Self-Medication with Antibiotics Among Children in China: A Cross-Sectional Study of Parents’ Knowledge, Attitudes, and Practices

Figures & data

Table 1 Basic Characteristics of Participants (N=1699)

Variables	Overall		Self-Medication				p-value
	(n=1699)		Yes (n=396)		No (n=1303)
	n	%	n	%	n	%
Child characteristics
Gender							0.073
Male	856	50.9	186	21.7	679	79.3
Female	834	49.1	210	25.2	624	74.8
Age							0.566
7	33	1.9	4	12.1	29	87.9
8	132	7.8	28	21.2	104	78.8
9	241	14.2	64	26.6	177	73.4
10	338	19.9	75	22.2	263	77.8
11	290	17.1	75	25.9	215	74.1
12	385	22.7	89	23.1	296	76.9
13	236	13.9	52	22.0	184	78.0
14	44	2.6	9	20.5	35	79.5
Having chronic diseases							0.047
No	1605	94.5	382	23.8	1223	76.2
Yes	94	5.5	14	14.9	80	85.1
Parent-reported health							0.695
Good	1330	78.3	316	23.8	1014	76.2
General	343	20.2	74	21.6	269	78.4
Bad	26	1.5	6	23.1	20	76.9
Parents characteristics
Father’s occupation							0.760
Civil servants	46	2.7	11	23.9	35	76.1
Medical workers	34	2.0	12	35.3	22	64.7
Technicians	299	17.6	73	24.4	226	75.6
Business or service	257	15.1	56	21.8	201	78.2
Workers	475	28.0	110	23.2	365	76.8
Farmers	243	14.3	55	22.6	188	77.4
Others	345	20.3	79	22.9	266	77.1
Mother’s occupation							0.313
Civil servants	21	1.2	7	33.3	14	66.7
Medical workers	50	2.9	16	32.0	34	68.0
Technicians	165	9.7	47	28.5	118	71.5
Business or service	342	20.1	72	21.1	270	78.9
Workers	411	24.2	93	22.6	318	77.4
Farmers	307	18.1	68	22.1	239	77.9
Others	403	23.7	93	23.1	310	76.9
Father’s education							0.762
Primary school and below	128	7.5	26	20.3	102	79.7
Junior high school	622	36.6	141	22.7	481	77.3
High school	448	26.4	109	24.3	339	75.7
University and above	501	29.5	120	24.0	381	76.0
Mother’s education							0.758
Primary school and below	166	9.8	35	21.1	131	78.9
Junior high school	615	36.2	141	22.9	474	77.1
High school	456	26.8	105	23.0	351	77.0
University and above	462	27.2	115	24.9	347	75.1
Home location							0.577
Urban	863	50.8	206	23.9	657	76.1
Rural	836	49.2	190	22.7	646	77.3
Having a doctor relative							0.456
Yes	621	36.6	151	24.3	470	75.7
No	1078	63.4	245	22.7	833	77.3
Self-rated household income							0.326
High income	92	5.4	19	20.7	73	79.3
Medium income	1345	79.2	307	22.8	1038	77.2
Low income	262	15.5	70	26.7	192	73.3

Figure 1 Most commonly used antibiotic for self-medication among children (N=396).

Figure 2 Most commonly symptoms of antibiotic self-medication among children (N=396).

Table 2 Parents’ Knowledge, Attitudes, and Practices of Antibiotics Use (N=1699)

Items	Overall (n=1699)		Self-Medication				p-value
			Yes (n=396)		No (n=1303)
	Proportion		Proportion		Proportion
	n	%	n	%	n	%
Knowledge
Antibiotics have no effect on viral flu. (Yes)	220	12.9	66	24.2	154	11.8	0.012
The more expensive the antibiotic, the effectiveness may not necessarily be better. (Yes)	715	42.1	180	45.5	535	41.1	0.121
The larger the dosage of antibiotics, the effect may not necessarily be good. (Yes)	954	56.2	241	60.9	713	54.7	0.031
Using multiple antibiotics is not necessarily better than using only one. (Yes)	934	55.0	247	62.4	687	52.7	0.001
Intravenous therapy may not necessarily be better than oral therapy. (Yes)	323	19.0	90	22.7	233	17.9	0.031
Knowledge scores (Mean±SD)	1.85±1.47		2.08±1.49		1.78±1.45		0.004
Attitudes
It is necessary to read the drug instructions carefully before antibiotics use. (Yes)	1549	91.2	360	90.9	1189	91.3	0.834
I will not increase or decrease the drugs on your own when using antibiotics. (Yes)	1044	61.4	214	54.0	830	63.7	0.001
It is necessary to observe the adverse reactions after using antibiotics. (Yes)	1272	74.9	284	71.7	988	75.8	0.099
I will withdraw drug immediately after occurring adverse reactions. (Yes)	1543	90.8	365	92.2	1178	90.4	0.287
Attitudes scores (Mean±SD)	3.18±0.94		3.08±0.93		3.21±0.94		0.022
Practices
Bought antibiotics from pharmacy without a prescription. (No)	572	33.7	50	12.6	522	40.1	<0.001
Stored antibiotics at home. (No)	510	30.0	76	19.2	434	33.3	<0.001

