Table 1 below presents a description of participants in the study. The sample (n=400) had an equal representation from both regions, with 26 (6.5%) more male respondents than female. Over half of the participants were between the ages of 18 and 34 years, with 219 (55%) having received a tertiary degree or currently enrolled in one. There were 56 (28%) more GAR compared to UWR residents who had at least a senior high/vocational school education. Further, more than twice as many women than men had no formal education; 28 (15%) women compared to 11 (5%) men.
Table 1. Characteristics of the sample (n=400)
Characteristics
|
n (%)
|
Independent variables
Region
Greater Accra
Upper West
Gender
Male
Female
Age
18-24
25-34
35-44
45-54
55-64
65+
Education
Primary school or lower
Junior high school
Senior high/vocational school
Tertiary
|
200 (50.00)
200 (50.00)
213 (53.25)
187 (46.75)
129 (32.25)
134 (33.50)
67 (16.75)
38 (9.50)
25 (6.25)
7 (1.75)
51 (12.78)
22 (5.51)
107 (26.82)
219 (54.89)
|
Dependent variables
Knowledge
Attitudes
Practices (appropriate use)
Yes
No
|
Mean (SD)
11.45 (3.55)
4.39 (0.46)
n (%)
261 (65.25)
139 (34.75)
|
Knowledge
Fig. 1 shows regional differences in knowledge about treatment with antibiotics. Given the varying levels of formal education in our sample, as well as to ensure clarity about what antibiotics are, participants were presented with physical samples of commonly used antibiotics purchased over-the-counter and asked whether they thought each of the infections listed could be treated with similar drugs. Two-thirds and one-fourth of respondents were not aware that antibiotics were inactive against viruses like the cold/flu and HIV/AIDS, respectively. Also, 183 (46%) incorrectly answered that antibiotics were effective against malaria. Overall, individuals in the younger age category, i.e., 18-24 years, had lower antibiotic knowledge compared to those in the older categories. Another was the high number of respondents who believed antibiotics were effective against headaches (39%; 155/400). Regarding knowledge about antibiotic resistance, only 148 (37%) of respondents had heard of the term, and less than 10% had heard of “superbugs” or “AMR”. Also, when asked whether participants were aware of the World Antibiotic Awareness Week (WAAW) campaign in 2017, only 67 (17%) responded in the affirmative. Twice as many residents of the UWR than GAR was familiar with the campaign.
Figure 1. Percentage of correct responses to the question “Do you think these infections can be treated with antibiotics?”
Regression
Table 2. OLS results for Knowledge (n=400)
Covariate
|
Unadjusted
|
Adjusted
|
B
|
95% CI
|
B
|
95% CI
|
Region
Greater Accra (ref. group)
Upper West
Gender
Male (ref. group)
Female
Age
18-24 (ref. group)
25-34
35-44
45-54
55-64
65+
Education
Primary/lower (ref. group)
Junior high school
Senior high/vocational school
Tertiary
|
0.12
0.26*
0.37**
0.61***
0.69***
0.70**
0.30
0.36
0.03
-0.18
|
(-0.07, 0.32)
(0.06, 0.45)
(0.13, 0.60)
(0.33, 0.90)
(0.34, 1.04)
(0.28, 1.12)
(-0.45, 1.03)
(-0.14, 0.86)
(-0.31, 0.36)
(-0.48, 0.13)
|
0.18
0.31**
0.43***
0.65***
0.78***
0.79***
0.47
0.47
0.37*
0.31
|
(-0.03, 0.39)
(0.11, 0.50)
(0.19, 0.66)
(0.35, 0.96)
(0.41, 1.16)
(0.36, 1.22)
(-0.29, 1.24)
(-0.02, 0.96)
(0.02, 0.73)
(-0.05, 0.66)
|
*p<0.05 **p<0.01 ***p<0.001
Generally, bivariate and multivariate results were comparable, with significant differences observed for gender and age. Women had 0.31 points higher on the Knowledge scale compared to men (p<0.01; 95% CI: 0.11-0.50) (Table 2). Furthermore, persons with a senior high/vocational school certificate had higher knowledge compared to those with primary/lower education (p<0.05; 95% CI: 0.02-0.73) (Table 2). Older age was also found to be a predictor of higher knowledge (p<0.001). However, we found no effect of place of residence on overall knowledge.
Attitudes
Table 3. Attitudes towards actions to reduce antibiotic resistance (n=400)
Statements
|
Agree strongly
n (%)
|
Agree slightly
n (%)
|
Neither agree nor disagree
n (%)
|
Disagree slightly
n (%)
|
Disagree strongly
n (%)
|
People should use antibiotics only when they are prescribed by a doctor
People should not keep antibiotics and use them later for other illnesses
Parents should make sure all of their children’s vaccinations are up-to-date
People should wash their hands regularly
Doctors should only prescribe antibiotics when they are needed
There is not much people like me can do to stop antibiotic resistance
|
348 (87.00)
278 (69.50)
365 (91.25)
383 (95.75)
361 (90.25)
110 (27.50)
|
34 (8.50)
29 (7.25)
29 (7.25)
13 (3.25)
29 (7.25)
82 (20.50)
|
5 (1.25)
20 (5.00)
5 (1.25)
3 (0.75)
4 (1.00)
80 (20.00)
|
9 (2.25)
25 (6.25)
0
0
3 (0.75)
46 (11.50)
|
4 (1.00)
48 (12.00)
1 (0.25)
1 (0.25)
3 (0.75)
82 (20.50)
|
It is observed from Table 3 that the majority of respondents had a positive attitude regarding the importance of childhood vaccinations, handwashing practices, and using only prescribed antibiotics. However, almost half believed there was not much they could do to stop antibiotic resistance.
