An-Najah National University



An-Najah National University

Faculty of Nursing

2014-2015

Knowledge, Attitudes and Practice of Mothers regarding Antibiotic Uses for their Children in Nablus City

Prepared by:

- Mohammad Amera - Hanadi Alayasi

- Haya Baker - Ahmad Qadadha

Supervisor (faculty sponsor):

Dr .Maream Al-Tell

Table of Contents

|No. |Content |Page |

| |Acknowledgment |5 |

| |List of Abbreviations |6 |

| |Abstract and key words |7 |

| |Chapter One | |

| |Background |8-10 |

|1.1 |Problem statement |10 |

|1.2 |Significance of study |10 |

|1.3 |Aim of the study |11 |

|1.4 |Objectives |11 |

|1.5 |Research questions |11 |

|1.6 |Hypothesis |11 |

|1.7 |Conceptual definition |12-13 |

| |Chapter Two | |

| |Literature review |14-19 |

| |Chapter Three | |

| |Methodology |20 |

|2.1 |Introduction |21 |

|2.2 |Study design |22 |

|2.3 |Site and sitting |22-23 |

|2.4 |Study population |23 |

|2.5 |Sample size and sample method |23 |

|2.6 |Inclusion and exclusion criteria |23 |

|2.7 |Data collecting tool |24 |

|2.8 |Validity |24 |

|2.9 |Pilot testing |24 |

|2.10 |Reliability |24 |

|2.11 |Ethical considerations |25 |

|2.12 |Field work |25 |

|2.13 |Study analysis |25 |

|2.14 |Dependent and independent variable |26 |

| |Chapter Four | |

| |Results |27-36 |

|3.1 |Hypothesis results |34 |

| |Chapter Five | |

| |Discussion |37-40 |

|4.1 |Discussion of hypothesis |40-42 |

| |Chapter Six | |

| |References |46-51 |

| |Annexes | |

| |Annex (1) Questionnaire. |53-58 |

| |Annex (2) Institutional review board (IRB). |59 |

| |Annex(3) Consent form |60-61 |

| |Annex(4) Approval |62 |

Acknowledgment:

We are highly appreciating the efforts of Dr.Aidah Al Kaissi in teaching us the science of nursing research, also we thanks Dr. Iman Shawish for its efforts in teaching us project coarse. Special thanks to Dr. Mariam Al tell that she supervised the project, thank them for their efforts for the success of this project. Thank the ministry of health for facilitating our entrance to the primary health care (governmental and United Nation Relief and Works Agency (UNRWA)) in Nablus city, and we thank the health care provider in all primary health care in Nablus city for their cooperation with us.

We also acknowledge everyone who participated in our project or helped us in working.

List of abbreviations:

1. UNRWA: United Nation Relief and Works Agency.

2. KAP: Knowledge, Attitude and Practice..

3. WHO: World Health Organization.

4. URTI: Upper Respiratory Tract Infection.

5. GABHS: Group-A Beta-Hemolytic Streptococci Isolates.

6. IPD: Invasive Pneumococcal Disease.

7. GPs: General Practitioners.

8. MOH: Ministry of Health.

9. SPSS: Statistical Package for Social Sciences.

10. PGFTU: Palestinian General Federation of Trade Union.

Abstract

Introduction: The use of antibiotics has become an important issue in the world that caution should be taken when using these antibiotics, the most important issue that result from misuse of antibiotics is antibiotic resistance and other side effects, different studies found that Knowledge, Attitude and Practice (KAP) of mothers might affect antibiotic uses, also other variable such as demographic data may cause antibiotic overuse and lead to other consequences.

Aim: this study aim to assess (KAP) of mothers regarding antibiotic uses.

Methods: Descriptive analytical quantitative study was conducted using simple random method to select the sample; the sample size was 300 participants selected from primary health care centers, approximately (20-25%) of the sample were taken from (UNRWA) centers and the rest of the sample from governmental centers.

Results: After analyzing the data on SPSS, the result showed that there was a significant relationship between level of knowledge and practice (p-value = 0.00), 51.7% of participants have been evaluated having poor level of knowledge, no significant relationship between level of practice and attitude (p-value=0.637), 72.2% of participants less than 20 years old having poor level of knowledge and the result showed that there is a significant relationship between level of knowledge and age. Comparing with attitude and other demographic data (place, level of education and income) the results showed that there is no significant relationship between level of knowledge and these variables.

Conclusion: Knowledge, practice and age affect antibiotic uses and there was association between them, regarding to attitude (60%) of participants have positive attitude and the results showed that attitude didn't affect antibiotic uses. based on this results mothers are in need to increase their awareness and knowledge about antibiotic through health education courses.

Key word: Antibiotic, Antibiotic uses, KAP, Antibiotic resistance, Antibiotic overuse.

Background

In 1928, Alexander Fleming noticed the same effect in a petridish, where a number of disease causing bacteria were killed by a fungus of the genus Penicillium. Fleming postulated that the effect is mediated by an antibacterial compound he named penicillin, and that it is antibacterial properties could be exploited for chemotherapy. He initially characterized some of its biological properties, and attempted to use a crude preparation to treat some infections, but he was unable to pursue its further development without the aid of trained chemists, (Fleming, 1980).

Antibiotics or antibacterial are type of antimicrobial used in treatment and prevention of bacterial infection. Originally, an antibiotic was a substance produced by one microorganism that selectively inhibits the growth of another. Synthetic antibiotic, usually chemically related to natural antibiotic, have since been produced that accomplish comparable tasks against microorganisms. Antibiotic are not effective against viruses such as the common cold or influenza and may be harmful when taken inappropriately, (European center for disease prevention and control, 2014).

Antibiotic are used in treating bacterial infection and are effective in reducing mortality and morbidity rates worldwide, (Teng et al., 2004). Several antibiotics are also effective against fungi and protozoan, and some are toxic to humans and animals, even when given in therapeutic dosage. Since the use of antibiotic has spread widely that lead to increase the potential for antibiotic misuse, (Cebotarenco 2008; Ahmed et al., 2005).

Regarding the misuse of antibiotics, West in (2002) indicated that antibiotic uses significantly to treat viral infection especially Upper Respiratory Tract Infection (URTI) because it is the most common infection affect the people especially children. When antibiotic is used to treat viral infection it is considered a misuse of antibiotic, (Bhasin et al., 2002).

There are many contraindications for antibiotic use; in 1976 a study conducted by Neuvonen P.J about interaction with the absorption of tetracycline indicated that milk and dairy product contain calcium which interferes with tetracycline absorption.

Another risk factor among community level that is more serious the development of antibiotic resistance and increase the chance for chronic diseases, which lead to increase the cost of health services, (Sorkhou et al., 2002; Emanuele, 2010).

Several factors might cause a community to overuse antibiotic, these include: factors related to policy that differ from country to country ;factors related to knowledge, attitude and practice among mothers; factors related to patient themselves about perceptions and experience about antibiotic,( Awad et al., 2005;Al-Azzam et al., 2007;Crossley 2005 et al).

