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.

Annex (2) Institutional review board (IRB).

Annex(3) Consent form

Annex(4) Approval

53-58

59

60-61

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 practice

Demographics e.g. age ,income level, health insurance, educational level, number of children

Knowledge (information about antibiotic use ,side effect ,effectiveness for bacteria and virus) practice

Mothers knowledge affected their practice

Knowledge Practice

Results:

Table (1): Distribution of percentages of participants regarding to their demographic dataNo. %

Place City 164 54.7Village 72 24.0Camp 64 21.3Total 300 100.0

Age <20 18 6.020-30 142 47.331-40 84 28.0>40 56 18.7Total 300 100.0

Marital status Married 274 91.3 Divorced 11 3.7 Widow 15 5.0Total 300 100.0

Education level Uneducated 16 5.3Primary 45 15.0Intermediate 48 16.0Secondary 86 28.7Academic 105 35.0Total 300 100.0

Job Work 68 22.7Don’t work 232 77.3Total 300 100.0

Income level <1000 53 17.71000-1499 100 33.31500-1999 54 18.0

>2000 93 31.0Total 300 100.0

No. of children ≥2children 108 36.03-5 145 48.36-8 39 13.0≥ 9 children 8 2.7Total 300 100.0

Insurance Yes 203 67.7No 97 32.3Total 300 100.0

Include all children Yes 176 58.7No 124 41.3Total 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 knowledgeItem Yes No Don’t

Know Total

No. % No. % No. % %Antibiotic used to prevent disease 191 63.7 90 30 19 6.3 100Anti 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 immunity

229 76.3 35 11.7 36 12 100

Antibiotic used to treat viral disease 207 69 65 21.7 28 9.3 100It is necessary and important to follow per scripted dose and time to be sure on the effectiveness of the antibiotic

281 93.7 15 5.0 4 1.3 100

Antibiotic is used to treat bacterial disease 193 64.3 54 18 53 17.7 100Table (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 42.0Abdominal pain 53 17.7Sore throat 224 74.7Cold 149 49.7Headache 54 18.0Joints pain 105 35.0Cough 103 34.3Flu 94 31.3Throat 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 informationItem No. %Do you have previous information about antibiotic

138 46%

Source of informationUniversity 37 12.3Courses 31 10.3Mother 73 24.3Neighbors 20 6.7Multimedia 73 24.3Internet 78 26.0Health 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 antibioticItem Always Usually Sometimes Never Total

No. % No. % No. % No. %I give the same antibiotic available if I have another child of my children diseased at the same time without the need to see a doctor

26 8.7 116 38.7 37 12.3 121 40.3 100

I give my child an antibiotic that already exists in the house

23 7.7 76 25.3 54 18 147 49 100

I Borrowed medicines, especially antibiotics from a neighbor.

14 4.7 50 16.7 25 8.3 211 70 100

If I did not notice an improvement of my child I will review the doctor

277 75.7 60 20 5 1.7 8 2.7 100

I give my child the prescribed dose of the antibiotic completely.

247 82.3 43 14.3 3 1 7 2.3 100

I stop giving my child the antibiotic when the symptoms disappear

73 24.3 80 26.7 51 17 96 32 100

I observe my child for any side effect after I give the antibiotics.

208 69.3 76 25.3 12 4 4 1.3 100

I return to doctor when I notice any side effect after giving the antibiotic.

214 71.3 63 21 20 6.7 3 1 100

I read the instructions before using the antibiotic.

262 87.3 19 6.3 13 4.3 6 2 100

I change the doctor if he did not prescribe an antibiotic to my child.

74 24.7 68 22.7 65 21 93 31 100

I use the same antibiotic to once again if the same previous disease returned without consulting the doctor

47 15.7 72 24 45 15 136 45.3 100

I buy antibiotics without a prescription. 29 9.7 67 22.3 75 25 129 43 100Retained the antibiotic to be used later on when needed.

27 9 53 17.7 63 21 157 52.3 100

I reduce the prescribed dose of the antibiotic if child feel better.

41 13.7 59 19.7 42 14 158 52.7 100

I change the prescribed dose by what I see fit for the case of my child.

48 16 41 13.7 24 8 187 62.3 100

I prepare the medication according to the instructions completely.

