Survey of non-prescribed use of antibiotics for children in an urban community in Mongolia
Open accessAbstract
OBJECTIVE: to estimate the prevalence and identify the determinants of non-prescription use of antibiotics for children in Mongolia. METHODS: a community-based cross-sectional survey was undertaken in 10 subdistricts in Ulaanbaatar, Mongolia's capital. We used a structured questionnaire to collect data from a random sample of 540 households with at least one child aged < 5 years. Logistic regression was used to identify factors associated with antibiotic misuse. FINDINGS: of 503 participating caregivers, 71% were mothers; 42.3% (95% confidence interval, CI: 37.8-46.9) of caregivers had used non-prescribed antibiotics to treat symptoms in their child during the previous 6 months. Symptoms commonly treated were cough (84%), fever (66%), nasal discharge (65%) and sore throat (60%). Amoxicillin was the most commonly used antibiotic (58%). Pharmacies were the main source (86%) of non-prescribed antibiotics. Non-prescribed use by mothers was significantly associated with keeping antibiotics at home (odds ratio, OR: 1.7; 95% CI: 1.04-2.79), caregiver self-medication (OR: 6.3; 95% CI: 3.8-10.5) and older child's age (OR: 1.02; 95% CI: 1.01-1.04). Caregivers with a better knowledge of antibiotics were less likely to give children non-prescribed antibiotics (OR: 0.7; 95% CI: 0.6-0.8). CONCLUSION: the prevalence of non-prescribed antibiotic use for young children was high in Ulaanbaatar. Because such use leads to the spread of bacterial resistance to antibiotics and related health problems, our findings have important implications for public education and the enforcement of regulations regarding the sale of antibiotics in Mongolia.
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The prevalence of pediatric ASM in India falls below rates in the Middle East (34%) and specific countries including Jordan (39.2%), Mongolia (42.3%), Tanzania (47.7%), and Yemen (60%).
“However, the prevalence in India falls below the rates observed in the Middle East (34%) [34] and specific countries like Jordan (39.2%) [37], Mongolia (42.3%) [38], Tanzania (47.7%) [39], and Yemen (60%) [40].”
From Prevalence and associated factors of self-medication with antibiotics among pediatric population in India: a systematic review and meta-analysis (2025) · cites this paper as [38]
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“[47] 213 503 ≤ 5 years CS Any illness Drug outlet Mongolia Lower-middleincome Within 6 months”
BackgroundParental self‐medication of antibiotics for children in Jordan
Mukattash, T. L., Alkhatatbeh, M. J., Andrawos, S., Jarab, A. S., AbuFarha, R. K., & Nusair, M. B. (2020) · Journal of Pharmaceutical Health Services Research · doi:10.1111/jphs.12331 · Cited by 36 · see citing works
Islam, M. W., Shahjahan, M., Azad, A. K., & Hossain, M. J. (2024) · Scientific Reports · doi:10.1038/s41598-024-52313-y · Cited by 36 · see citing works
“Similar findings have been previously reported 19,70,73,74 .”
ResultAbobotain, A. H., Sheerah, H. A., AlOtaibi, F. N., Joury, A., Mishiddi, R., Siddiqui, A. R., & Saeed, A. B. (2013) · Saudi Medical Journal · doi:10.15537/1658-3175.5805 · Cited by 36 · see citing works
Dache, A., Dona, A., & Ejeso, A. (2021) · SAGE Open Medicine · doi:10.1177/20503121211042461 · Cited by 35 · see citing works
Le, T. H., Ottosson, Chuc, Giang, & Allebeck (2011) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s22769 · Cited by 34 · see citing works
Khoury, G. E., Ramia, E., & Salameh, P. (2017) · Evaluation & the Health Professions · doi:10.1177/0163278716686809 · Cited by 33 · see citing works
“Since management of childhood illnesses depends considerably on parents’ perception of the diseases as well as their perception of treatment regimens (Belongia, Naimi, Gale, & Besser, 2002; Togoobaatar et al., 2010) and view the lack of any similar assessment in the Lebanese population, the objective of our study was…”
BackgroundLanyero, H., Eriksen, J., Obua, C., Lundborg, C. S., Nanzigu, S., Katureebe, A., Kalyango, J. N., & Ocan, M. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235164 · Cited by 33 · see citing works
Majaj, L., Nassar, M., & Allegri, M. D. (2013) · BMC Women s Health · doi:10.1186/1472-6874-13-26 · Cited by 33 · see citing works
“Furthermore, women’s use of informal care, including both over the counter and traditional drugs, raises important concerns on treatment efficacy, potential herb-drug and drug-drug interactions, and the development of resistance [62-66].”
