibiotic use
4. Discussion probably affected treatment outcomes and led to antibiotic
resistance. Nearly, half of the participants in our study also
The principles of appropriate antibiotic use practices have believed that antibiotics could cure them again for similar
been encouraged, with adherence being more important medical symptoms in the future, likely because of their
than ever. The disheartening fact is that antibiotics are often inadequate knowledge of antibiotic use. Nonetheless, these
used incorrectly. The downturn of new antibiotic develop- results differ from an earlier report from Harar city [11], in
ment combined with inappropriate use poses unanticipated part because of differences in study populations and their
challenges to the availability of effective therapies [27]. The access to information on antibiotic use.
6 Advances in Pharmacological and Pharmaceutical Sciences

Participants responses to antibiotic use belief questions

I believe that decisions regarding the prescription of ABCs
should not be taken by physicians 25.8 51.4 7.6 7.6 7.6
I believe that ABCs will cure me again for similar symptoms

Belief question items

11.8 22 19.9 35.1 11.1
in the future
I believe that ABCs are generally safe (do not have any side
19.2 39.6 19.7 16.8 4.7
effects or ADRs).
I believe that interrupting of ABCs course will not affect the
18.2 49.3 11.8 15.4 5.2
outcomes of treatment regimen
I believe that an injury to the skin can be cured quickly by
9.5 30.6 30.8 21.1 8.1
pouring ABC powders onto the injury
I believe that ABCs can prevent any illnesses from
10.4 24.9 34.8 27 2.8
becoming worse.
I believe that ABCs can cure any diseases. 15.6 34.6 33.9 13.3 2.6

0 10 20 30 40 50 60 70 80 90 100
(%)

Strongly Disagree
Disagree
Uncertain
Agree
Strongly Agree

Figure 3: Participant belief on the antibiotic use.

Table 3: Participant responses to antibiotic use practice questions.

S. no Practice questions Frequency (%)
Yes 273 (64.7)
1 Have you taken any antibiotics in the last year?
No 149 (35.3)
Yes 127 (30.1)
2 Have you ever shared your medications with/from somebody else?
No 295 (69.9)
Amoxicillin 153 (36.3)
Ampicillin 37 (8.8)
Metronidazole 37 (8.8)
3 Which antibiotics have you used? (n � 291 (69%)) Ciprofloxacin 24 (5.7)
Doxycycline 16 (3.8)
Tetracycline 15 (3.6)
Chloramphenicol 9 (2.1)
Myself 256 (60.7)
4 Who used the drug (n � 301)
Family members 45 (10.7)
Cough 82 (19.4)
Diarrhea 43 (10.2)
Fever 36 (8.5)
RTI 13 (3.1)
5 For what health problem did you use the drug(s)? (n � 289) Wound 45 (10.7)
UTI 16 (3.8)
Headache 27 (6.4)
Colic pain 21 (5.0)
Other 6 (1.4)
From health professional prescription 262 (62.1)
Directly bought from pharmacy 30 (7.1)
6 Where did you get the drugs? (n � 298)
Lend from other family member, neighbor 1 (0.2)
Bought from nonpharmacy source 5 (1.2)
Yes 209 (49.5)
7 Did you discontinue therapy once your symptoms subsided? (n � 301)
No 92 (21.8)
Yes 150 (35.5)
8 Do you keep leftovers antibiotics for future use?
No 272 (64.5)
Never 238 (56.4)
Rarely 138 (32.7)
9 How often do you use nonprescribed antibiotics?
Often 33 (7.8)
Very often 13 (3.1)
Advances in Pharmacological and Pharmaceutical Sciences 7

Table 4: Antibiotic awareness by participants at primary hospitals of Northwest Ethiopia.