Table 3 Hierarchical Regression Analysis of Knowledge, Attitudes, and Practices Towards SMA

Variable	Control Group	Reference Group	Model 1		Model 2		Model 3		Model 4
			OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Antibiotic knowledge score	–	–			1.146	1.055–1.244**	1.165	1.072–1.266***	1.163	1.067–1.268**
Antibiotic attitude score	–	–					0.822	0.727–0.930**	0.864	0.759–0.983*
Buying antibiotics from pharmacy	Yes	No							4.304	3.099–5.977***
Storing antibiotics at home	Yes	No							1.475	1.097–1.983*
Gender	Male	Female	0.812	0.646–1.020	0.803	0.638–1.010	0.798	0.634–1.005	0.801	0.631–1.017
Age	–	–	1.007	0.939–1.080	1.014	0.946–1.088	1.019	0.949–1.093	1.024	0.952–1.102
Physical condition	Good	Bad	0.870	0.335–2.261	0.829	0.318–2.159	0.831	0.318–2.173	0.984	0.364–2.660
	General		0.805	0.304–2.131	0.794	0.300–2.107	0.777	0.292–2.068	0.850	0.309–2.338
Chronic disease	No	Have	1.792	0.992–3.237	1.846	1.020–3.343*	1.789	0.987–3.241	1.959	1.072–3.578*
Father’s occupation	Other	Civil servants/ Medical workers/technicians	0.962	0.620–1.492	0.988	0.635–1.537	0.943	0.605–1.472	0.971	0.609–1.547
	Farmers		1.106	0.556–2.202	1.188	0.595–2.373	1.165	0.583–2.325	1.220	0.605–2.461
	Workers		1.060	0.676–1.663	1.092	0.695–1.715	1.082	0.688–1.703	1.128	0.707–1.801
	Business or service workers		0.967	0.628–1.488	1.026	0.664–1.583	1.035	0.670–1.598	1.065	0.679–1.672
Mother’s occupation	Other	Civil servants/ Medical workers/technicians	0.710	0.440–1.144	0.739	0.457–1.195	0.737	0.455–1.193	0.643	0.387–1.068
	Farmers		0.567	0.280–1.149	0.588	0.289–1.196	0.589	0.290–1.196	0.528	0.256–1.087
	Workers		0.611	0.362–1.032	0.638	0.377–1.081	0.652	0.384–1.105	0.609	0.353–1.052
	Business or service workers		0.602	0.381–0.950*	0.620	0.392–0.980*	0.626	0.395–0.990*	0.575	0.357–0.927*
Father’s education	Primary school and below	University and above	0.971	0.461–2.046	1.057	0.499–2.237	1.034	0.488–2.191	0.936	0.426–2.055
	Junior high school		1.134	0.691–1.862	1.146	0.697–1.884	1.145	0.696–1.884	1.155	0.686–1.942
	High school		1.238	0.817–1.877	1.265	0.833–1.920	1.261	0.829–1.917	1.234	0.801–1.902
Mother’s education	Primary school and below	University and above	0.929	0.464–1.861	0.949	0.473–1.907	0.891	0.442–1.796	1.073	0.517–2.229
	Junior high school		0.966	0.581–1.609	1.014	0.608–1.691	0.980	0.586–1.637	1.107	0.651–1.883
	High school		0.947	0.619–1.449	0.961	0.628–1.472	0.967	0.630–1.483	1.020	0.656–1.584
Home location	Urban	Rural	1.003	0.730–1.378	0.983	0.714–1.352	0.986	0.717–1.355	1.025	0.736–1.428
Having a doctor relative	Yes	No	1.053	0.824–1.346	1.015	0.793–1.301	1.040	0.811–1.334	1.034	0.799–1.338
Self-rated household income	–	–	1.232	0.982–1.544	1.226	0.977–1.539	1.253	0.998–1.572	1.223	0.967–1.546

Notes: The bold text means p<0.05. *p < 0.05, **p < 0.01, ***p < 0.001.

Table 4 Predictors of SMA in Urban and Rural Areas

Variable		Reference Group	Urban		Rural
			OR	95% CI	OR	95% CI
Antibiotic knowledge scores	–	–	1.178	1.050–1.322**	1.175	1.023–1.351*
Antibiotic attitude scores	–	–	0.941	0.763–1.161	0.846	0.710–1.008
Purchasing antibiotics from pharmacy	Yes	No	5.776	3.551–9.396***	3.476	2.199–5.495***
Storing antibiotics at home	Yes	No	1.788	1.133–2.821*	1.385	0.924–2.076

Notes: All the models controlled covariates, including gender, age, physical condition, chronic disease, parent-reported health, father’s occupation, mother’s occupation, father’s level of education, mother’s level of education, having a doctor relative, self-rated household income. The bold text means p<0.05. *p < 0.05, **p < 0.01, ***p < 0.001.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.