274 91.3 21 7 2 0.7 3 1 100

Table (3) showed that 40.3% of participants "never gave the same

available antibiotic if they have another child of their children diseased at

the same time without the need to see a doctor"; also 49% of them "never

gave the child an antibiotic that already exists in their house". 70% of the

participants "never borrowed antibiotics from a neighbor".75.7% of the

participants "always reviews the doctor if they did not notice an

improvement of their child". 82.3% of the participants "always gave their

child the prescribed dose of the antibiotic completely". 26.7% of them

"usually stop giving their child the antibiotic when the symptoms disappear".

69.3% of the participants "always observe their child for any side effect after

they give the antibiotics". 71.3% of participants "always return to doctor

when they notice any side effect after giving the antibiotic". 87.3% of

participants "always read the instructions before using the antibiotic".31% of

the participants "change the doctor if he did not prescribe an antibiotic to

their child". 45.3% of the participants "never I use the same antibiotic to

once again if the same previous disease returned without consulting the

doctor". 43% of them "never used the same antibiotic to once again if the

same previous disease returned without consulting the doctor". 52.3% of

them "never retained the antibiotic to be used later on when needed". 52.7%

"reduce the prescribed dose of the antibiotic if child feel better". 62.3%

"reduce the prescribed dose of the antibiotic if child feel better". 91.3% of

participants always "prepared the medication according to the instructions

completely".

Table (4): Distribution of percentages of participants regarding to their attitude about antibiotic useItem Agree Disagree Don’t

Know Total

No. % No. % No. %Antibiotic used to treat all pathological cases. 57 19 211 70.3 32 10.3 100I 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 of time.

181 60.3 70 23.3 49 16.3 100

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 health

181 60.3 81 27 38 12.7 100

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 antibioticWhich one of the following you mostly use No. %

Ampicillin 48 16.0Amoxicillin 91 30.3

Augmentin 93 31.0 I don’t know 68 22.7Total 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 36.7Poor 155 51.7Good 35 11.7Total 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 practiceLevel of practice No. %very poor 57 19.0Poor 63 21.0Good 125 41.7very good 55 18.3Total 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 40.0Positive 180 60.0Total 300 100.0Table (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 practice

Level of knowledge Total Chi P-value.very

poorPoor good

very poor 48.2%

4591.8%

00.0%

49100%

44.0010.00

Poor 3836.2%

5249.5%

1514.3%

105100%

Good 6847.2%

5638.9%

2013.9%

144100%

very good 00.0%

2100%

00.0%

2100%

Total 11036.7%

15551.7%

3511.7%

300100%

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 Group

Level of knowledge Total Chi P-valuevery

poorpoor good

< 20 211.1%

1372.2%

316.7%

18100%

31.9320.00

20-30 5438.0%

7854.9%

107.0%

142100%

31-40 3946.4%

4047.6%

56.0%

84100%

> 40 1526.8%

2442.9%

1730.4%

56100%

Total 11036.7%

15551.7%

3511.7%

300100%

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 attitudeLevel of practice Level of attitude Chi

p-valueVery poor 1530.0%

3570%

Poor 1330.2%

3069.8

1.6990.637

Good 3931.2%

8668.8%

Very good 1923.2%

6376.8%

Total 8628.7%

21471.3

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 levelLevel of knowledge Income level Chi

P-value<1000 1000-1499 1500-1999 >2000Very poor 17

32.1%3535.0%

2546.3%

3335.5%

8.8530.182

Poor 3464.2%

4949.0%

2342.6%

4952.7%

Good 23.8%

1616.0%

611.1

1111.8%

Total 53100%

100100%

54100%

93100%

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-valuePositiv

e

Negative

Very poor 34

30.9%

76

69.1%

Poor 43

27.7%

112

72.3%

0.4850.785

Good 9

25.7%

26

74.3%

Total 56

28.7%

214

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(

الرحيم الرحمن الله بسم

الوطنية النجاح جامعة

الصحة وعلوم الطب كلية

" باستخدام يتعلق فيما والمعتقدات والسلوك المعرفة قياسمستوى حول استبيان

اطفالهم مع الأمهات قبل من الحيوية " .المضادات

التعليمات حسب التالية الاسئلة كامل عن الاجابة حضرتك من نرجو الام عزيزتيلكل , والسرية الخصوصية يضمن تعليمي لبحث يهدف الاستبيان هذا ادناه المذكورةعلى , , توافقين كنت اذا شخصية معلومة اي عن سؤالك يتم ولن بالدراسة مشترك