Antibiotic resistance is becoming an important health care issue worldwide and it is increase overtime. Antibiotic resistance is highly associated with the overuse of antibiotics, (Albrich et al., 2004). (Tomaz 1994, Frick et al., 1998) showed in their studies that children who are receiving antibiotics without need it especially for (URTI) are at high risk for developing penicillin-resistant streptococcus pneumonia.

Antibiotic overuse including the children need to be managed effectively, (Huang et al., 2007). The overuse of antibiotic causes many problem that affect health status. One of the most adverse effects is gastrointestinal effects and it is common in children, (Simasek; Blandino, 2007).

In many countries (Saudi Arabia, Australia and Thailand), the problem of antibiotic overuse is exacerbated as a result of a deficit in the possibilities of government, or inadequate regulation on the distribution of antibiotics. In many of these countries, antibiotics can be obtained from the pharmacies without a prescription, low economic status and low educational level about antibiotics use also affect the antibiotic use without take care about consequences,( Green,2006).Also Greece is one of the countries with high rate of antibiotic consumption Europe, (Hadjichristodoulou, 2012).

It is worth that parents should take care when use antibiotic for children, to protect their children from antibiotic resistance, especially in countries that get the antibiotic without a prescription.

Statement of problem:

Antibiotic is good against bacterial disease but misuse it can lead to unwanted consequences: Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria are "resistant" and continue to multiply in the presence of therapeutic levels of an antibiotic, it increases healthcare costs, causes people to stay in hospital for longer, results in treatment failures, and sometimes death.

Significance of study:

  This study will provide more information about the causes and risk factors that lead to misuse of antibiotic by mothers that increase resistant of antibiotic, it is very important study. In the end and according to result will provide recommendation to increase awareness about uses of antibiotic by providing health education, program and session about antibiotic use.

Aim of the study:

The aim of this study was to assess Knowledge, Attitude and Practice (KAP) of mothers regarding antibiotic uses.

Objectives:

- To assess level of knowledge of mothers about antibiotic uses.

- To assess attitude of mothers toward antibiotic treatment disease.

- To assess the practice of mothers regarding how antibiotic use.

Research questions:

Are there differences in antibiotic uses between mothers regarding to their age?

What is the level of mother's knowledge about antibiotic use?

What is the level of attitude among mothers toward antibiotic treatment disease?

What is the level of practice among mothers when they use antibiotic?

Hypothesis:

H0: There is no relation between practice and knowledge.

H0: There is no relation between attitude and practice.

H0: There is no relation between attitude and knowledge.

Definition of terms:

Antibiotics or antibacterial are type of antimicrobial used in treatment and prevention of bacterial infection. Originally, an antibiotic was a substance produced by one microorganism that selectively inhibits the growth of another. Synthetic antibiotic, usually chemically related to natural antibiotic, have since been produced that accomplish comparable tasks against microorganisms. Antibiotic are not effective against viruses such as the common cold or influenza and may be harmful when taken inappropriately, (European center for disease prevention and control, 2014).

Antibiotic are used in treating bacterial infection and are effective in reducing mortality and morbidity rates worldwide, (Teng et al., 2004). Several antibiotics are also effective against fungi and protozoan, and some are toxic to humans and animals, even when given in therapeutic dosage. Since the use of antibiotic has spread widely that lead to increase the potential for antibiotic misuse, (Cebotarenco 2008; Ahmed et al., 2005).

(KAP) Knowledge, Attitude and Practice is a survey and a quantitative method used to enhance the (KAP) of a specific situation, and identify what is known about this situation and how to implement it, also help in determine the relationships between variables is there relationships or not, (Medicins du Moude, 2011).

Antibiotic resistance is a major global problem that results from the overuse of unprescribed antibiotic or related to antibiotic misuse when used for children to treat disease and this lead to decrease child immunity and other side effects may develop, (Albrich, 2004).

Antibiotic overuse: uses of antibiotic without need for it, especially to treat respiratory tract infection may be related to poor level of knowledge, also easily access to antibiotic without prescription lead to antibiotic misuse, (Arason, 2006).

Literature Review:

World health organization (WHO) in 2014 defined antimicrobial resistance as “a microorganism’s resistance to an antimicrobial drug that was once able to treat an infection by that microorganism’’. Causes of antibiotic resistance include: incorrect choosing of broad spectrum antibiotic, access to antibiotics without prescription, especially in areas with low and middle income and increasing global availability over time since 1950s.

Study conducted by (Jain et al., 2008) about antibiotic resistance in India to determine the prevalence and degree of antibacterial resistance in Group-A Beta-Hemolytic Streptococci isolates (GABHS). The study showed that GABHS has high resistance and the prevalence was 10.2%. Another study by (Lloyd et al., 2007) supported the result of previous study; it was found that the prevalence of antibiotic resistance was 10.2%. The In- appropriate use of antibiotic" ampicillin group" could lead to serious infection such as sore throat because penicillin lead to the selection of resistant "mutant forms" of staphylococcus aureus, (Fleming, 1995). WHO confirm these results by warned that bacterial resistance cause infectious effect such as sore throat and other infectious disease, and theses infection increase gradually and should take warning when use antibiotic because antibiotic resistance become worse problem in the future,(Braine, 2011).

Jhon Synder conducted a study in 2012 about the overuse of antibiotics, he found in his study that when bacteria exposed to antibiotics, they killed them and inhibited there action. However random transition that occur during division cause antibiotic resistance that lead to bad consequences such as skin infection caused by methicillin-resistant staph aureaus.

Study conducted in China medical centers to monitors bacterial antibiotic resistance. Study showed that the resistant of staphylococcus pneumonia to penicillin is differing between age group and the resistance is high. For example, erythromycin resistance in children less than five year old was 96.9% but in children higher than five years was 87.8%, (Chuanqing et al., 2011).

The findings of studies by Takeuchi,(2009) ; Kusakari,(2004) revealed that bacterial resistance can decrease through the appropriate use of antibiotic for daily treatment to clarify retrospectively changes in the use of antibiotics related to a decrease in resistant bacteria. Also they argued that limited use of antibiotic for outpatient treatment within one year can completely inhibit H.influnza and S.pneumonia resistance.

Many study suggested that children who don’t need antibiotic when they exposed to upper respiratory tract infection are at high risk for developing penicillin-resistant streptococcus pneumonia, (Tomaz 1994; Frick et al 1998).

A study conducted in 2008 by wge et al in Bristol UK utilizing parents of 9723 children of age 3_4.5 yrs to investigate if homeopathic product users consumed fewer antibiotics .The result showed that no relation between the two of them, but there were many factor associated with homeopathic uses such as high educational level of mothers and mothers using homeopathic products.

The study conducted in Portugal to assess the attitudes and knowledge of community pharmacists in Portugal about microbial resistance and the antibiotic dispensing process, utilizing 50 practicing pharmacists the result showed that the correlation coefficients were fair to good for all statements about knowledge and attitude (Roque et al., 2014).