BackgroundStudying the knowledge, attitude and practice of antibiotic misuse among Alexandria population
El-Hawy, R. M., Ashmawy, M. I., Kamal, M. M., Khamis, H. A., El-Hamed, N. M. A., Eladely, G., Abdo, M. H., Hashem, Y., Ramadan, M., & Hamdy, D. A. (2016) · European Journal of Hospital Pharmacy · doi:10.1136/ejhpharm-2016-001032 · Cited by 32 · see citing works
Roien, R., Bhandari, D., Hosseini, S. M. R., Mosawi, S. H., Ataie, M. A., Ozaki, A., Martellucci, C. A., Kotera, Y., Delshad, M. H., Sawano, T., et al. (2021) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2021.1951229 · Cited by 32 · see citing works
Tsadik, M., Lam, L., & Kahsay, Z. H. (2019) · HIV/AIDS - Research and Palliative Care · doi:10.2147/hiv.s210977 · Cited by 31 · see citing works
“As a consequence, patients may prefer to have self-medication accessed from private facilities with limited counseling of antibiotic drug use that potentially lead to drug resistance.(8)”
BackgroundAziz, M. M., Haider, F., Rasool, M. F., Hashmi, F. K., Bahsir, S., Li, P., Zhao, M., Alshammari, T. M., & Fang, Y. (2021) · Antibiotics · doi:10.3390/antibiotics10050482 · Cited by 31 · see citing works
“As in studies from China and Mongolia, we revealed the use of non-prescribed antibiotics for children [36,37].”
Nyeko, R., Otim, F., Obiya, E. M., & Abala, C. (2022) · BMC Pediatrics · doi:10.1186/s12887-022-03375-2 · Cited by 31 · see citing works
In-home antibiotic storage among Australian Chinese migrants
Hu, J., & Wang, Z. (2014) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2014.04.017 · Cited by 30 · see citing works
“Antibiotics available at home have been found to be an important risk factor for self-medication.(7,8) In addition,”
BackgroundA qualitative study on community use of antibiotics in Kinshasa, Democratic Republic of Congo
Shembo, A. K. P., Musumari, P. M., Srithanaviboonchai, K., Tangmunkongvorakul, A., & Dalleur, O. (2022) · PLoS ONE · doi:10.1371/journal.pone.0267544 · Cited by 30 · see citing works
“Storage of antibiotics for future use is a common practice in low- and middle-income settings, and it has been shown to be associated with inappropriate use of antibiotics [42, 43].”
BackgroundBanerjee, I., Sathian, B., Gupta, R. K., Amarendra, A., Roy, B., Bakthavatchalam, P., Saha, A. C., & Banerjee, I. (2016) · Nepal Journal of Epidemiology · doi:10.3126/nje.v6i2.15165 · Cited by 33 · see citing works
Al-Shawi, M. M., Darwish, M. A., Wahab, M. M. A., & AlShamlan, N. A. (2018) · Journal of Family and Community Medicine · doi:10.4103/jfcm.jfcm_46_17 · Cited by 30 · see citing works
“The results of questions on self‐prescription in some studies were similar revealing that throat pain was the most common reason,[4,9,13,25,33,34] but other symptoms such as fever[5,7] were reported as higher in some other studies; earache,[18,32] common cold,[3] and cough.[3] Most of these symptoms that compel parent…”
ResultBert, F., Gualano, M. R., Gili, R., Scaioli, G., Lovato, E., Angelillo, I. F., Brusaferro, S., Vito, E. D., Torre, G. L., Manzoli, L., et al. (2016) · European Journal of Public Health · doi:10.1093/eurpub/ckw209 · Cited by 29 · see citing works
“11-13,15,19 Moreover, several studies demonstrated that attitudes of parents could influence the decision of the paediatrician about the prescription of an antibiotic, making the lack of knowledge of the parents about this issue even more dangerous.”
