Cited by 199Antibiotic Use and ResistancePharmacy and Medical PracticesPharmaceutical and Antibiotic Environmental Impacts

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Survey of non-prescribed use of antibiotics for children in an urban community in Mongolia

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Togoobaatar, Ganchimeg, Ikeda, Nayu, Ali, Moazzam, Sonomjamts, Munkhbayarlakh, Dashdemberel, Sarangerel, Mori, Rintaro, Shibuya, Kenji·2010·Bulletin of the World Health Organization

DOI 10.2471/blt.10.079004PMC PMC2995192

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Abstract

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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Nyeko, R., Otim, F., Obiya, E. M., & Abala, C. (2022) · BMC Pediatrics · doi:10.1186/s12887-022-03375-2 · Cited by 31
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
“Antibiotics available at home have been found to be an important risk factor for self-medication.(7,8) In addition,”
Background
A 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
“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].”
Background
Self-medication practice among preclinical university students in a medical school from the city of Pokhara, Nepal
Banerjee, 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
Misconceptions of parents about antibiotic use in upper respiratory tract infections: A survey in primary schools of the Eastern Province, KSA
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
“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…”
Result
Knowledge and attitudes towards the use of antibiotics in the paediatric age group: a multicenter survey in Italy
Bert, 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
“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.”
Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion
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
“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…”
Burden and Risk Factors of Antimicrobial Use in Children Less Than 5 Years of Age with Diarrheal Illness in Rural Bangladesh
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
“scribing antimicrobials by unlicensed health-care providers, which allows for excess use of antimicrobials in Bangladesh.(29) Greater distance fromahospital was clearly associatedwith”
BackgroundInfluential
Prevalence 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
Antimicrobial storage and antibiotic knowledge in the community: A cross-sectional pilot study in north-western Angola
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
“It has been shown that storing antimicrobials at home is related to their inappropriate use (Yu et al., 2014; Togoobaatar et al., 2010).”
Background
Medicine use practices in management of symptoms of acute upper respiratory tract infections in children (≤12 years) in Kampala city, Uganda
Ocan, 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
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
“, 2008), or mother’s experience with previous children (Togoobaatar et al., 2010).”
Background
Beliefs 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
“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…”
Background
Self-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
“Similar findings have been reported in other studies as well [7,15,16].”
Result
A cross-sectional analysis of falsified, counterfeit and substandard medicines in a low-middle income country
Khurelbat, 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
The vicious cycle of the public's irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review
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
“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).”
BackgroundInfluential
Intern doctors’ views on the current and future antibiotic resistance situation of Chattagram Maa O Shishu Hospital Medical College, Bangladesh
Haque, M., Mostafa, A., & Hoque, R. (2015) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s90110 · Cited by 24
Practice of parents and pharmacists regarding antibiotics use in pediatrics: A 2017 cross‐sectional study in Lebanese community pharmacies
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
Antibiotics self-medication practices among health care professionals in selected public hospitals of Addis Ababa, Ethiopia
Tefera, T. K., Gedif, T., Andualem, T., & Aferu, T. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e08825 · Cited by 22
“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).”
Background
Change in parental knowledge, attitudes and practice of antibiotic use after a national intervention programme
Ivanovska, 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
Use of antibiotics for common illnesses among children aged under 5 years in a rural community in Indonesia: a cross-sectional study
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
Awareness of Rational Medication Use and Antibiotic Self- Medication Practices among Undergraduate Students in a University in Sri Lanka
Gunawardhana, C., Sakeena, M. H. F., & Sivayoganthan, C. (2015) · Tropical Journal of Pharmaceutical Research · doi:10.4314/tjpr.v14i4.23 · Cited by 21
Prevalence of antibiotic self-medication behavior and related factors among children aged 0 to 5 years
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
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
“Furthermore, one study provided evidence that most family caregivers were female and around the reproductive age (Togoobaatar et al., 2010).”
Background
A community survey of antibiotic consumption among children in Madagascar and Senegal: the importance of healthcare access and care quality
Padget, 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
Community Pharmacists’ Views of the Enforced Antibiotics Dispensing Law and Its Impact on Oral Antibiotics Sales in Saudi Arabia
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
“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…”
Rate and pattern of antibiotic resistance in microbiological cultures of sepsis patients in a low-middle-income country's ICU.
Bataar, O., Khuderchuluun, C., Lundeg, G., Chimeddorj, S., Brunauer, A., Gradwohl-Matis, I., & Dünser, M. W. (2013) · PubMed · Cited by 18
Antibiotic prescription from qualified sources for children with fever/cough: cross-sectional study from 59 low- and middle-income countries
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
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
“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…”
Background
Global, WHO Regional, and Continental Prevalence of Self-medication from 2000 to 2018: A Systematic Review and Meta-analysis
Ghasemyani, 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
“However, this type of self-medication is more prevalent in developing countries (9, 17, 18).”
Background
Self medication among patients seen at ophthalmology clinics at four hospitals in dar es salaam tanzania
Kagashe, G. A. B. (2012) · IOSR Journal of Pharmacy (IOSRPHR) · doi:10.9790/3013-25502125 · Cited by 16
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
“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…”
BackgroundResultInfluential
Containing 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
Enabling factors for antibiotic prescribing for upper respiratory tract infections: Perspectives of Lithuanian and Russian general practitioners
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
“The increased antibiotic use when antibiotics are directly accessible to patients without a prescription is a widely known phenomenon (38,39).”
Background
Factors 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
“Togoobaatar et al (2010) found that likelihood of treating the child with non-prescribed antibiotics increasedwith children’s age.”
Background
The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment
Cheo, 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
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
Faecal Carriage of Gram-Negative Multidrug-Resistant Bacteria among Patients Hospitalized in Two Centres in Ulaanbaatar, Mongolia
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
Parental Antibiotic Use in Urban and Peri-Urban Health Care Centers in Lima: A Cross-Sectional Study of Knowledge, Attitudes, and Practices
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
“5 (2-12) 8 (2-18) 8 (2-12) Number of children, n (%) One 34 (30.”
Bacterial profile and multi-drug resistance pattern of bacterial isolates among septicemia suspected cases: a meta-analysis report in Ethiopia
Abayneh, M., Hailemariam, S., & Asnake, M. (2021) · Journal of Laboratory Medicine · doi:10.1515/labmed-2020-0124 · Cited by 11
“3% of caregivers had used non prescribed antibiotics to treat symptoms in their child during the previous six months [57].”
Background
Antimicrobial resistance and molecular epidemiology of Staphylococcus aureus from Ulaanbaatar, Mongolia
Nair, 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
“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).”
BackgroundInfluential
Prevalence 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
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 13
“Prevalence rates of self-medication are reported to be higher in developing countries [4].”
Background
Self-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

Authors: Togoobaatar, G., Ikeda, N., Ali, M., Sonomjamts, M., Dashdemberel, S., Mori, R., & Shibuya, K.
Affiliations: The University of Tokyo (JP)
ORCID: Ikeda, Nayu
Ali, Moazzam
Sonomjamts, Munkhbayarlakh
Mori, Rintaro
Shibuya, Kenji
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)
DOI: 10.2471/blt.10.079004
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: Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
Health Sciences › Health Professions › Pharmacy › 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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Survey of non-prescribed use of antibiotics for children in an urban community in Mongolia

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