Other study conducted in (2014) by Sanched and Roberts in united states to explore knowledge, attitudes, and self reported practices regarding antibiotic drug resistance and antibiotic drug selection for common infections. The researcher use in-depth interviews with 36 primary care providers, the results showed that primary care providers do not always follow and adhere to guidelines because they thought and believe broad-spectrum antibiotics may be most affected to cure an infection.

In Saudia Arabia conducted, study conducted by Shibl between 2000 and 2004 to determine vaccine coverage of Invasive Pneumococcal Disease (IPD) in children aged 5 years or less, 350 IPD isolates were tested for antibiotic susceptibility. The results showed 46%, 42% and 12% were penicillin-sensitive, penicillin intermediate, and penicillin-resistant, respectively. Rates of resistance to erythromycin and cefotaxime were 26% and 6%, respectively.

In Washington James et al conducted a study in the Seattle, in 2003 to determine the effectiveness of educational materials in improving the attitudes of parents of young children about appropriate and correct use of antibiotic use. they us the methodology a randomized controlled trial by recruiting parents of children who were younger than 24 months and being seen for any reason in primary care pediatric offices. The results showed a simple educational effort was successful in modifying parental attitudes about the correct way use of antibiotic.

A study conducted in Southeastern France by (Pradier et al, 1999) utilizing 535 physicians to estimate the frequency of inappropriate prescription of antibiotics and to identify other related factors. The result showed that knowledge and awareness of physician about antibiotic use and not use is very important in antibiotic prescription, also General Practitioners (GPs) usually respond more to the desire of parents to prescribe antibiotic to their child despite not necessary more than pediatricians. Another study conducted in 2013 by Pulcinic C et al , utilizing 4921 GPs and 301 pediatricians .This study found that GPs prescribe antibiotics more than pediatricians, also both of them prescribe penicillin's, cephalosporin, macrolides, respectively mostly in winter more than summer semester .

In rural China a study conducted in 2014 by Yu et al .utilizing 933 of primary caregivers to investigate parent's perceptions of antibiotic use for their children, interaction between parents and physicians regarding treatment with antibiotics and factor associated with parents self medicating children with antibiotics. The result showed that the usual source of taking information is books, internet & newspapers, also people from central towns more knowledgeable than people from villages. Moreover awareness of antibiotics associated with higher educational level. However most of parents believe that antibiotics used for viral infection and shorten the duration of the disease and some parents give their children antibiotics as a prophylactic for common cold and half of parents request antibiotic prescription for their child despite it is not necessary.

A study conducted in Italy by (Napolitano, et al., 2013) utilizing 630 parents of student in the school to investigate the level of knowledge, attitudes and behavior regarding antibiotic use by parents and the correlation of these item. The result showed that being employed in health care sector increasing the knowledge about antibiotics although they still take the antibiotics without prescription usually for sore throat, teeth problem and common cold either they have it in their home or buying it from the pharmacy Another study conducted by (Quet , et al.,2015)showed that experience is very important to improve the knowledge about antibiotics because the majority of participants thought that antibiotic are extremely used in our life but at the same time some of them still agreed that if antibiotics that prescribed is not useful for the disease it will not harm.

Another study conducted by (Scaioli , et al.,2015) in Italy utilizing 1050 student and aimed at evaluating the knowledge and attitudes of the school medicines student toward antibiotic use and antibiotic resistance and the result showed that the majority of participants knew that antibiotic are effective for bacterial infection but also cause many other side effect.

Follow up survey study conducted in 2011 among adult 18 year or above selected randomly utilizing 1569 participants to assess use of antibiotics and antibiotic resistance in Hong Kong. Result showed that 67% of them believed that antibiotics used to treat flu and viral infections and it is effective for these diseases. Also lower educational level associated with their beliefs. Where the study pointed out that only 56% of participants heard about antibiotics resistance from the television and health professional, (Tham et al., 2011).

In Kuwait (Awad & Aboud ,2015) conducted a study to determine knowledge, attitude & practices toward antibiotic use, utilizing 770 individuals, the result found that there were some reasons to stop taking antibiotic and not complete the full course e.g. decrease the disease symptoms , forgot taking antibiotics , adverse effect of using antibiotics.

Another study conducted in Jordan in 2010 by Albsoul-Younes et al. By random distribution of a structured questionnaire to 405 pharmacies was utilized. To investigate abuse/misuse of prescription and nonprescription drugs in community pharmacies in Jordan, the result showed that study indicated that a problem of drug abuse/misuse of drugs that can be bought without prescription exists in Jordan .And it is necessary to establish and implement practice guidelines with respect to the dispensing of such drugs in addition to networking of pharmacies. Pharmacy faculties in Jordan should play a more active role in training pharmacists in matters pertaining to the management of drug abuse/misuse by adopting a concentrated reduction program.

The study conducted in Riyadh in 2011 by Abdulhak et al. 327 pharmacies was utilized, that determined the percentage of pharmacies who sell antibiotics without medical prescriptions. The result showed that antibiotic was dispensed without a medical prescription in 244(77.6%) of 327, it also showed that antibiotics could be easily obtained without a medical prescription or an evidence based indication. There are major potential squeal associated with this practice.

The study conducted in Jordan in 2007 by AL-Azzam et al .utilized 1943 households (9281 persons) selected from among different cities in Jordan. Results indicated 842 (39.5%) of 2133 antibiotic users identified via the survey had used antibiotics without a prescription within a one-month study period. The aim of this study to assess the prevalence of self-medication with antibiotics in Jordan and evaluate the factors associated with antibiotic misuse. The result found that a problem of drug misuse can be related to buy it without prescription.

Risk factors for antibiotic misuse related to low educational level and inadequate information about antibiotic use among parents, free access to antibiotics without prescription, also low economic status it is important risk factor for antibiotic use, (Panagakou et al., 2012).

Methodology

Introduction:

Self administrative questionnaire (annex 1) was used to collect data about (KAP) regarding antibiotics uses among mothers in Nablus city, to facilitate analyzing information that is taken from 300 mothers from different primary health care to explain factors that affect antibiotic use and achieve the aims of study.

Study design:

A quantitative, descriptive analytical study was conducted to achieve the aim and objectives of the study.

Site and Sitting:

The study conducted at Nablus city, from both governmental primary health care centers (Balata, Almakhfia, Central Clinic and maternal and child care) and (UNRWA) centers (Askar camps, Alain camp, Balata camp).

Governmental Primary health care centers work five days a week, vacation on Friday and Saturday, start work at 8 AM and finished at 3 PM.

URWA primary health care centers work six day a week, vacation only on Friday, start work at 8 AM and finished at 2 PM.

Services provided by clinics:

- Maternity care ( care for pregnant women, pre and post delivery care)

- Child care: measure weight, height and head circumference, provide vitamin for children, PKU test.

- Vaccination.

- Hypertensive patient care.

- Some centers provide also dental care.

