Public awareness, risk perceptions and behaviour towards antibiotic use in food-producing animals and antimicrobial resistance in Malaysia: A cross-sectional study.

Antimicrobial resistance (AMR) is a growing global public health problem, particularly in low- and middle-income countries, including Malaysia. Understanding risk perceptions on antimicrobial use (AMU) in food-producing animals from the general public perspective is an essential component in addressing AMR. However, little is known about public risk perceptions of AMU and AMR in food-producing animals in Malaysia. The objectives of this study were to assess the level of awareness, risk perceptions, and behaviour regarding antibiotic use in food-producing animals and antimicrobial resistance and to examine the factors associated with risk perceptions and the relationship between knowledge, awareness, risk perceptions and behaviour among the general public in Malaysia. A cross-sectional survey was used. Both descriptive and analytical statistics were used to analyse data and present results. Correlation and regression analyses were conducted to examine the factors associated with risk perceptions and the relationship between risk perceptions and behaviour. A total of 416 individuals participated in the study. The majority of the participants (69.2 %) had low knowledge of antibiotics and antibiotic use in food-producing animals. The levels of awareness of antibiotic use and the perceived route of antibiotic resistance transfer were moderate. Participants had a high level of general risk perception (GRP) of antibiotic use, a moderate level of personal-level risk perception (PRP) of antibiotic resistance transmission, and a high level of societal-level risk perception (SRP) of antibiotic resistance transmission. Awareness of antibiotic use was a significant predictor of GRP (ß = 0.27, 95 %CI: 0.12-0.31, P < 0.001). Awareness of route of resistance transfer was a significant predictor of PRP (ß = 0.54, 95 %CI: 0.32-0.44, P < 0.001) and SRP (ß = 0.47, 95 %CI: 0.32-0.46, P < 0.001). PRP is the only significant predictor of behavioural changes towards antibiotic use and antibiotic resistance (OR = 1.45 [1.02-2.07], P = 0.041). Overall, there is a general lack of knowledge and little awareness of antibiotic use and antibiotic resistance in food-producing animals in Malaysia. Risk perceptions were moderate to high and were significantly predicted by awareness of antibiotic use and route of resistance transfer. Personal-level risk perception was a significant predictor of behavioural changes aimed at reducing the risk of AMU and AMR. It is imperative to raise public awareness and understanding of the risks associated with AMU in food-producing animals. Risk communication should be emphasised to ensure the translation of public risk perceptions into behavioural changes.

Use of Complementary and Alternative Medicine and Adherence to Medication Therapy Among Stroke Patients: A Meta-analysis and Systematic Review.

Purpose: To identify the use patterns of complementary and alternative medicine (CAM) and its impact on medication adherence among patients with stroke. Method: A systematic search through Science Direct, Google Scholar, and PubMed was performed to identify potential studies up to June 2021.The primary outcome was CAM use, and the secondary outcome was medication adherence among patients with stroke. Articles included in the review met the following criteria: 1) patients with stroke ≥18 years old on prescribed medications, and 2) medication adherence reported status. Meta-analyses were conducted to estimate the pooled prevalence of complementary and alternative medicine and adherence in stroke patients using a random-effects model. Results: A total of 1,330 studies were screened, of which 22 were included in the final analysis. The type of studies included were cross-sectional surveys, cohort studies, retrospective studies and prospective survey. The pooled prevalence of CAM usage was at 38% (29-48% CI) and medication non-adherence among stroke patients was at 29% (20-48% CI). The most common reason for inadequate stroke therapy and higher dependence on CAM was the patients' lack of knowledge and the regimen complexity of the medication. Other factors for medication non-adherence were forgetfulness, side effects, cost, and lack of doctor-patient communication. Conclusion: A low prevalence of CAM usage and non-adherence to medications was observed among patients with stroke. Studies investigating the association between CAM usage and medication adherence among patients with stroke are scarce and future researches are needed to explore the influence of CAM use on stroke medication adherence.

Factors associated with the intention of community pharmacists to report adverse drug reactions to regulatory authority in Malaysia: application of the theory of planned behaviour.