Haenssgen, M. J., Charoenboon, N., Zanello, G., Mayxay, M., Reed‐Tsochas, F., Jones, C. O. H., Kosaikanont, R., Praphattong, P., Manohan, P., Lubell, Y., et al. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2017-000621 · Cited by 29 · see citing works
“The majority of quantitative analyses of healthcare behaviour in LMICs instead adopt a single-stage approach, implying that a patient ‘chooses’ once from a portfolio of healthcare options, some of which may be more likely to involve antibiotics than others.(15) 16 This conventional analysis can be useful to measure ra…”
Ahmed, S., Korpe, P. S., Ahmed, T., Chisti, M. J., & Faruque, A. S. G. (2018) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.17-0988 · Cited by 29 · see citing works
“scribing antimicrobials by unlicensed health-care providers, which allows for excess use of antimicrobials in Bangladesh.(29) Greater distance fromahospital was clearly associatedwith”
BackgroundInfluentialPrevalence and risk factors for antibiotic utilization in Chinese children
Guo, S., Sun, Q., Zhao, X., Shen, L., & Zhen, X. (2021) · BMC Pediatrics · doi:10.1186/s12887-021-02706-z · Cited by 28 · see citing works
Cortez, J., Rosário, E., Pires, J. E., Taborda Lopes, J., Francisco, M., Vlieghe, E., & Brito, M. (2017) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2017.05.011 · Cited by 26 · see citing works
“It has been shown that storing antimicrobials at home is related to their inappropriate use (Yu et al., 2014; Togoobaatar et al., 2010).”
BackgroundOcan, M., Aono, M., Bukirwa, C., Luyinda, E., Ochwo, C., Nsambu, E., Namugonza, S., Makoba, J., Kandaruku, E., Muyende, H., et al. (2017) · BMC Public Health · doi:10.1186/s12889-017-4770-1 · Cited by 26 · see citing works
Mothers’ knowledge and practices of managing minor illnesses of children under five years
Abu‐Baker, N. N., Gharaibeh, H., Al-Zoubi, H. M., Savage, C. L., & Gharaibeh, M. K. (2012) · Journal of research in nursing · doi:10.1177/1744987112451576 · Cited by 26 · see citing works
“, 2008), or mother’s experience with previous children (Togoobaatar et al., 2010).”
BackgroundBeliefs About the Use of Nonprescribed Antibiotics Among People in Yogyakarta City, Indonesia
Widayati, A., Suryawati, S., de Crespigny, C., & Hiller, J. E. (2012) · Asia Pacific Journal of Public Health · doi:10.1177/1010539512445052 · Cited by 26 · see citing works
“Gender Male 12 (48) Female 13 (52) Age in years, median (range) 36 (20-60) Education background University 10 (40) Senior high school 12 (48) Junior high school 1 (4) Elementary school 1 (4) Did not mention 1 (4) Family income level (US$) ≥800 2 (8) 150-800 9 (36) <150 14 (56) Number of family sharing in the household…”
BackgroundSelf-medication with antibiotics in Sana’a City, Yemen
Albawani, S. M., Hassan, Y. B., Abd-Aziz, N., & Gnanasan, S. (2017) · Tropical Journal of Pharmaceutical Research · doi:10.4314/tjpr.v16i5.30 · Cited by 26 · see citing works
“Similar findings have been reported in other studies as well [7,15,16].”
ResultKhurelbat, D., Dorj, G., Sunderland, B., Sanjjav, T., Bayarsaikhan, E., Damdinjav, D., Dorj, G., Jigjidsuren, A., Lkhagvasuren, O., & Erdenetsetseg, B. (2020) · BMC Public Health · doi:10.1186/s12889-020-08897-x · Cited by 25 · see citing works
Duan, L., Liu, C., Wang, D., Lin, R., Qian, P., Zhang, X., & Liu, C. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.985188 · Cited by 24 · see citing works
“High levels of antibiotic consumption are often accompanied by high expectations, leading to leftover or nonprescription purchasing antibiotic products to be used for selfmedication (69, 71, 96, 97).”
BackgroundInfluentialHaque, M., Mostafa, A., & Hoque, R. (2015) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s90110 · Cited by 24 · see citing works
Hallit, S. R., Zahreddine, L., Saleh, N., Shakaroun, S., & Lahoud, N. (2019) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13165 · Cited by 23 · see citing works
Tefera, T. K., Gedif, T., Andualem, T., & Aferu, T. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e08825 · Cited by 22 · see citing works
“3% children used non-prescribed antibiotics for upper respiratory tract infection symptoms such as cough, fever or nasal and throat problems (Togoobaatar et al., 2010).”
BackgroundIvanovska, V., Angelovska, B., van Dijk, L., Zdravkovska, M., Leufkens, H. G. M., & Mantel-Teeuwisse, A. K. (2017) · European Journal of Public Health · doi:10.1093/eurpub/ckx240 · Cited by 22 · see citing works
Alkaff, R. N., Kamigaki, T., Saito, M., Ariyanti, F., Iriani, D. U., & Oshitani, H. (2019) · Tropical Medicine and Health · doi:10.1186/s41182-019-0173-6 · Cited by 20 · see citing works
Gunawardhana, C., Sakeena, M. H. F., & Sivayoganthan, C. (2015) · Tropical Journal of Pharmaceutical Research · doi:10.4314/tjpr.v14i4.23 · Cited by 21 · see citing works
Wu, J., Yang, F., Yang, H., Zhang, G., Mu, K., Feng, J., Wang, J., & Yin, X. (2021) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2021.1882303 · Cited by 22 · see citing works
Knowledge and practices related to antibiotic use among women in Malang, Indonesia
Yunita, S. L., Yang, H.-W., Chen, Y., Kao, L., Lu, Y.-Z., Wen, Y.-L., To, S.-Y., & Huang, Y. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.1019303 · Cited by 19 · see citing works
“Furthermore, one study provided evidence that most family caregivers were female and around the reproductive age (Togoobaatar et al., 2010).”