Study population:

Women who had children less than 18 years were selected, the population of the study reach about (192,103) in Nablus city and ( 33,446) in refugee camps according to Nablus Municipality in 2011 , the proportion of women of childbearing age (15-49 year) in Palestine was 24.6% (PHIC, 2014:20). Based on these ratios and statistics it was decided to take approximately 20-25% of sample from the UNRWA centers.

Sample size and sampling method:

Simple random method was used to select 300 mothers that every other woman entered the clinic, met the inclusion criteria was included in the study.

Inclusion and Exclusion criteria:

• Inclusion criteria: mothers who have children less than 18 year.

• Exclusion criteria: any women who married but don’t had children.

Data collecting tool:

Self-administrative questionnaire (annex1) was developed based on literature review (Awad & Aboud, 2015), it filled by mothers themselves if they can, and if they can not the researcher asks the mother and fill out the form.

It consisted of four Sections as following :

First section consisted of 9 items to assess demographic information, filled by multiple choice answers.

Second section consisted of 11 items that assess knowledge of mothers about antibiotic uses.

Third section consisted of 16 items of 4 likert scale choices to assess the practices about antibiotic uses.

Fourth section consisted of 9 items of 3 likert scale choices to assess attitude about antibiotic uses.

Validity:

The questionnaire of the study was reviewed by expert at nursing department at An-Najah National University to approve its suitability for the purpose of study; there were no valuable comments to do any change in questionnaire.

Pilot testing:

It was conducted at 10% of the sample size from primary health care centers (10 questionnaires was collected from UNRWA centers and 20 from governmental centers) to make sure that the questionnaire is clear and understandable for mothers.

Reliability:

The Cronbach Alpha coefficient was used to find out the reliability for the questionnaire. The reliability coefficient was (0.663).

Ethical consideration:

The approval to conduct the study was accepted from the Institutional review board (annex 2) - An-Najah National University to ensure confidentiality. In addition consent form (annex 3) was taken to ensure participation and involvement in the study, the participants have the right to refuse participation in the study, withdraw any time during filling the questionnaire.

Field work:

The data was collected between the periods of 1-21Oct in 2015, reliability and validity were insured, and permission was sent from Al-Najah National University to get approval (annex4) to conduct the study from Ministry of Health (MOH) and UNRWA centers.

Several visits were conducted to MOH and UNRWA centers, aim and objectives have been discussed with manager and care stuff in centers then mothers have been met to fulfill the questionnaire.

Study analysis:

The data was analyzed using Statistical Package for Social Sciences (SPSS) mainly descriptive statistics methods such as percentage distribution and Chi-square test were used to test the relationship between variables.

Dependent and independent variable:

|Hypothesis |Independent variable |Dependent variable |

|Demographics affect practice |Demographic |Practice |

|Demographics affected knowledge and |Demographics e.g. age ,income level, health|Knowledge (information about antibiotic use|

|practice |insurance, educational level, number of |,side effect ,effectiveness for bacteria |

| |children |and virus) practice |

|Mothers knowledge affected their practice |Knowledge |Practice |

Results:

Table (1): Distribution of percentages of participants regarding to their demographic data

| | |No. |% |

|Place |City |164 |54.7 |

| |Village |72 |24.0 |

| |Camp |64 |21.3 |

| |Total |300 |100.0 |

|Age |40 |56 |18.7 |

| |Total |300 |100.0 |

|Marital status | Married |274 |91.3 |

| | | | |

| | | | |

| | Divorced |11 |3.7 |

| | Widow |15 |5.0 |

| |Total |300 |100.0 |

|Education level |Uneducated |16 |5.3 |

| |Primary |45 |15.0 |

| |Intermediate |48 |16.0 |

| |Secondary |86 |28.7 |

| |Academic |105 |35.0 |

| |Total |300 |100.0 |

|Job |Work |68 |22.7 |

| |Don’t work |232 |77.3 |

| |Total |300 |100.0 |

|Income level |2000 |93 |31.0 |

| |Total |300 |100.0 |

|No. of children | ≥2children |108 |36.0 |

| |3-5 |145 |48.3 |

| |6-8 |39 |13.0 |

| |≥ 9 children |8 |2.7 |

| |Total |300 |100.0 |

|Insurance |Yes |203 |67.7 |

| |No |97 |32.3 |

| |Total |300 |100.0 |

|Include all children |Yes |176 |58.7 |

| |No |124 |41.3 |

| |Total |300 |100.0 |

Table (1) showed that "47.3% of participants age was between 20-30years , 91.3% of them are married ,level of education 35% academic , 33.3% had the income level between 1000-1499NIS , 77.3% of them don’t have a work , 67.7% of them have insurance but 58,7% include all children in their insurance".

Table (2.a): Distribution of percentages of participants regarding to their knowledge

|Item |Yes |No |Don’t Know |Total |

| |No. |% |No. |% |No. |% |% |

|Antibiotic used to prevent disease |191 |63.7 |90 |30 |19 |6.3 |100 |

|Anti biotic have side effect that affect your child health |193 |64.3 |72 |24 |35 |11.7 |100 |

|Diarrhea, vomiting and fever are a side effect of antibiotic. |114 |38 |104 |34.7 |82 |27.3 |100 |

|Some of antibiotic is contraindicated to be taken with diary product |132 |44 |61 |20.3 |107 |35.7 |100 |

|Repeated and continuous use of antibiotic may reduce your child |229 |76.3 |35 |11.7 |36 |12 |100 |

|immunity | | | | | | | |

|Antibiotic used to treat viral disease |207 |69 |65 |21.7 |28 |9.3 |100 |

|It is necessary and important to follow per scripted dose and time to |281 |93.7 |15 |5.0 |4 |1.3 |100 |

|be sure on the effectiveness of the antibiotic | | | | | | | |

|Antibiotic is used to treat bacterial disease |193 |64.3 |54 |18 |53 |17.7 |100 |

Table (2.a) Showed that 63.7% of participants agreed that "antibiotic was used for prevention of disease". 64.3% and 69% of them agreed that "antibiotic was used to treat bacterial and viral disease respectively. 64.3% of participants agreed that "antibiotic have side effect" and 98% of them agreed that "diarrhea, vomiting and fever are a side effect of antibiotic" .44% of them agreed that "antibiotic is contraindicated to be taken with diary product". 76.3% agreed that "repeated and continuous use of antibiotics may reduce their child immunity". 93.7% of the participants reported that "it is necessary and important to follow the prescription dose and time".

Table (2.b): Distribution of percentage of participants about their uses of antibiotic

|Antibiotic used to treat this symptoms |No. |% |

|Fever |126 |42.0 |

|Abdominal pain |53 |17.7 |

|Sore throat |224 |74.7 |

|Cold |149 |49.7 |

|Headache |54 |18.0 |

|Joints pain |105 |35.0 |

|Cough |103 |34.3 |

|Flu |94 |31.3 |

|Throat congestion |198 |66.0 |

Table (2.b) showed that 74.7% of participants reported that "antibiotic is used to treat sore throat, 66% used it to treat throat congestion, and 49.7% used it to treat cold".

Table (2.c): Distribution of percentages of participants regarding to their source of information

|Item |No. |% |

|Do you have previous information about antibiotic |138 |46% |

|Source of information |

|University |37 |12.3 |

|Courses |31 |10.3 |

|Mother |73 |24.3 |

|Neighbors |20 |6.7 |

|Multimedia |73 |24.3 |

|Internet |78 |26.0 |

|Health sector |115 |38.3 |

Table (2.c) showed that 46% of the participants reported that "they have previous information about antibiotics". The main source of information was health sector (38%) and 26% of them got their information from the internet, 24.3% from multimedia and 24.3% from mothers.

Table (3): Distribution of percentages of participants regarding to their practice toward antibiotic

|Item |Always |Usually |Sometimes |Never |Total |

| |No. |% |No. |% |

| |No. |% |No. |% |No. |% | |

|Antibiotic used to treat all pathological cases. |57 |19 |211 |70.3 |32 |10.3 |100 |

|I can use any antibiotic without consulting my doctor. |56 |18.7 |233 |77.7 |11 |3.7 |100 |

|The antibiotic is effective if my child improve in a short period |181 |60.3 |70 |23.3 |49 |16.3 |100 |

|of time. | | | | | | | |

|I think the antibiotics didn’t have any side effects |57 |19 |193 |64.3 |50 |16.7 |100 |

|Stop giving the antibiotic in the case the child feel better. |99 |33 |184 |61.3 |17 |5.7 |100 |

|The indiscriminate use of antibiotic can impair your child immunity|242 |80.7 |26 |8.7 |32 |10.7 |100 |

|The same antibiotics can be given for more than one child |52 |17.3 |218 |72.7 |30 |10 |100 |

|Failure to complete the antibiotic adversely affect your child's |181 |60.3 |81 |27 |38 |12.7 |100 |

|health | | | | | | | |

Table (4) showed that 70.3% of participants "disagreed that antibiotics is used to treat all the pathological cases", also 77.7% of them "disagreed that they can use the antibiotics without consulting the doctor" .60.3% "agreed that the antibiotics is effective if the child improve in a short period of time".64.3% "disagreed that the antibiotics didn’t have side effect". 61.3% of them "stop giving the antibiotics when the child feels better". 80.7% "agreed that indiscriminate use of antibiotics can impair the child immunity". 17.3% "agreed that the same antibiotics can be given for more than one child" and 27% of them "disagreed that failure to complete the antibiotics adversely affects the child health".

Table (5): Distribution of percentages of participants regarding the mostly used antibiotic

|Which one of the following you mostly use |No. |% |

| Ampicillin |48 |16.0 |

|Amoxicillin |91 |30.3 |

| Augmentin |93 |31.0 |

| I don’t know |68 |22.7 |

|Total |300 |100.0 |

Table (5) showed that the most used antibiotic were Augmentine and Amoxicillin respectively (31%, 30.3%).

Table (6): Distribution of percentages of participants regarding to their level of knowledge

|Level of knowledge |No. |% |

|Very poor |110 |36.7 |

|Poor |155 |51.7 |

|Good |35 |11.7 |

|Total |300 |100 |

Table (6) showed that 51.7% of participants have been evaluated having poor level of knowledge.

Table (7): Distribution of percentages of participants regarding to their level of practice

|Level of practice |No. |% |

|very poor |57 |19.0 |

|Poor |63 |21.0 |

|Good |125 |41.7 |

|very good |55 |18.3 |

|Total |300 |100 |

Table (7) showed that 41.7% of participants have been evaluated having good level of practice.

Table (8): Distribution of percentages of participants regarding to their attitude

|Attitude |No. |% |

|Negative |120 |40.0 |

|Positive |180 |60.0 |

|Total |300 |100.0 |

Table (8) showed that 60% of participants have positive attitude.

Hypothesis results:

Table (9): Distribution of percentages of participants regarding to their relationship between level of practice &level of knowledge

|Level of |Level of knowledge |Total |Chi |

|practice | | |P-value. |

| |very poor |Poor |good | | |

|very poor |4 |45 |0 |49 |44.001 |

| |8.2% |91.8% |0.0% |100% |0.00 |

|Poor |38 |52 |15 |105 | |

| |36.2% |49.5% |14.3% |100% | |

|Good |68 |56 |20 |144 | |

| |47.2% |38.9% |13.9% |100% | |

|very good |0 |2 |0 |2 | |

| |0.0% |100% |0.0% |100% | |

|Total |110 |155 |35 |300 | |

| |36.7% |51.7% |11.7% |100% | |

Table (9) showed that there was a significant relationship between level of knowledge and practice.

Table (10): Distribution of percentages of participants regarding to their relationship between level of knowledge& age group

|Age |Level of knowledge |Total |Chi |

|Group | | |P-value |

| |very poor |poor |good | | |

|< 20 |2 |13 |3 |18 |31.932 |

| |11.1% |72.2% |16.7% |100% |0.00 |

|20-30 |54 |78 |10 |142 | |

| |38.0% |54.9% |7.0% |100% | |

|31-40 |39 |40 |5 |84 | |

| |46.4% |47.6% |6.0% |100% | |

|> 40 |15 |24 |17 |56 | |

| |26.8% |42.9% |30.4% |100% | |

|Total |110 |155 |35 |300 | |

| |36.7% |51.7% |11.7% |100% | |

Table (10) showed that there was a significant relationship between level of knowledge and age group because the significant p-value less than 0.05 (reject H0).

Table (11): Distribution of percentages of participants between level of practice and attitude

|Level of practice |Level of attitude |Chi |

| | |p-value |

|Very poor |15 |35 | |

| |30.0% |70% | |

|Poor |13 |30 |1.699 |

| |30.2% |69.8 |0.637 |

|Good |39 |86 | |

| |31.2% |68.8% | |

|Very good |19 |63 | |

| |23.2% |76.8% | |

|Total |86 |214 | |

| |28.7% |71.3 | |

Table (11) showed that there was no significant relationship between level of practice and attitude.

Table (12.a): Distribution of percentages of participants between level of knowledge and income level

|Level of knowledge |Income level |Chi |

| | |P-value |

| |2000 | |

|Very poor |17 |35 |25 |33 |8.853 |

| |32.1% |35.0% |46.3% |35.5% |0.182 |

|Poor |34 |49 |23 |49 | |

| |64.2% |49.0% |42.6% |52.7% | |

|Good |2 |16 |6 |11 | |

| |3.8% |16.0% |11.1 |11.8% | |

|Total |53 |100 |54 |93 | |

| |100% |100% |100% |100% | |

Table (12.a) showed that there was no relationship between the level of knowledge and income level.

Table (12.b): Distribution of percentages of participants between level of knowledge and level of attitude

|Level of knowledge |Level of attitude |Chi |

| | |P-value |

| |Positive |Negative | |

|Very poor |34 |76 | |

| |30.9% |69.1% | |

|Poor |43 |112 |0.485 |

| |27.7% |72.3% |0.785 |

|Good |9 |26 | |

| |25.7% |74.3% | |

|Total |56 |214 | |

| |28.7% |71.3% | |

Table (12.b) showed that there was no relationship between the level of knowledge and level of attitude.

