PREVALENCE OF INAPPROPRIATE ANTIBIOTIC USE AND ITS ASSOCIATED FACTORS AMONG ADULTS ATTENDING PRIMARY HEALTHCARE CENTERS: A CROSS-SECTIONAL STUDY

Mareh Adeeb Ahmed*

ABSTRACT

Background: Inappropriate antibiotic use is a major public health concern that accelerates antimicrobial resistance and compromises treatment outcomes. Primary healthcare centers are critical settings for investigating antibiotic-use practices because they represent the first point of contact with healthcare services for many adults. This study aimed to assess the prevalence of inappropriate antibiotic use and identify its associated factors among adults attending primary healthcare centers. Methods: A descriptive analytical cross-sectional study was conducted among 408 adults aged 18 years and older attending primary healthcare centers. A non-probability consecutive sampling technique was used to recruit participants. Data were collected using a structured questionnaire administered through face-to-face interviews, covering sociodemographic characteristics, antibiotic-use practices, and knowledge regarding antibiotics and antimicrobial resistance. Inappropriate antibiotic use was defined as one or more of the following: using antibiotics without an appropriate prescription or professional assessment, using antibiotics for conditions not warranting antibacterial treatment, using antibiotics prescribed for another person or previous illness, sharing antibiotics, or independently modifying the prescribed dose or duration. Associations were examined using chi-square tests and multivariable logistic regression, with p < 0.05 considered statistically significant. Results: Among 408 participants (mean age 38.7 ± 12.4 years; 58.8% female), 287 (70.3%) reported antibiotic use during the preceding three months. Among these users, 168 (58.5%; 95% CI: 52.8%–64.2%) engaged in at least one inappropriate antibiotic-use behavior, corresponding to an overall prevalence of 41.2% (95% CI: 36.5%–46.0%) among all surveyed adults. The most common inappropriate practices were using antibiotics without appropriate prescription or professional assessment (32.4%) and using antibiotics for conditions not warranting antibacterial treatment (27.2%). Self-medication with antibiotics was reported by 32.4% of users, sharing antibiotics by 14.3%, and using antibiotics prescribed for another person by 12.5%. Only 43.6% of participants had good antibiotic-related knowledge. In multivariable logistic regression, self-medication (aOR = 4.12; 95% CI: 2.08–8.16; p < 0.001), previous antibiotic use in the past six months (aOR = 2.67; 95% CI: 1.52–4.69; p < 0.001), non-prescription source of antibiotics (aOR = 2.45; 95% CI: 1.38–4.35; p = 0.002), poor knowledge (aOR = 2.31; 95% CI: 1.35–3.95; p = 0.002), no formal education (aOR = 2.84; 95% CI: 1.12–7.21; p = 0.028), and lack of health insurance (aOR = 1.74; 95% CI: 1.01–3.00; p = 0.046) were independently associated with inappropriate antibiotic use. Conclusion: Inappropriate antibiotic use was highly prevalent among adults attending primary healthcare centers, with self-medication, recent antibiotic exposure, non-prescription access, poor knowledge, low education, and lack of health insurance identified as key independent predictors. These findings underscore the need for multifaceted antimicrobial stewardship interventions that combine targeted educational programs, regulatory enforcement to restrict non-prescription access, and efforts to improve healthcare access and health literacy. Addressing both demand-side and supply-side determinants of inappropriate antibiotic use is essential to promote rational antibiotic use and limit the development and spread of antimicrobial resistance.

Keywords: Inappropriate antibiotic use; antimicrobial resistance; self-medication; primary healthcare; knowledge; associated factors; cross-sectional study.