Regression
Table 4 OLS results for Attitudes towards actions to reduce antibiotic resistance (n=400)
Covariate
|
Unadjusted
|
Adjusted
|
B
|
95% CI
|
B
|
95% CI
|
Region
Greater Accra (ref. group)
Upper West
Gender
Male (ref. group)
Female
Age
18-24 (ref. group)
25-34
35-44
45-54
55-64
65+
Education
Primary/lower (ref. group)
Junior high school
Senior high/vocational school
Tertiary
|
-0.20*
0.08
-0.06
0.02
-0.26
-0.42
-0.98*
0.47
0.39*
0.70*
|
(-0.40, -0.004)
(-0.12, 0.28)
(-0.30, 0.18)
(-0.27, 0.32)
(-0.62, 0.10)
(-0.85, 0.002)
(-1.74, -0.23)
(-0.01, 0.96)
(0.07, 0.72)
(0.40, 0.99)
|
-0.04
0.15
0.01
0.19
-0.004
-0.18
-0.55
0.40
0.37*
0.67***
|
(-0.25, 0.17)
(-0.05, 0.34)
(-0.23, 0.25)
(-0.12, 0.49)
(-0.39, 0.38)
(-0.61, 0.25)
(-1.32, -0.23)
(-0.10, 0.90)
(0.01, 0.73)
(0.31, 1.03)
|
*p<0.05 **p<0.01 ***p<0.001
Table 4 examines differences in mean Attitudes score by region, gender, age, and education. Fairly similar associations were observed in the unadjusted and adjusted models, with negative associations observed for region and age, and positive associations for gender and education. Nonetheless, significant differences were observed for only education in the multivariate model net of the other covariates. Individuals with a senior high school/vocational education and tertiary education, on average, had significantly higher scores (p<0.05; 95% CI: 0.01-0.73 and p<0.001; 95% CI: 0.31-1.03, respectively) compared to the referent primary/lower education group.
Practices
In the last year prior to the survey, 132 (66%) and 146 (73%) of GAR and UWR residents, respectively, had taken at least one antibiotic. Of these, more men than women reported taking antibiotics. Further, 275 (69%) received a doctor’s prescription, while 95 (24%) assumed it was alright to share antibiotics with friends and family. The majority of participants without a doctor’s prescription purchased antibiotics from a pharmacy (81%; 101/125). Moreover, some individuals had used more than one type of antibiotic, with one respondent taking up to five antibiotics during their last illness. The top five frequently used antibiotics were Amoxicillin, Amoxicillin-clavulanic acid, Ampicillin, Ciprofloxacin, and Metronidazole.
Among individuals aged 18-34 years, more residents of the GAR than UWR reported prudent antibiotic use (Fig. 2). Also, better use was observed in the 25-34 than 18-24-age group, although this association was not statistically significant (Table 5). Further, older individuals aged 35-44 years were more likely to use antibiotics appropriately compared to the younger referent 18-24-year category (OR: 2.42; p<0.05; 95% CI:(1.19- 4.91) (Table 5). Results also showed that women were more likely than men to practice prudent antibiotic use (OR:1.60; p<0.05; 95% CI:1.03-2.47).
Fig. 2 Appropriate antibiotic use by age and region
Regression
Table 5 Logistic regression results for Practices (n=400)
|
Unadjusted
|
Adjusted
|
Covariate
|
OR
|
95% CI
|
OR
|
95% CI
|
Region
Greater Accra (ref. group)
Upper West
Gender
Male (ref. group)
Female
Age
18-24 (ref. group)
25-34
35-44
45-54
55-64
65+
Education
Primary/lower (ref. group)
Junior high school
Senior high/vocational school
Tertiary
|
0.90
1.56*
1.29
2.29*
2.32
1.53
0.54
0.55
0.78
0.64
|
(0.59, 1.35)
(1.02, 2.37)
(0.78, 2.12)
(1.18, 4.45)
(1.02, 5.30)
(0.62, 3.80)
(0.12, 2.51)
(0.19, 1.56)
(0.37, 1.62)
(0.33, 1.26)
|
0.90
1.60*
1.37
2.42*
2.33
1.62
0.50
0.50
0.93
0.84
|
(0.57, 1.41)
(1.03, 2.47)
(0.82, 2.28)
(1.19, 4.91)
(0.95, 5.67)
(0.62, 4.23)
(0.99, 2.53)
(0.17, 1.50)
(0.40, 2.13)
(0.37, 1.93)
|
*p<0.05 **p<0.01 ***p<0.001