Discussion:

This is a quantitative, simple random study, conducted in 2015, self administrative questionnaire used to assess knowledge, attitude and practice among mothers regarding antibiotic use, validity and reliability achieve in this study by pilot testing and this study help to identify the factors that affect antibiotic use and lead to resistance and many complication.

The finding of this study (table1) showed that "approximately (54.7%) of the participants were from Nablus city" based on statistics from Nablus Municipality (2011), and "nearly (47.3%) of participants aged between 20-30", this age period is the main time for childbearing , "nearly one third (35%) of the participants have academic level" , "nearly four fifths (77.3%) of them didn't have a job", it might be related to the prevailing habits in our society that the women work as housewife and the most carrier for men, also "one third of participants (33.3%) have an income level between 1000-1499NIS", according to Palestinian General Federation of Trade Union (PGFTU) in 2013, the minimum salary level for employees in Palestine is 1450NIS .

 

The finding of this study (table 2.a) showed that about two third (63.7%) of the participants reported that "antibiotics used as a prophylactic drugs". This finding agreed with a study conducted by Yu et al (2014) who found that (43%) of parents used antibiotic as prophylactic for their children.

The finding also (table 2.a) showed that "(64.3%) of participants reported that antibiotic has many adverse effects". These finding agreed with a study conducted by Simasek;Blandino (2007) who found that the overuse of antibiotic causes many problem that affect health status. Also, approximately two fifths (44%) of them reported that "diary product is contraindicated to be taken with some form of antibiotics". This result was in the same line with a study conducted by Neuvonen (1976) who found that milk and dairy products which contain calcium interferes with tetracycline absorption. About two third (69%) of them are reported that" viral disease can be treated with antibiotics". This finding was coherent with a study conducted by Tham (2011) who found that (67%) of them believed that antibiotics used to treat flu and viral infections and it is effective for these diseases.

The finding of this study (table 2.b) showed that three fourth (74.7%) of the participants reported that "sore throat symptom can be treated with antibiotics". In the contrast, a study conducted in Italy by Yu et al (2014) found that (55.1%) of participants agreed that" antibiotics must not be used to treat sore throat".

The finding in (table 2.c) showed that "health sectors, internet and mothers were the most common source of information for the participants (26%, 24.3%, and 24.3% respectively) and (10.3%) from courses". A study conducted by Awad;Aboud (2015) found that approximately (16%) of participants got their information from family and (28%) from the internet. These results reflected that the most source of information from health sectors; it might be related to questions that asked to health care providers by mothers when prescribed the antibiotics. But less information were taken from courses, it might be related to lack of courses (medical and awareness) and training program in primary health care centers. In addition, work overloads and disorganized health education sessions for mothers lead to this result.

The finding of this study (table 3) showed that nearly half (47.4 %) of the participants "shared antibiotics between their children who were diseased at the same time", approximately one-third (33.0%) of participants "used the antibiotics that existing in their home". This finding was coherent with a study conducted by Al-Azzam et al (2007) who found that (46.6%) of participants used antibiotic that stored in their house. This might be related to lack of knowledge about the different diseases that are treating by specific antibiotic. Also it was found that one fifth (21.5%) of participants "borrow antibiotic from neighbors". This result was in the same line with a study conducted by Al-azzam et al (2007) who found that (8.1%) of participants borrow it from neighbors and friends. The majority (96.6%) of the participants "gave their child the prescribed dose of antibiotics completely" but half of the participants (50%) "stop giving the remaining course of antibiotics when the symptoms disappear". These results were different from a study conducted in Kuwait by Awad;Aboud ( 2015) who found that about two-third (64.4%) of participants completed the antibiotic course and (36%) of participants "stop the course of antibiotic when child felt better". Nearly one third (32.0%) of them "buy antibiotics without a prescription". This result was coherent with a study conducted by Awad;Aboud (2015) who found that (27.5%) of participants used antibiotic without medical prescription. In the contrast, a study conducted in Saudia Arabia by Shibl (2008) found that (77.6%) of pharmacies sale antibiotic without medical prescription. Also approximately one third (33.4%) of participants "reduce the prescribed dose of the antibiotic if severity of symptoms of child is reduced" it might be related to wrong idea that if symptoms begun relieved; they can reduce dose of antibiotic.

The finding of this study (table 4) showed that two thirds (70.3%) of the participants "disagreed that antibiotic use for all disease". A study conducted by Awad;Aboud (2015) found that (54.%) of participants agreed that antibiotic used to treat common cold, (41.2%) used it to treat sore throat, (24.6%) used it to treat cough, (13.7%) used it to treat genitourinary infection, and (6.4%) used it to treat superficial wounds.

The finding of this study (table 5) showed that the most antibiotic used were Augmentin and Amoxicillin, and (31, 30%) of participants reported using of Augmentin and Amoxicillin respectively. This finding was in the same line with a study conducted in Jordan by Al-Azzam et al (2007) who found that the most antibiotic used among participants was penicillin. These results might be related to participant's views that these antibiotics used commonly because it can be obtained easily and have effective and current impact to reduce sign and symptoms of disease.

The finding (table 6) showed that nearly half (51.7%) of participants "have poor levels of knowledge". This finding was in the same line with a study conducted in Kuwait by Awad;Aboud (2015) who found that (47.0%) of participants have low level of knowledge.

The finding of this study in table (7) showed that (41.7%) of participants "have good practice" and (19%) of participants have "very poor practices". This result was coherent with a study conducted by Panagakou (2015) who found that there was a wrong practice among participants when using antibiotic and used it frequently without prescription especially to treat (URTI).

Finding of this study (table 8) showed that approximately one-third (40%) of participants "have negative attitude about antibiotics". This finding was in agreement with a study conducted by Awad;Aboud (2015) who found that 41% of participants have negative attitude.

Discussion of hypothesis:

The finding of this result (table 9) indicated the relationship between level of knowledge and level of practice, the majority (91.8%) of participants "who have very poor practice have poor knowledge", and approximately half (47.2%) of participants "who have good practice have very poor knowledge with a significant relationship between level of knowledge and practice". These results were disagreement with a study conducted in Greece by Hadjichristodoulou (2012) who found that there was a significant relationship between level of knowledge about antibiotic uses and level of practice that low level of knowledge related to inadequate education lead to improper practice. These differences might be related to although mothers don’t have information about antibiotic but they follow the doctor and physician instruction and they learn the correct role about antibiotic use, also when their children expose to any disease mothers don’t use any antibiotic without prescription but use it according to doctor order.

The finding of this study (table 10) showed that "there was a significant relationship between level of knowledge and age of participants", approximately half (54.9%) of participants between 20-30 years "have poor knowledge" and nearly half (48.6%) of participants more than 40 years old "have good knowledge".