التالية الاسئلة على الاجابة يرجى .المشاركة

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

المشروع على : القائمين

قدادحة أحمد

عميره محمد

بكر هيا

العيسة هنادي

الدكتورة بإشراف

الطل مريم

التابعة الصحية المراكز من المعلومات جمع تم

الاونروا لمراكز للحكومة

الشخصية : المعلومات الأول القسم

اشارة ( وضع المناسبة) :Xيرجى الاجابة عند

السكن : مكان

مخيم قرية مدينة

العمرية : الفئة

من من 40 - 31 30 - 20 20اقل 40اكثر

الاجتماعية : الحالة

أرملة مطلقة متزوجة

التعليمي :المستوى

اعدادي ابتدائي متعلمة غير

جامعي ثانوي

: الوظيفة

أعمل لا أعمل

البيت دخل : مستوى

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

الاطفال :عدد

3 -5 6-8 9 أكثر أقل 2 أو أو

لا نعم صحي تأمين تملكي هل

لا نعم أطفالك كل يشمل هل

: الحيوية المضادات استخدام حول بالمعلومات تتعلق أسئلة الثاني القسم

اشارة ( وضع المناسبة) :Xيرجى الاجابة عند

K1 . لا لا نعم الأمراض من للوقاية الحيوي المضاد يستخدمأعلم

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

K3 . لا, نعم الحيوي للمضاد الجانبية الاثار من والحرارة التقيؤ الاسهالأعلم لا

K4 . لا نعم الألبان منتجات مع يتعارضمفعولها الحيوية المضادات بعضأعلم لا

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

K6 . لا لا نعم الفيروس على للقضاء فعال الحيوي المضادأعلم

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

. الدواء فعالية من للتأكد

K8 . لا لا نعم البكتيريا على للقضاء فعال الحيوي المضاداعلم

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

الحلق آلام البطن آلام الحرارة درجة ارتفاع

المفاصل آلام الشديدة الراس آلام البرد نزلات

الحلق احتقان الرشح السعال

K10: الحيوية المضادات عن مسبقة طبية معلومات لديك هل

لا نعم

K11: منها المعلومات اخذ تم التي المصادر ما

الاعلام وسائل الجارات الأم دورات الجامعة

الصحي القطاع الانترنت

الثالث بالممارسات: القسم متعلقة أسئلة

اشارة ( وضع المناسبة) :Xيرجى الاجابة عند

الرقم

دائما غالبا أحيانا نادرا بتاتا

P1 المتوفر الحيوي المضاد نفس بإعطاء اقومفي أطفالي من أخر مرضطفل حال في لدي

الطبيب مراجعة الى الحاجه دون الوقت نفس.

P2 موجود حيوي مضاد طفلي بإعطاء اقومالبيت في . مسبقا

P3 المضادات وخاصة الادوية باستعارة أقومالجارات أحد من . الحيوية

P4 بمراجعة اقوم طفلي تحسن عدم حال في. الطبيب

P5 المضاد من الموصوفة الجرعة لطفلي أقدمكامل بشكل . الحيوي

P6 عند الحيوي المضاد طفلي اعطاء عن اتوقفالمرض اعراض . زوال

P7 جانبية اعراضا ظهور من تخوفا طفلي اراقبالحيوي المضاد اعطائه بعد

P8 على عرضجانبي اي ظهور عند الطبيب اراجعالحيوي المضاد اعطائه بعد . طفلي

P9 المضاد استخدام قبل الإرشادات نشرة اقرأ. الحيوي

P10 حيوي مضاد يصف لم اذا الطبيب بتغيير أقومطفلي .لحالة

P11 اخرى لمرة الحيوي المضاد باستخدام أقومدون السابق المرض بنفس الطفل اصابة بعد

الطبيب . استشارةP12 طبية وصفة بدون الحيوي المضاد بشراء اقوم

.