BackgroundPadget, M., Tamarelle, J., Herindrainy, P., Ndir, A., Sarr, F. D., Richard, V., Piola, P., Guillemot, D., & Delarocque‐Astagneau, E. (2016) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkw446 · Cited by 19 · see citing works
Al-Rukban, M. O., AlRuthia, Y. S., Almasaoud, M. A., Alowairdhi, M. A., Alsouan, A. A., Alrabiah, A., Al-Shaikh, A. H., Alsuhaibani, A. A., & Aleidan, A. (2020) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s278404 · Cited by 19 · see citing works
“Similarly, another study that explored the rate of DAwP in community pharmacy settings in Egypt using a simulated patient method for two viral infections scenarios (eg, acute bronchitis and common cold) found that antibiotics were dispensed in 98% of 238 visits that were made.(18) Most of the dispensed antibiotics wit…”
Bataar, O., Khuderchuluun, C., Lundeg, G., Chimeddorj, S., Brunauer, A., Gradwohl-Matis, I., & Dünser, M. W. (2013) · PubMed · Cited by 18 · see citing works
Hossain, M. S., Islam, M. F., Arka, P. B., Rohman, M., Ahmed, T. S., Ahammed, T., Chowdhury, M. A. B., & Uddin, M. J. (2023) · EClinicalMedicine · doi:10.1016/j.eclinm.2023.102055 · Cited by 18 · see citing works
Pharmacy students’ knowledge and attitudes about antibiotics in Kosovo
Fejza, A., Kryeziu, Z., Kadrija, K., & Musa, M. (2016) · Pharmacy Practice · doi:10.18549/pharmpract.2016.01.715 · Cited by 17 · see citing works
“Studies from the American, Asian and European countries indicate that between 22% and 70% of parents have misconceptions about the appropriate applications and efficacy of antibiotics and often use them without a prescription.(3) One of the key areas in the control of antibiotic resistance is a change in the behavior…”
BackgroundGhasemyani, S., Roohravan Benis, M., Hosseinifard, H., Jahangiri, R., Aryankhesal, A., Shabaninejad, H., Rafiei, S., & Ghashghaee, A. (2022) · Annals of Public Health · doi:10.55085/aph.2022.585 · Cited by 31 · see citing works
“However, this type of self-medication is more prevalent in developing countries (9, 17, 18).”
BackgroundKagashe, G. A. B. (2012) · IOSR Journal of Pharmacy (IOSRPHR) · doi:10.9790/3013-25502125 · Cited by 16 · see citing works
Parents' knowledge and attitude to self-medication of children with antibiotics
Sharif, S., Masalmeh, B. M., Osama, A., Bugaighis, L. M. T., Abdulmqasood, Y. A., & Awad, H. A. (2015) · Archives of Pharmacy Practice · doi:10.4103/2045-080x.166592 · Cited by 15 · see citing works
“Our findings support those of previous studies in Mongolia[6] and the USA,[15] as most respondents in our study suggested past experience as the main reason for medicating their children with antibiotics but contrast with reports in 0% 10% 20% 30% 40% 50% 60% Clavulinic-Amoxicillin (Augmentin) Amoxicillin Metronidazol…”
BackgroundResultInfluentialContaining antimicrobial resistance: a renewed effort
Weerasuriya, K., Stelling, J. M., & O’Brien, T. (2010) · Bulletin of the World Health Organization · doi:10.2471/blt.10.084236 · Cited by 14 · see citing works
Jaruševičienė, L., Jurgute, R. R., Bjerrum, L., Jurgutis, A., Jaruševičius, G., & Lazarus, J. V. (2013) · Upsala Journal of Medical Sciences · doi:10.3109/03009734.2013.778925 · Cited by 13 · see citing works
“The increased antibiotic use when antibiotics are directly accessible to patients without a prescription is a widely known phenomenon (38,39).”