The finding of this study (table 11) showed that "there was no significant relationship between level of practice and level of attitude", nearly two-third (68.6%) of participants "who have good practice have positive attitude". This result was disagreed with a study conducted in Washington by James et al (2003) who found that there was a significant relationship between level of practice and level of attitude.

The finding of this study (table 12.a) showed "that there was no significant relationship between the level of knowledge and income", nearly half (49%) of participants "who have income level (1000-1499 NIS) have poor knowledge". These results were in the same line with a study conducted by Awad;Aboud (2015) who found that there was no significant relationship between level of knowledge and income. While it was different from a study conducted by Hadjichristodoulou (2012) who found that there was a significant relationship between level of knowledge and income.

The finding of this study (table 12.b) showed that "there was no significant relationship between level of knowledge & attitude", nearly two third (72.3%) of participants "who have poor knowledge have negative attitude". This finding incoherent with a study conducted by Awad;Aboud (2015) who found that there was a significant relationship between level of knowledge & attitude.

Conclusion:

Attitude, Knowledge and Practice affect the antibiotic use among mothers for their children, regarding to knowledge half of mothers have poor level of knowledge and this affect antibiotic use, where many women know that antibiotic used to treat all diseases, used against viruses and it has no effect on children.

Also, the results of this study found that many mothers have knowledge that the antibiotic used to treat common cold and flu, and it is effective against this cases.

This study found that most mothers in general have good practice about antibiotic use, most of them follow the prescribed dose and time when using antibiotic and always read the instruction before using it. While sharing antibiotic between their children and using the available antibiotic that found in their house are present and reflect negative practice.

The most antibiotic used among mothers for their children was Augmentin, the use of these antibiotics can be easily and can be obtained without medical prescription.

Antibiotic resistance the most side effect among children that may lead to decrease immunity especially for children, unfortunately mothers have negative attitude about this point because they believe that repeated use of antibiotic didn’t lead to antibiotic resistance.

Recommendation:

According to study, results showed that the participants need more recommendation:

-Work to raise awareness of mothers by distributing brochures about antibiotics (uses, side effects, how to save and .etc.).

-Put or activation a law of non- dispensing antibiotics without a prescription.

-Doctor who described the antibiotic to the child must guidance mother on the proper way to use it also the pharmacy do that.

-Provide training courses of antibiotics proper practices by health clinics which are frequently visited by mothers.

- Put the protocol that necessitate sensitivity test prior to antibiotic prescription for young children to avoid antibiotic adverse reaction

-Warn parents and caregivers about proper use of antibiotic like completion of the course, side effects predicted and disposal of antibiotic when finishing course

Limitation:

There were many difficulties that have been faced during this study:

-Difficulty communicating with the group because of the lack of adequate time for the meeting

-Transportation problem due to the occupation barriers.

-Delays in the arrival of approval for governmental primary health care.

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Annexes

Annex (1)……………………………………………….Questionnaire

Annex (2)……………………………………………….Institutional review board (IRB).

Annex (3)………………………………………………..Consent form

Annex (4)…………………………………………………Approval

Annex (1(

بسم الله الرحمن الرحيم

جامعة النجاح الوطنية

كلية الطب وعلوم الصحة

"استبيان حول قياس مستوى المعرفة والسلوك والمعتقدات فيما يتعلق باستخدام

المضادات الحيوية من قبل الأمهات مع اطفالهم. "

عزيزتي الام نرجو من حضرتك الاجابة عن كامل الاسئلة التالية حسب التعليمات المذكورة ادناه , هذا الاستبيان يهدف لبحث تعليمي يضمن الخصوصية والسرية لكل مشترك بالدراسة , ولن يتم سؤالك عن اي معلومة شخصية , اذا كنت توافقين على المشاركة يرجى الاجابة على الاسئلة التالية.

اسم المشاركة :....................... التوقيع :............

القائمين على المشروع :

أحمد قدادحة

محمد عميره

هيا بكر

هنادي العيسة

بإشراف الدكتورة

مريم الطل

تم جمع المعلومات من المراكز الصحية التابعة

للحكومة لمراكز الاونروا

|القسم الأول : المعلومات الشخصية |

يرجى وضع اشارة (X) عند الاجابة المناسبة :

مكان السكن :

مدينة قرية مخيم

الفئة العمرية :

اقل من 20 20 - 30 31 - 40 اكثر من 40

الحالة الاجتماعية :

متزوجة مطلقة أرملة

المستوى التعليمي:

غير متعلمة ابتدائي اعدادي

ثانوي جامعي

الوظيفة :

أعمل لا أعمل

مستوى دخل البيت :

أقل من 1000 1000- 1499 1500-1999 2000 أو أكثر

عدد الاطفال:

3 -5 6-8 9أو أكثر 2 أو أقل

هل تملكي تأمين صحي نعم لا

هل يشمل كل أطفالك نعم لا

|القسم الثاني: أسئلة تتعلق بالمعلومات حول استخدام المضادات الحيوية |

يرجى وضع اشارة (X) عند الاجابة المناسبة :

K1 يستخدم المضاد الحيوي للوقاية من الأمراض. نعم لا لا أعلم

K2 المضاد الحيوي له مضاعفات جانبية تؤثر على صحة طفلك. نعم لا لا أعلم

K3الاسهال,التقيؤ والحرارة من الاثار الجانبية للمضاد الحيوي. نعم لا لا أعلم

K4بعض المضادات الحيوية يتعارض مفعولها مع منتجات الألبان . نعم لا لا أعلم

K5 الاستخدام المتكرر للمضاد الحيوي يمكن أن يقلل من مناعة طفلك. نعم لا لا أعلم

K6 المضاد الحيوي فعال للقضاء على الفيروس . نعم لا لا أعلم

K7 من الضروري اتباع الوصفة الطبية من حيث الجرعة والوقت نعم لا لا أعلم

للتأكد من فعالية الدواء.

K8 المضاد الحيوي فعال للقضاء على البكتيريا . نعم لا لا اعلم

K9 في أي من الحالات التالية يستخدم المضاد الحيوي: (يمكنك اختيار أكثر من حالة)

ارتفاع درجة الحرارة آلام البطن آلام الحلق

نزلات البرد آلام الراس الشديدة آلام المفاصل

السعال الرشح احتقان الحلق

K10 هل لديك معلومات طبية مسبقة عن المضادات الحيوية :

نعم لا

K11 ما المصادر التي تم اخذ المعلومات منها:

الجامعة دورات الأم الجارات وسائل الاعلام

الانترنت القطاع الصحي

|القسم الثالث : أسئلة متعلقة بالممارسات |

يرجى وضع اشارة (X) عند الاجابة المناسبة :

|الرقم | |دائماً |غالباً |أحياناً |نادراً |بتاتاً |

|P1 |اقوم بإعطاء نفس المضاد الحيوي المتوفر لدي في حال مرض طفل أخر من | | | | | |

| |أطفالي في نفس الوقت دون الحاجه الى مراجعة الطبيب . | | | | | |

|P2 |اقوم بإعطاء طفلي مضاد حيوي موجود مسبقا في البيت . | | | | | |

|P3 |أقوم باستعارة الادوية وخاصة المضادات الحيوية من أحد الجارات . | | | | | |

|P4 |في حال عدم تحسن طفلي اقوم بمراجعة الطبيب . | | | | | |

|P5 |أقدم لطفلي الجرعة الموصوفة من المضاد الحيوي بشكل كامل . | | | | | |

|P6 |اتوقف عن اعطاء طفلي المضاد الحيوي عند زوال اعراض المرض . | | | | | |

|P7 |اراقب طفلي تخوفا من ظهور اعراضاً جانبية بعد اعطائه المضاد الحيوي | | | | | |

|P8 |اراجع الطبيب عند ظهور اي عرض جانبي على طفلي بعد اعطائه المضاد الحيوي| | | | | |

| |. | | | | | |

|P9 |اقرأ نشرة الإرشادات قبل استخدام المضاد الحيوي . | | | | | |

|P10 |أقوم بتغيير الطبيب اذا لم يصف مضاد حيوي لحالة طفلي. | | | | | |

|P11 |أقوم باستخدام المضاد الحيوي لمرة اخرى بعد اصابة الطفل بنفس المرض | | | | | |

| |السابق دون استشارة الطبيب . | | | | | |

|P12 |اقوم بشراء المضاد الحيوي بدون وصفة طبية . | | | | | |

|P13 |احتفظ بالمضاد الحيوي لاستخدامه لاحقاً عند الحاجة اليه . | | | | | |

|P14 |اقوم بتقليل الجرعة الموصوفة من المضاد الحيوي في حال شعرت بتحسن طفلي | | | | | |

| |. | | | | | |

|P15 |أقوم بتغيير الجرعة الموصوفة حسب ما أراه مناسباً لحالة طفلي. | | | | | |

|P16 |اقوم بتحضير الدواء حسب الارشادات تماما . | | | | | |

|القسم الرابع : أسئلة متعلقة بالتوجهات |

يرجى وضع اشارة (X) عند الاجابة المناسبة :

| | |أوافق |لا أوافق |لا أعلم |

|A1 |المضاد الحيوي يستخدم لعلاج جميع الحالات المرضية. | | | |

|A2 |بامكاني أن أستخدم أي مضاد حيوي دون استشارة الطبيب. | | | |

|A3 |يكون المضاد الحيوي فعال اذا تحسن طفلي خلال فترة زمنية قصيرة. | | | |

|A4 |اعتقد انه لا يوجد أي مضاعفات جانبية للمضادات الحيوية. | | | |

|A5 |يتم التوقف عن اعطاء المضاد الحيوي حالة الشعور بتحسن الطفل. | | | |

|A6 |الاستخدام العشوائي للمضاد الحيوي يمكن أن يضعف من مناعة طفلك. | | | |

|A7 |يمكن اعطاء المضاد الحيوي نفسه لاكثر من طفل | | | |

|A8 |عدم اكمال المضاد الحيوي يؤثر سلبا على صحة طفلك | | | |

أي من المضادات الحيوية التالية تستخدميه بشكل اكثر :

امبيسلين Ampicillin

اموكسيسلين Amoxicillin

اوجمين augmentin

لا اعلم

شكرا جزيلا ونتمنى دوام الصحة لكم ولاطفالكم (

Annex (2)

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Annex (3)

Describe how participants will be informed about the research before they give their consent. Be sure to submit with this protocol a copy of the informed consent/assent letter(s) you will use. Please prepare your informed consent letter at the 8th grade reading level or lower as dictated by the needs of the subjects. (See IRB website for required elements of an informed consent.)

موافقه للاشتراك في البحث العلمي

إسم الباحث:.محمد طه عميرة , احمد قدادحة , هيا بكر , هنادي العيسه

عنوان البحث: مستوى المعرفة والسلوك والتطبيق فيما يتعلق با ستخدام المضادات الحيوية من قبل الاهالي مع اطفالهم .

مكان إجراء البحث : سيتم اجراء هذا البحث في (مدينة نابلس (

أنت مدعو(ة) للمشاركة ببحث علمي سريري سيجرى في كلية التمريض\ جامعة النجاح الوطنية. الرجاء أن تأخذ(ي) الوقت الكافي لقراءة المعلومات التالية بتأن قبل أن تقرر(ي) إذا كنت تريد(ين) المشاركة أم لا. بإمكانك طلب إيضاحات أو معلومات إضافية عن أي شيء مذكور في هذه الإستمارة أو عن هذه الدراسة ككل من الباحثين.

أ. وصف البحث العلمي وهدفه وتفسير مجرياته: يقوم البحث على تعبئة الاستمارة واجابة الاسئلة بعد قراءتها جيدا لمعرفة العوامل المؤدية للاستخدام الخاطئ للمضادات الحيوية مع اطفالهم ويهدف البحث لتوعية الناس وتقديم توصيات عن كيفية الاستخدام الصحيح للمضادات الحيوية .

‌ ب. لا يوجد أي تأثيرات سلبية يمكن ان يسببها الإشتراك في هذا البحث

ج.من الفوائد التي نرجو تحقيقها:

. تحسين وتطوير حلول للعوامل التي تؤدي للاستخدام الخاطئ للمضادات الحيوية .

د. البدائل المتاحة:في حالة رفضك الإشتراك فى هذا البحث فسوف يتم اخذ عينة اخرى من المرضى

ه. سرية معلوماتك: في حال وافقت على المشاركة في هذه الدراسة، سيبقى إسمك طي الكتمان . لن يكون لأي شخص، ما لم ينص القانون على ذلك، حق الإطلاع على الاستمارة بعد تعبئتها علما بان هذه المعلومات لن تستخدم الا لغرض البحث العملي فقط و بدرجة عالية من السرية و الخصوصية.

و. حقك فى الإنسحاب : من حقك الإنسحاب من البحث فى اى وقت دون إبداء أسباب لذلك او ايقاع عواقب سلبية عليك .

موافقة الباحث:

تم الشرح بالتفصيل للمشترك في البحث العلمي طبيعته ومجرياته وتأثيراته السلبية. ولقد أجبت على كل أسئلته بوضوح على خير ما أستطيع. وسوف أعلم المشترك بأي تغييرات في مجريات هذا البحث أو تأثيراته السلبية أو فوائده في حال حصولها أثناء البحث.

إسم الباحث او الشخص المولى الحصول على موافقة المشترك

1-محمد طه عميرة .

2-احمد قدادحة .

3-هنادي العيسة .

4- هيا بكر .

التاريخ : / /

موافقة المشترك:

لقد قرأت استمارة القبول هذه وفهمت مضمونها. تمت الأجابة على أسئلتي جميعها. وبناء عليه فأنني، حرا مختارا، أجيز إجراء هذا البحث و أوافق على الإشتراك فيه , واعلم انه يمكنني الاستفسار عن اي سؤال خلال الاجابة عن هذه الاسئلة وطلب المساعدة من قبل اي باحث .

التاريخ

Annex (4)

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