OBJECTIVES: It is known that community pharmacists in Malaysia underreport adverse drug reactions (ADRs). In order to improve ADR reporting, a theory-based understanding of the factors associated with the community pharmacists' reporting behaviour is important. This study used the theory of planned behaviour (TPB) to identify the predictors of behavioural intention to report ADRs to the regulatory authority among community pharmacists in Malaysia and to assess the relative importance of the predictors. METHODS: A questionnaire-based study was conducted among 188 randomly selected community pharmacists in the state of Johor, Malaysia. The questionnaire included four main TPB constructs (intention, attitude, subjective norms and perceived behavioural control) and related measures, including perceived moral obligation, past reporting behaviour and sociodemographic variables. Descriptive and hierarchical regression analyses were conducted. KEY FINDINGS: A total of 164 questionnaires were collected. The mean score of intention to report ADRs was 15.43 (SD = 2.99). The final model of the hierarchical regression analysis showed that attitude towards ADR reporting (P = 0.004), subjective norm (P = 0.010) and perceived moral obligation (P = 0.014) were significant predictors of intention to report ADRs. Attitude was the most significant predictor, followed by subjective norm and perceived moral obligation. CONCLUSIONS: Interventions targeting community pharmacists' attitude, subjective norms and perceived moral obligations towards ADR reporting, with a specific focus on attitude would likely have a positive impact on improving ADR reporting in Malaysia.

Risk Minimization Measures in Off-Label Drug Use: A Survey of Community Pharmacists in Malaysia.

BACKGROUND: While off-label drug use is common and sometimes necessary, it also presents considerable risks. Therefore, measures intended to prevent or reduce the potential exposure to off-label risks have been recommended. However, little is known about community pharmacists' beliefs regarding these measures in Malaysia. OBJECTIVES: This study examined community pharmacists' beliefs towards risk minimization measures in off-label drug use in Malaysia and assessed the relationship between perceived risk of off-label drug use and beliefs towards risk minimization measures. METHODS: A cross-sectional survey was conducted among 154 pharmacists practicing in randomly selected community pharmacies in Kuala Lumpur and the State of Selangor, Malaysia. RESULTS: The majority agreed or strongly agreed that adverse drug events from the off-label drug should be reported to the regulatory authority (90.9%) and the off-label drug should only be used when the benefit outweighs potential risks (88.3%). Less than half (48.1%) agreed or strongly agreed that written informed consent should be obtained before dispensing off-label drugs and a majority (63.7%) agreed or strongly agreed that the informed consent process will be burdensome to healthcare professionals. Beliefs towards risk minimization measures were significantly associated with perceived risk of off-label drug use regarding efficacy (p = 0. 033), safety (p = 0.001), adverse drug rection (p = 0.001) and medication errors (p = 0.002). CONCLUSION: The community pharmacists have positive beliefs towards most of the risk minimization measures. However, beliefs towards written informed consent requirements are not encouraging. Enhancing risk perception may help influence positive beliefs towards risk minimization measures.

Factors associated with prescribing restriction on oncology formulary drugs in Malaysia.

Background Drugs listed on formularies are often subjected to a variety of utilization restriction measures. However, the degree of restriction is influenced by multiple factors, including the characteristics and attributes of the listed drugs. Objective To identify the factors that are associated with the levels of prescribing restriction on oncology formulary drugs in Malaysia. Setting Oncology formulary in Malaysia. Method The Malaysia Drug Code assigned to each of the drug products on the Malaysia Ministry of Health (MOH) drug formulary was used to identify oncology drugs belonging to WHO ATC class L (antineoplastic and immunomodulating agents). Main outcome measures Categories of prescribing restrictions, therapeutic class, drug type, administration mode, number of sources and the post-approval use period. Results Oncology drugs having a shorter post-approval use period (p < 0.001), biologic oncology drugs (p = 0.01) and oncology drugs belonging to immunosuppressant therapeutic class (p = 0.03) were all significantly associated with a greater likelihood of being subjected to a higher level of prescribing restriction. Conclusion This study suggests that safety concerns, costs and potentials for inappropriate use were the important considerations influencing a higher level of prescribing restriction placement on oncology drugs in the Malaysia MOH drug formulary.

Knowledge and attitude of healthcare workers about Middle East Respiratory Syndrome in multispecialty hospitals of Qassim, Saudi Arabia.