BackgroundFactors Associated with Parental Self-medication of Antibiotics in Health Centers of Manila
Bulario, J. S., Cruz, I. L. P., Pilapil, M., & Gutiérrez, M. M. M. (2018) · KnE Social Sciences · doi:10.18502/kss.v3i6.2427 · Cited by 13 · see citing works
“Togoobaatar et al (2010) found that likelihood of treating the child with non-prescribed antibiotics increasedwith children’s age.”
BackgroundCheo, R., Ge, G., Godager, G., Liu, R., Wang, J., & Wang, Q. (2020) · Health Economics Review · doi:10.1186/s13561-020-00290-z · Cited by 13 · see citing works
Bringing Medicine from Pakistan and Self-Medication Among Pakistani Mothers in New Zealand
Akhtar, S. S., Heydon, S. J., & Norris, P. (2021) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-021-01228-1 · Cited by 13 · see citing works
Baljin, B., Baldan, G., Chimeddorj, B., Tulgaa, K., Gunchin, B., Sandag, T., Pfeffer, K., MacKenzie, C. R., & Wendel, A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0168146 · Cited by 12 · see citing works
Paredes, J. L., Navarro, R., Riveros, M., Picon, V., Conde, F., Suito, M., & Ochoa, T. J. (2019) · Clinical Medicine Insights Pediatrics · doi:10.1177/1179556519869338 · Cited by 12 · see citing works
“5 (2-12) 8 (2-18) 8 (2-12) Number of children, n (%) One 34 (30.”
Abayneh, M., Hailemariam, S., & Asnake, M. (2021) · Journal of Laboratory Medicine · doi:10.1515/labmed-2020-0124 · Cited by 11 · see citing works
“3% of caregivers had used non prescribed antibiotics to treat symptoms in their child during the previous six months [57].”
BackgroundNair, R., Hanson, B., Kondratowicz, K., Altantsetseg, D., Bulgan, D., Enkhtuya, B., Tundev, O., & Smith, T. C. (2013) · PeerJ · doi:10.7717/peerj.176 · Cited by 11 · see citing works
“The study found approximately 50% of the children in participating households were prescribed antibiotics, of which roughly 51% children were given both prescribed and non-prescribed antibiotics by their caregiver (Togoobaatar et al., 2010).”
BackgroundInfluentialPrevalence and Predictors of Self-Medication with Antibiotics for Children in Makkah, Saudi Arabia
Alfalogy, E. H. (2017) · European Journal of Preventive Medicine · doi:10.11648/j.ejpm.20170505.12 · Cited by 11 · see citing works
Study on Self-medication Practices among University Students of Bangladesh
Idris, T., Khanum, S., Uddin, M., Asaduzzaman, M., Islam, M. D., Nasrin, F., & Haider, S. (2016) · Journal of Advances in Medicine and Medical Research · doi:10.9734/bjmmr/2016/24364 · Cited by 11 · see citing works
“Prevalence rates of self-medication are reported to be higher in developing countries [4].”
BackgroundSelf-medication practice among children in Antananarivo, Madagascar
Tsifiregna, R. L., Razafimahatratra, S., Raveloharimino, N. H., Rakotomalala, R. L. H., & Ravelomanana, N. (2016) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20163991 · Cited by 11 · see citing works
- Authors
- Togoobaatar, G., Ikeda, N., Ali, M., Sonomjamts, M., Dashdemberel, S., Mori, R., & Shibuya, K.
- Affiliations
- The University of Tokyo (JP)
- Venue
- Bulletin of the World Health Organization
- Publisher
- WHO Press
- Published
- 2010-12-01
- Volume
- 88
- Issue
- 12
- Pages
- 930-936
- ISSN
- 0042-9686 (ISSN-L)
- PMC
- PMC2995192
- OpenAlex
- W2158815913
- Cited by
- 199
- References
- 36
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 9 · 2023: 11 · 2022: 23 · 2021: 18 · 2020: 16 · 2019: 21 · 2018: 22 · 2017: 14 · 2016: 16 · 2015: 11 · 2014: 9 · 2013: 10 · 2012: 8
- FWCI
- 9.33
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Bulletin of the World Health Organization (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc-nd)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Asian Development Bank
- Ministry of Health, Labour and Welfare
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Physical Sciences › Environmental Science › Pollution › Pharmaceutical and Antibiotic Environmental Impacts
- Keywords
- antibiotic misuse, children, self-medication, antibiotic knowledge, amoxicillin, pharmacy, antibiotic resistance, Ulaanbaatar, Mongolia
- MeSH terms
- Adult, Anti-Bacterial Agents, Child, Preschool, Cross-Sectional Studies, Nonprescription Drugs, Female, Humans, Infant, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Mongolia, Urban Population, Health Care Surveys, Young Adult
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