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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 80-85

Knowledge and attitude of antibiotic resistance in the time of COVID-19 among patients attending a dental hospital in Bhubaneswar city


1 Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
2 Department of Periodontics and Oral Implantology, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
3 Senior Research Fellow, NICED, ICMR, Kolkata, West Bengal, India
4 Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed-to-be University, Bhubaneswar, Odisha, India

Date of Submission25-Jul-2021
Date of Acceptance20-Feb-2022
Date of Web Publication21-Jun-2022

Correspondence Address:
Dr. Gunjan Kumar
Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed-to-be University, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijam.ijam_93_21

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  Abstract 


Introduction: The present study aims to assess the knowledge and attitude among the patients attending a dental hospital in Bhubaneswar, Odisha, India.
Materials and Methods: A cross-sectional questionnaire-based survey was conducted among the general population from July 2020 to September 2020. It included 205 patients attending the outpatient department of Kalinga Institute of Dental Sciences, Bhubaneswar. A self-structured 17 item questionnaire regarding antibiotic resistance was used to assess the knowledge and attitude of the patients. Data were entered into Microsoft Excel sheet and analyzed using SPSS version 25.0.
Results: The present study comprised 47.3% males and 52.7% females. Comparison of the knowledge and attitude domain scores was made across the educational levels of the participants and a significant difference was observed in the attitude domain scores.
Conclusion: The present study stresses on the dire need for educating the general public about the rational use of antibiotics, thereby reducing further abuse leading to a global problem.
The following core competencies are addressed in this article: Medical knowledge, Systems-based practice, Practice-based learning and improvement.

Keywords: Antibiotic resistance, awareness, COVID-19, globally, knowledge, public health problem


How to cite this article:
Kumar G, Singh DK, Hazarika SJ, Barman D, Dash P, Swain P. Knowledge and attitude of antibiotic resistance in the time of COVID-19 among patients attending a dental hospital in Bhubaneswar city. Int J Acad Med 2022;8:80-5

How to cite this URL:
Kumar G, Singh DK, Hazarika SJ, Barman D, Dash P, Swain P. Knowledge and attitude of antibiotic resistance in the time of COVID-19 among patients attending a dental hospital in Bhubaneswar city. Int J Acad Med [serial online] 2022 [cited 2022 Jul 2];8:80-5. Available from: https://www.ijam-web.org/text.asp?2022/8/2/80/347827




  Introduction Top


“Antibiotic resistance is threatening a fundamental coverage for universal health coverage”-Otto Cars. Antibiotic resistance poses major threats to global health, food security, and development today.[1] This occurs when the mechanism of bacterial action changes in response to the repetitive use of these medicines, which often leads to an increase in the cost of medical treatment, and leading to a rise in mortality.[1] The long-term problem of antibiotics being used inappropriately in health care settings is worsening due to the COVID-19 pandemic. It was reported that of those taking the antibiotics, 79%–96% reported were not infected with COVID-19 but were taking antibiotics to prevent from getting infected.[2]

The first antibiotic to be discovered was penicillin, in the year 1928, by Alexander Fleming. The period between the years 1930 and 1960 gave rise to the discovery of many antibiotics. The most commonly prescribed drugs in clinical practice are antibiotics.[3] In recent times, it has been observed that antibiotics have been used inappropriately, which has significantly contributed to the issue of antibiotic resistance.[4] The last antibiotic-resistant microorganism to be identified was Candida Auris toward Amphotericin B in the year 2016.[5]

Over-use and misutilization of antibiotics in animals has also contributed immensely to the rising threat of antibiotic resistance. Some types of bacteria that cause serious infections in humans have already developed resistance to most or all of the accessible treatments. A systematic review published in The Lancet Planetary Health found that interventions that restricted the use of antibiotics in food-producing animals reduced antibiotic-resistant bacteria by up to 39%. This research immediately enlightened the development of WHO's new guidelines. Hence, WHO recommended to reduce the overall use of all types of vital antibiotics in food-producing animals, including completely restricting these antibiotics for promotion of growth and prevention of disease without proper diagnosis.[6]