BACKGROUND: With the increase in prevalence of Middle East Respiratory Syndrome (MERS), healthcare workers (HCWs) are at risk of acquiring and subsequently transmitting this lethal virus. In view of this, HCWs were evaluated for their knowledge of and attitude towards MERS in Saudi Arabia. METHODS: A cross sectional study was performed in two hospitals of Qassim region in Saudi Arabia. A total of 280 healthcare workers were selected to participate in this study. Knowledge and attitude were assessed by using self-administered and pretested questionnaire. Descriptive statistics were carried out to express participants' demographic information, mean knowledge score and mean attitude score of HCWs. Inferential statistics (Mann-Whitney U test and Kruskal Wallis tests, p < 0.05) were used to examine differences between study variables. Chi squares tests were used to assess the association between study variables and attitude questions. Spearman's rho correlation was used to identify the association between the knowledge, attitude scores. RESULT: Participants demonstrated good knowledge and positive attitude towards MERS. The mean scores of knowledge and attitude were 9.45 ± 1.69 (based on 13 knowledge questions) and 1.82 ± 0.72 (based on 7 attitude questions). The correlation between knowledge and attitude was significant (correlation coefficient: 0.12; P <0.001). HCWs were less educated about the management (42.4%), source (66%) and consequences of MERS (67.3%), while a majority of them were well aware of the hallmark symptoms (96%), precautionary measures (96%) and hygiene issues (94%). Although the majority of respondents showed positive attitude towards the use of protective measures (1.52 ± 0.84), their attitude was negative towards their active participation in infection control program (2.03 ± 0.97). Gender and experience were significantly associated with knowledge and attitude (P < 0.05). CONCLUSIONS: The findings of this study showed that healthcare workers in Qassim region of Saudi Arabia have good knowledge and positive attitude towards MERS. Yet there are areas where low knowledge and negative attitude of HCWs was observed. However, studies are required to assess the knowledge and attitude of HCWs at national level so that effective interventions could be designed as surveillance and infection control measures are critical to global public health.

Exploring antibiotic use and practices in a Malaysian community.

BACKGROUND: In Malaysia, antibacterial agents are among the most utilized drugs. There has been an increase in their use in recent years, contributing to an increase of antimicrobial resistance (AMR). OBJECTIVES: This study explores the pattern of antibiotic use and practices in a Malaysian community and identifies the variables associated with a likelihood of non-compliance with a course of antibiotic treatment. SETTING: The study was conducted in Cheras, a community located to the south-east of Kuala Lumpur, the capital city of Malaysia. METHOD: A cross-sectional survey was conducted with 250 individuals, using an interviewer-administered questionnaire in Cheras, Kuala Lumpur, Malaysia. MAIN OUTCOME MEASURES: Frequency of antibiotic use, sources of antibiotics, use of antibiotics without prescription, discontinuation of antibiotic treatment, antibiotic resistance awareness, handling of unused antibiotics, and association between respondents characteristics and compliance with a course of antibiotic treatment. RESULTS: Approximately 36 % of the participants (n = 91) had taken antibiotics in the year of the study. The majority (66.8 %) obtained antibiotics from clinics. Almost 80 % of the participants had never obtained antibiotics without a doctor's prescription. Nearly 55 % discontinued the course of antibiotics once symptoms disappeared. The most common method of disposing leftover antibiotics was throwing them into the household rubbish bin (78.8 %). Only 6.4 % of participants returned leftover antibiotics to the pharmacist or doctor. Univariate analysis revealed that male gender (p = 0.04), lack of knowledge of antibiotic functions (p < 0.0001), and lack of awareness of antibiotic resistance (p < 0.0001) were all significantly associated with a greater likelihood of non-compliance with a full course of prescribed antibiotic treatment. CONCLUSION: Most individuals in the Malaysian community obtained antibiotics through prescription. Non-completion of a course of antibiotic treatment and improper disposal of unused antibiotics need to be addressed to prevent AMR. Male gender, lack of knowledge and awareness of antibiotics and resistance were significantly associated with a greater likelihood of non-compliance with a full course of prescribed antibiotic treatment. Therefore, patient education and counselling about antibiotics and antibacterial resistance is very important to enhance compliance to antibiotic therapy.