Date of Award

2-16-2020

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Rehana Siddiqui

Second Advisor

k Dr. Sobiya Sawani

Department

Community Health Sciences

Abstract

Background: Colds are the common viral infections in children. It is usually a self-limiting disease requiring no active treatment. However, antibiotics are required if cold leads to bacterial infections such as otitis media or chest infections. Cold is one of the significant factor of antibiotic overuse globally. Self-medication and inappropriate dosages of antibiotic to manage common colds is common practice by parents around the world. Similarly, prescription of antibiotic for colds is common practice by General Physicians (GPs) of private clinics. Objectives The objective of this study is to assess Knowledge, Attitudes and Practices (KAP) of Parents regarding management of common colds and antibiotic use in children between 1-5 years of age. Another objective is to explore the prescribing practices of GPs to manage common colds in children and to determine the factors associated with prescribing of antibiotic by General physicians for treating common colds in children between 1-5 years of age.
Methods It is a mixed methods study conducted in 3 union councils of Karachi including, Azizabad, Karimabad and Aisha Manzil over a period of 3 months from July 1st to September 30th . Quantitative data were collected via KAP questionnaire from 379 Parents through purposive and snow ball sampling method. Qualitative data were collected through semi structured in-depth interview from six GPs of private clinics selected on basis of convenience sampling Percentages were calculated for categorical variables on Socio demographic profile of Parents and child information on history of colds. Mean and Standard deviations were calculated for continuous variables for age and scores for Knowledge (0-7), Attitude (0-6) and Practice (0-7). KAP scores were categorized as good, moderate and poor. Thematic analysis of the qualitative data was done.
Results: Of the 379 participants 78.6% were mothers (n=298). The mean age of participant’s children between 1-5 years of age was 3 years (SD=1.39). More than 70% of parents reported graduate and above level of education (mothers 78% and fathers 71%). Nearly half of the fathers had office job and mothers were housewives. Around 70% reported that their child had cold one to two times in past six months and 25% reported that their child suffered from cold in last month. The mean KAP scores of parents were 3.51 (SD =1.40) for Knowledge, 3.97 (1.34) for Attitudes, and 4.40 (1.43) for Practices. Overall 20.0% of the parents had good knowledge score (>4.5-7/7), 59.0% had a moderate level of scores (2.5-4.5/7) and 21.0% had poor knowledge (0- < 2.5/7) on management of colds in children. Overall, 44% of parents had scored good on Practices and Attitudes. Mean Knowledge and Practices scores differed significantly between mothers and fathers. More than 40 % of the participants (n=170; 44.9%) stated that whenever child gets cold it requires ABX and 29% would use the same ABX that was prescribed previously for similar symptoms. More than half of the participants (n=214; 56.5%) responded that antibiotic accelerates recovery from colds. Thematic analysis yielded 4 themes, 12 categories and 13 sub categories. Following were the Themes; Diagnosis of a common cold in children between 1 to 5 years, GPs management of common colds in children, Practices of Parents for managing Colds in Children and Daily routine of clinic. GPs prescribe antibiotics on basis of symptoms that indicate bacterial infections including fever, discolored nasal discharge and lethargic appearance. Antibiotics are prescribed by GPs in conditions where there was an uncertainty of follow up.
Conclusion: The participants had a moderate level of knowledge regarding management of common colds and use of antibiotics, with significant difference in mothers and fathers. Practices of Parents related to management of common colds and antibiotic use is in-adequate. Common behaviors of parents included; giving inappropriate antibiotic dosages, use of previous kept prescriptions, restocking antibiotic prescriptions and discontinuing antibiotic course before its completion if symptoms get resolved. GPs 7 | P a g e prescribe antibiotics when children have fever along with cold symptoms and in situations when they are not sure of the follow up.

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1

Last Page

107

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