title: Antibiotic use in rural China: a cross-sectional survey of knowledge, attitudes and self-reported practices among caregivers in Shandong province.
abstract: BACKGROUND
  To improve antibiotic use globally, we must deepen our understanding of the public's knowledge, attitudes and practices (KAP) concerning antibiotics. Children are frequent users of antibiotics, and their caregivers play important roles in determining how antibiotics are used. The purpose of this study was to describe caregivers' KAP in a rural province in eastern China, and to identify socio-demographic factors associated with inappropriate antibiotic use.
  
  
  METHODS
  A cross-sectional questionnaire based survey was conducted in 12 villages in one county in Shandong Province. A total of 727 individuals who were the primary day-to-day caregiver for a child aged 0-7 years were randomly selected and invited to participate. All caregivers were surveyed face-to-face using a semi-structured questionnaire focusing on the use of antibiotics in children.
  
  
  RESULTS
  Almost all invited caregivers (99.3 %) completed the questionnaire in full. Caregivers expressed high levels of over-expectation for antibiotics for common childhood symptoms, stating that antibiotics were always or usually necessary when a child has a fever (46 %) or dry cough (42 %). Most caregivers (93 %) were aware that they should follow the doctor's advice when giving their children antibiotics. Many, however, reported that they had previously deviated from advice; this was most commonly through using antibiotics intermittently rather than regularly, but also by increasing and decreasing doses. Caregivers that were older and that had less formal education had higher levels of self-reported adherence (p < 0.01). A third of caregivers admitted to storing leftover antibiotics at home, and almost all of these caregivers (97 %) had used the antibiotics on a second occasion for their child.
  
  
  CONCLUSIONS
  We have identified important gaps in knowledge, attitudes and practices concerning antibiotics among this rural population of caregivers. There is a clear need for multifaceted interventions that target village doctors, to improve prescribing and communication, as well as the general public, to improve health-seeking behaviours and promote responsible individual use of antibiotics.
authors.affiliation: School of Health Care Management, Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, Jinan, Shandong Province, 250012, China. liluding@163.com.|Global health - Health Systems and Policy: Improving the use of medicines, Department of Public Health Sciences, Karolinska Institutet, Stockholm, 17171, Sweden. liluding@163.com.
authors.forename: Lilu
authors.initials: L
authors.lastname: Ding
authors.affiliation: School of Health Care Management, Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, Jinan, Shandong Province, 250012, China. qiangs@sdu.edu.cn.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Sun
authors.affiliation: School of Health Care Management, Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, Jinan, Shandong Province, 250012, China. 763854410@qq.com.
authors.forename: Weishuai
authors.initials: W
authors.lastname: Sun
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong Province, 250012, People's Republic of China. duyihuisdu@163.com.
authors.forename: Yihui
authors.initials: Y
authors.lastname: Du
authors.affiliation: School of Health Care Management, Center for Health Management and Policy, Key Lab of Health Economic and Policy Research of Ministry of Health, Shandong University, Jinan, Shandong Province, 250012, China. 1172864300@qq.com.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.affiliation: Jinan Center for Disease Control and Prevention, Jinan, Shandong Province, 250021, China. 1342212940@qq.com.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Bian
authors.affiliation: Yanggu County Center for Disease Control and Prevention, Liaocheng city, Shandong Province, 252300, China. 854037609@qq.com.
authors.forename: Guiqin
authors.initials: G
authors.lastname: He
authors.affiliation: Yanggu County Center for Disease Control and Prevention, Liaocheng city, Shandong Province, 252300, China. 497751957@qq.com.
authors.forename: Huidong
authors.initials: H
authors.lastname: Bai
authors.affiliation: Global health - Health Systems and Policy: Improving the use of medicines, Department of Public Health Sciences, Karolinska Institutet, Stockholm, 17171, Sweden. oliver.dyar@ki.se.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Dyar
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D002654:Child Care / Q000706:statistics & numerical data; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data; D057566:Self Report; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents