Understanding parental self-medication with antibiotics for children in China: a multi-nationality analysis

Background: Bacterial resistance has become an important public health concern which mainly caused by irrational use and self-medication with antibiotics. This study aims to explore the association between parent's nationality and parental self-medication with antibiotics under the one Chinese health service system, and further compare differences in medical knowledge, attitudes and behaviors about antibiotics amongst nationalities. Methods: Based on a structured questionnaire survey, a cross-sectional study was designed to investigate a cluster of 310 parents in an International Department of an International School in Xi'an, Shaanxi, China, including Chinese, other Asians and Occidental. Binary Logistic Regression was used to examine the association between nationality and parental self-medication with antibiotics for children. The differences in medical knowledge, attitudes and behaviors about antibiotics were analyzed by Pearson Chi-square test. Results: The proportion of parental self-medication with antibiotics on children was 20.10%, 5.00% and 2.67% for Chinese, other Asians and Occidental, respectively ( P <0.001). Chinese parents were more likely to have self-medication with antibiotics for children compared to Occidental parents (OR=8.221, 95%CI: 1.646-41.054, P <0.01 in Model1 and OR=6.086, 95%CI: 1.012-36.594, P <0.05 in Model2). Occidental parents had higher rate of correct medical knowledge, attitudes and behaviors about antibiotics than Chinese and followed by other Asians in total ( P <0.001). Conclusions: Nationality is significantly associated with parental self-medication with antibiotics for children, showing that Chinese parents are more likely to self-medicate with antibiotics for children than Occidental parents. Occidental parents perform better in medical knowledge, attitudes and behaviors about antibiotics compared to Chinese and other Asians. This study highlights that the effectiveness of more efforts placed on health educations to parents on antibiotics use from demand side beyond the supervision and regulation on health service supplier in China. Key words: Parental self-medication with antibiotics; Nationalities; Medical knowledge; Attitudes; Behaviors