Awad and Aboud in their study done among the public in Kuwait found out that almost 47% of participants had low knowledge regarding action, use, safety, and resistance of antibiotics.[7] Similarly, it was seen that in a study carried out by Yasmin et al. among patients attending the outpatient department (OPD) of a dental hospital in Dhaka, almost 97.5% have never heard of the term antibiotics resistance.[3]

The WHO has called its member countries to start up educational interventions for patients and the general public targeting the rational use of antibiotics to combat resistance.[8]It is hoped that improving knowledge and bringing in a change in attitude will be an effective strategy. Keeping this in mind, the present study has been conducted to assess the knowledge and attitude among the patients attending OPD of a dental college in Bhubaneswar, Odisha, India.


  Materials and Methods Top


A cross-sectional questionnaire-based survey was conducted among the general population belonging to various educational levels and having a different range of income. The study was hosted for a duration of 3 months from July 2020 to September 2020. The study participants included 205 patients attending OPD of Kalinga Institute of Dental Sciences, Bhubaneswar. The Ethical Clearance was obtained from the Institutional Review Board/Ethics Committee review, and the corresponding protocol/approval number was KIDS/RES/006/2020.

A self-structured 17 item questionnaire regarding antibiotic resistance was used to assess the knowledge and attitude of the patients. For every correct answer for the knowledge questions, participants were given a score of 1 and for incorrect answers a score of 0. Questions assessing attitude were marked on a 5-point Likert scale.[9] A pilot study was conducted to check the feasibility and validation of the questionnaire. The validity of the questionnaire was checked by a panel of five subject experts and modifications were made accordingly before the start of the study. Training and calibration of the investigator and the assistant were done in the Department of Public Health Dentistry, Kalinga Institute of Dental Sciences. The Cronbach's α value was calculated to 0.98, which denoted excellent reliability.

The questionnaire was distributed among the study participants by the investigator. All the patients visiting the OPD and giving written informed consent were included in the study. Data were entered in Microsoft Excel sheet and analyses were done using “SPSS Statistics for Windows, version 25. 0 (SPSS Inc., Chicago, Ill., USA).” Inferential statistics were performed using the Chi-square test. Categorical variables were described using frequency and percentages. Intergroup comparisons of various domain scores were done using the Mann–Whitney U test. The level of statistical significance was set at 0.05.


  Results Top


The present study comprises 47.3% males and 52.6% females. The average literacy rate of Bhubaneswar is 91.87%[10] and most of the participants belonged to a middle school (26.3%) in this study. The income of most of the participants (27.3%) ranged from 49,962 to 74,755 INR.[11]

Comparisons were made among the various age groups for the knowledge and attitude domain scores. It was seen that majority of the participants belonged to the age group of 40-55 years; this age group also had the highest mean knowledge score (16.89 ± 3.20). The highest mean score in the attitude domain was (13.79 ± 2.53) in the age group of 26–39 years. These differences did not reach statistical significance [Table 1].
Table 1: Comparison of the study population age and gender wise

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Comparisons were made among the gender groups for the knowledge and attitude domain scores. The mean domain scores for the knowledge and attitude domains were compared. No significant difference was observed among the groups [Table 1].

Comparison of the knowledge and attitude domain scores was made across the levels of education of the participants. There was no significant difference observed in the knowledge domain score. However, a significant difference was observed in the attitude domain scores when stratified by education level (P < 0.01) [Table 2].
Table 2: Comparison of the study population based on the levels of education and income

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Comparison of the participants for the knowledge and attitude domains was made according to their income and there was no significant difference seen among the groups [Table 2].


  Discussion Top


This is study quantitatively assessed the levels of knowledge, attitude, and practice of the general public toward the usage of antibiotics and their concern toward a major public health problem of antibiotic resistance. It was conducted to compare the various levels of knowledge and attitudes among various patients visiting the tertiary care outpatient department in Bhubaneswar city. Comparisons were made according to age categories, gender differences, educational qualifications, and income.