S. no Items Frequency (%)
Amoxicillin 155 (36.7)
Ampicillin 59 (14.0)
Augmentin 21 (5.0)
Tetracycline 31 (7.3)
Ciprofloxacin 34 (8.1)
1 Among the list, which drug(s) you know?
Cotrimoxazole 18 (4.3)
Metronidazole 36 (8.5)
Doxycycline 10 (2.4)
Chloramphenicol 10 (2.4)
None 48 (11.4)
I do not know 251 (59.5)
Other disease 19 (4.5)
2 Can you mention its (their) importance? Infection 100 (23.7)
Trauma 20 (4.7)
Headache and pain 32 (7.6)
Unable to differentiate 58 (13.7)
Able to differentiate one 85 (20.1)
3 Ability to differentiate displayed antibiotics Able to differentiate two 93 (22.0)
Able to differentiate three 81 (19.2)
Able to differentiate four and above 105 (24.9)
Physician or pharmacist (1) 353 (83.6)
Drug leaflet (2) 14 (3.3)
Until disappearance of symptoms (3) 15 (3.6)
4 Appropriate antibiotic use duration (period) should be indicated by Relief of symptoms (4) 18 (4.3)
Family members or friends (5) 14 (3.3)
One and two 5 (1.2)
One, two, and three 3(0.7)
Relatives 19 (4.5)
Friends 18 (4.3)
5 Who is the source of your information?
Health professionals 377 (89.3)
Mass media 8 (2.1)

Table 5: Mean knowledge score differences among the respondents regarding antibiotics use illustrated with the independent-samples T test
and One-Way ANOVA analysis table.
Overall score of knowledge of antibiotic use
Variables Category
Mean (±SD) T/F Pvalue
Male 3.6 (1.6)
Sex −0.74∗ 0.460
Female 3.8 (1.8)
Urban 3.8 (1.6)
Residence 0.867∗ 0.386
Rural 3.6 (1.8)
Unable to read and write 3.3 (1.7)
Read and write only 3.9 (1.7)
Primary education 3.8 (1.6)
Educational status 2.3∗∗ 0.043
Secondary education 3.96 (2.1)
Diploma 3.95 (1.5)
Degree and above 3.7 (1.2)
Farmer 3.5 (1.6)
Merchant 3.3 (1.6)
Occupation types Employee 3.8 (1.5) 3.3∗∗ 0.011
Studenta 4.3 (1.8)
House wife 3.5 (1.9)
Single 3.9 (1.7)
Marital status Married 3.5 (1.7) 2.4∗∗ 0.096
Ever married 3.85 (1.5)
Strong belief 3.8 (1.8)
Belief of antibiotic use Moderate belief 3.7 (1.7) 0.6∗∗ 0.572
Weak belief 3.4 (1.6)
∗
T-Independent-samples the T-test was used for variables with two categories; ∗∗ F-One-Way ANOVA was used for variables with three or more categories;
a-
students (individuals who were attending school at primary, secondary, and higher institutions); bold values denote significant differences (p < 0.05).
8 Advances in Pharmacological and Pharmaceutical Sciences

Our study indicates that significant numbers of the Conflicts of Interest

study participants had used antibiotics in the past year and
then shared them with others, which concurs well with The authors declare that they have no conflicts of interest.
earlier studies [7, 11]. Amoxicillin was the most frequently
used medication (36.7%), followed by ampicillin (14%) and Authors’ Contributions
metronidazole. The findings of our study also indicated
widespread malpractice of antibiotic consumption that was AKN contributed to the conception, project administration,
attributed to using antibiotics without a medical pre- formal analysis, investigation, methodology, data curation,
scription, sharing medications, and discontinuing and and resources and wrote and edited the original draft of the
keeping unused antibiotics for future use. This lends manuscript. AKS contributed to the formal analysis,
support to previous results [39, 40]. These findings could be methodology, data curation, and supervision and reviewed
due to poor levels of knowledge, the inappropriate beliefs and edited the final manuscript. Both authors of this
about antibiotic use, and consumption trends [41]. In manuscript read and approved the final version of this
addition, the poor healthcare systems in developing manuscript.
countries could also be an important contributor to these
malpractices [42].
Study participants who held a diploma educational level
Acknowledgments
had higher mean knowledge scores on antibiotic use than The authors would like to thank the data collectors and
those who were unable to read and write. A study from Bahir participants.
Dar (Ethiopia) also indicated that lower education status was
associated with lower knowledge levels and contributed to
the inappropriate use of antibiotics [41]. Likewise, students References
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