P13 عند لاحقا لاستخدامه الحيوي بالمضاد احتفظاليه . الحاجة

P14 المضاد من الموصوفة الجرعة بتقليل اقومطفلي بتحسن شعرت حال في . الحيوي

P15 أراه ما حسب الموصوفة الجرعة بتغيير أقومطفلي لحالة .مناسبا

P16 تماما الارشادات حسب الدواء بتحضير . اقوم

بالتوجهات : متعلقة أسئلة الرابع القسم

اشارة ( وضع المناسبة) :Xيرجى الاجابة عند

لاأوافقأوافق

أعلم لا

A1 الحالات جميع لعلاج يستخدم الحيوي المضاد.المرضية

A2 دون حيوي مضاد أي أستخدم أن بامكانيالطبيب .استشارة

A3 خلال طفلي تحسن اذا فعال الحيوي المضاد يكونقصيرة زمنية .فترة

A4 للمضادات جانبية مضاعفات أي يوجد لا انه اعتقد.الحيوية

A5 حالة الحيوي المضاد اعطاء عن التوقف يتمالطفل بتحسن .الشعور

A6 أن يمكن الحيوي للمضاد العشوائي الاستخدامطفلك مناعة من .يضعف

A7 طفل من لاكثر نفسه الحيوي المضاد اعطاء يمكن

A8 صحة على سلبا يؤثر الحيوي المضاد اكمال عدمطفلك

اكثر بشكل تستخدميه التالية الحيوية المضادات من : أي

Ampicillin امبيسلين

Amoxicillin اموكسيسلين

augmentin اوجمين

اعلم لا

ولاطفالكم لكم الصحة دوام ونتمنى جزيلا شكرا

Annex (2)

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.)

العلمي البحث في للاشتراك موافقه

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

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

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

\ ( ) النجاح جامعة التمريض كلية في سيجرى سريري علمي ببحث للمشاركة ة مدعو أنت( ) ( ) ي. تقرر أن قبل بتأن التالية المعلومات لقراءة الكافي الوقت ي تأخذ أن الرجاء الوطنية

. ( ) شيء أي عن إضافية معلومات أو إيضاحات طلب بإمكانك لا أم المشاركة ين تريد كنت إذاالباحثين من ككل الدراسة هذه عن أو الإستمارة هذه في .مذكور

: واجابة. الاستمارة تعبئة على البحث يقوم مجرياته وتفسير وهدفه العلمي البحث وصف أمع الحيوية للمضادات الخاطئ للاستخدام المؤدية العوامل لمعرفة جيدا قراءتها بعد الاسئلة

الصحيح الاستخدام كيفية عن توصيات وتقديم الناس لتوعية البحث ويهدف اطفالهمالحيوية . للمضادات

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

تحقيقها. نرجو التي الفوائد من :ج

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

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

: طي. إسمك سيبقى الدراسة، هذه في المشاركة على وافقت حال في معلوماتك سرية هالاستمارة . على الإطلاع حق ذلك، على القانون ينص لم ما شخص، لأي يكون لن الكتمان

بدرجة و فقط العملي البحث لغرض الا تستخدم لن المعلومات هذه بان علما تعبئتها بعدالخصوصية و السرية من .عالية

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

الباحث :موافقة

. ولقد السلبية وتأثيراته ومجرياته طبيعته العلمي البحث في للمشترك بالتفصيل الشرح تم . في تغييرات بأي المشترك أعلم وسوف أستطيع ما خير على بوضوح أسئلته كل على أجبت

البحث أثناء حصولها حال في فوائده أو السلبية تأثيراته أو البحث هذا .مجريات

المشترك موافقة على الحصول المولى الشخص او الباحث إسم

عميرة -1 طه .محمد

قدادحة -2 .احمد

العيسة -3 .هنادي

بكر - 4 .هيا

/ / : التاريخ

المشترك :موافقة

. . وبناء جميعها أسئلتي على الأجابة تمت مضمونها وفهمت هذه القبول استمارة قرأت لقدانه , واعلم فيه الإشتراك على أوافق و البحث هذا إجراء أجيز مختارا، حرا فأنني، عليه

قبل من المساعدة وطلب الاسئلة هذه عن الاجابة خلال سؤال اي عن الاستفسار يمكننيباحث . اي

التاريخ

Annex (4)