According to the 2011 census, the overall literacy rate is 73.5% which is marginally behind the national average of 74.04% and in our study, about 26.3% of the participants belonged to a middle school.[10] Similar studies have been conducted in various parts of the globe.[12],[13],[14],[15],[16],[17 Almost similar responses were noted among the groups of interest. The overall knowledge score ranked moderate across the groups and there was no statistically significant difference observed between the groups. The percentage of correct responses ranked 55% in the present study. The probable reason would be that in the present study about 85.36% were literate. This finding was better than studies conducted by Al-Yasseri[18] and Shehadeh et al.[19] in Jordan. The knowledge and awareness were comparatively higher in a study conducted by Haenssgen et al., in the southeast Asian population.[20]

In the present study, the majority of the participants agreed to use antibiotics for curing bacterial infections. This agreed with the study conducted by Nair et al., Chinnasami et al., and Awad and Aboud.[21],[22] The majority of the present study participants believed that viral infections were also cured by antibiotics; this has been noted in other studies.[23],[24],[25] The majority of the participants took antibiotics in the last 1 month, which was similar to a study conducted by Zajmi et al.[26] The participants of the present study believed that newer antibiotics were more potent in curing infections as compared to the old ones. There were varying responses toward the exact recommendation of the antibiotics. The study population believed that increasing the frequency of antibiotics would reduce the incidence of the infection. In a study conducted by Zajmi et al.[26] almost a quarter of participants took antibiotics without the prescription, which was greater than the present study finding, where the majority of the participants did not.

A large number of participants from the present study knew about the concept of antibiotic resistance or antibiotic misuse. There are other authors with similar findings. Authors have reported that health-care workers were identified as the most trustworthy information source on antibiotic usage. As rightly mentioned by Haenssgen et al.,[20] a difference was noted between the exact understanding of the terminologies “antibiotic resistance” and “antibiotic misuse.” The difference was also noted among the various sections of the population classified according to the Kuppuswamy Socio-Economic Scale 2020. This finding was contrasting to the present study where no statistically significant difference was noted among the study population in terms of understanding and conceptualizing antibiotic resistance. Some authors also reported that the availability of antibiotic medications in certain rural communities was not uniform.[22],[23],[25] Several international[16],[27] and national[28],[29],[30] studies have been conducted and reported to comment on the levels of awareness but unfortunately, trials to educate the public are in their infancy. Recommendations to transform the knowledge into practice would be beneficial in dealing with the present public health concern globally.

Selection bias was reduced by attaining representative samples, the improper distribution of the participants based on their education levels, age, and income. Randomization at the participant selection would reduce similar kinds of bias. Subjective response-based studies also possess the limitation of recall bias. The investigators do acknowledge that the present study design has several limitations. As closed-ended questions were implified to assess the level of knowledge on antibiotic resistance, participants may have selected the most favorable answer instead of using qualitative methods to reveal misconceptions.[31] This survey had a representation of respondents with at least a primary education which could have affected the application of our results on the whole community.[32] These limitations might affect the external validity in terms of generalizing the outcome to a wider group of individuals belonging to different parts of the country.

Although SARS-CoV-2 is a viral disease that cannot be treated with antibiotics, antibiotic usage has significantly increased throughout the pandemic across nations. With increased antibiotic usage, the prevalence of antibiotic resistance, which was already a global problem before COVID-19, has also escalated.[33]


  Conclusion Top


The present study infers that moderate knowledge is present among the participants of the study. It could be attributed to various sources of knowledge including magazines, articles, or interactions with health workers. The attitude toward antibiotic usage holds strong because of the confidence of the drug as the “Drug of Choice” for various bacterial infections and viral diseases for certain scenarios. There is a major requirement for educating the general public about the need to reduce the unnecessary abuse of antibiotics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

The authors of this manuscript declare that this scientific work complies with reporting quality, formatting, and reproducibility guidelines set forth by the EQUATOR Network. The authors also attest that this clinical investigation was determined to require Institutional Review Board/Ethics Committee review, and the corresponding protocol/approval number is KIDS/RES/006/2020.



 
  References Top

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[PUBMED]  [Full text]  
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