The study aimed to evaluate the knowledge, attitude, and perception of undergraduate medical students regarding antibiotic stewardship and resistance. A survey was conducted of 231 students from a medical school in Nepal. The students' mean knowledge score was 2.41/5, indicating inadequate knowledge, though their attitude and perception scores suggested positive views. Scores were significantly higher for clinical versus basic science students. Over half of students lacked adequate knowledge, highlighting a need to strengthen curriculum on antibiotic stewardship starting in basic sciences.
Assessment of Knowledge Regarding Antibiotic Use, its Resistance, and Future ...BRNSS Publication Hub
Antimicrobial resistance poses a growing threat to public health, as infections from resistant strains of microbial become increasingly difficult and expensive to treat, resulting in prolonged illness and greater risk of death. A cross-sectional descriptive study was done among 471 higher secondary level students of private schools in Kathmandu Valley. Data were collected from Grade 11 and 12 non-science faculty students through self-administered questionnaires. Half (50.5%) of the students gave correct response by saying that antibiotic kills bacteria and 49.1% said that it is for fever. Majority (93.0%) of them said that it should be taken with water. Regarding the response on when to stop taking antibiotic, 46.9% said correctly by saying when all prescribed medicines are taken whereas and 40.8% said that after feeling better. More than half (58.8%) of the students had not heard about antibiotic resistance, whereas those who have heard among them 24% of students said that they had heard from doctor and nurses and 21.8% from family member and friends. Nearly one-third (32.7%) of students knew that antibiotic resistance occurs using antibiotic when they are not necessary. Regarding the response on consequences of antibiotic resistance, more than one-third (38.2%) of students gave correct answer. Nearly half of the students have lack of knowledge about antibiotic. Thus, it is imperative to create awareness among students by introducing a specific course on antibiotic in the 9th and 10th grade core curriculum to prevent antibiotic resistance and its consequences.
Kailash Nagar Research Article publicationKailash Nagar
A Study to Assess the Effectiveness of Planned Teaching
Programme on Prevention of Selected Life Style Diseases
in Terms of Knowledge and Attitude among Male Adults at
Selected PHC of Kheda District
Background: The numbers of caregivers burdened by dementia is increasing. Depression is also found more in this group and
causes higher morbidity. The aim of this study was to investigate the predictors of depression among Thai family caregivers in order to develop effective interventions in primary care Methods: A total of 177 participants were recruited in primary care setting. They were assessed for sociodemographic data, health status, caregiver burden and depressive symptoms measured by Charlsons Comorbidities (CCI), Zarit Burden Interview (ZBI) and Patient Health Questionnaire (PHQ-9), respectively. The data for dementia patients included severity and functional status. Depression was defi ned as PHQ-9 ≥ 9. Multivariate linear regression model was applied to assess the independent relationship between possible risk factors and risk of depression.
American Research Journal of Humanities & Social Science (ARJHSS) is a double blind peer reviewed, open access journal published by (ARJHSS).
The main objective of ARJHSS is to provide an intellectual platform for the international scholars. ARJHSS aims to promote interdisciplinary studies in Humanities & Social Science and become the leading journal in Humanities & Social Science in the world.
Factors that affect the Quality of Life of Patients with Behcet's DiseaseMinistry of Health
Objective: To assess the quality of life in patients with Behçet's disease, and to address the factors impact the domains of Quality of Life.
Methods: We surveyed101 patients with Behcet's disease no less than 3 months before the study. Data were collected using Short Form 36 Quality of life Scale. Results: The quality of life scores in patients with Behçet's disease were low and were adversely influenced by socio-demographic characteristics such as gender, age, work status and education status. Furthermore, disease manifestations such as oral and genital ulcerations, arthritis, and skin lesions affected the quality of life scores. Moreover, patients who experienced pain, poor sleep and fatigue lower the quality of life scale and patients whose social relations were influenced by the disease had significantly lower the quality of life scores. Conclusion: Patients with Behcet's disease reported a low level of quality of life.
Keywords: Behcet's disease, Factors affecting, Quality of life, Jordan.
Assessment of Knowledge Regarding Antibiotic Use, its Resistance, and Future ...BRNSS Publication Hub
Antimicrobial resistance poses a growing threat to public health, as infections from resistant strains of microbial become increasingly difficult and expensive to treat, resulting in prolonged illness and greater risk of death. A cross-sectional descriptive study was done among 471 higher secondary level students of private schools in Kathmandu Valley. Data were collected from Grade 11 and 12 non-science faculty students through self-administered questionnaires. Half (50.5%) of the students gave correct response by saying that antibiotic kills bacteria and 49.1% said that it is for fever. Majority (93.0%) of them said that it should be taken with water. Regarding the response on when to stop taking antibiotic, 46.9% said correctly by saying when all prescribed medicines are taken whereas and 40.8% said that after feeling better. More than half (58.8%) of the students had not heard about antibiotic resistance, whereas those who have heard among them 24% of students said that they had heard from doctor and nurses and 21.8% from family member and friends. Nearly one-third (32.7%) of students knew that antibiotic resistance occurs using antibiotic when they are not necessary. Regarding the response on consequences of antibiotic resistance, more than one-third (38.2%) of students gave correct answer. Nearly half of the students have lack of knowledge about antibiotic. Thus, it is imperative to create awareness among students by introducing a specific course on antibiotic in the 9th and 10th grade core curriculum to prevent antibiotic resistance and its consequences.
Kailash Nagar Research Article publicationKailash Nagar
A Study to Assess the Effectiveness of Planned Teaching
Programme on Prevention of Selected Life Style Diseases
in Terms of Knowledge and Attitude among Male Adults at
Selected PHC of Kheda District
Background: The numbers of caregivers burdened by dementia is increasing. Depression is also found more in this group and
causes higher morbidity. The aim of this study was to investigate the predictors of depression among Thai family caregivers in order to develop effective interventions in primary care Methods: A total of 177 participants were recruited in primary care setting. They were assessed for sociodemographic data, health status, caregiver burden and depressive symptoms measured by Charlsons Comorbidities (CCI), Zarit Burden Interview (ZBI) and Patient Health Questionnaire (PHQ-9), respectively. The data for dementia patients included severity and functional status. Depression was defi ned as PHQ-9 ≥ 9. Multivariate linear regression model was applied to assess the independent relationship between possible risk factors and risk of depression.
American Research Journal of Humanities & Social Science (ARJHSS) is a double blind peer reviewed, open access journal published by (ARJHSS).
The main objective of ARJHSS is to provide an intellectual platform for the international scholars. ARJHSS aims to promote interdisciplinary studies in Humanities & Social Science and become the leading journal in Humanities & Social Science in the world.
Factors that affect the Quality of Life of Patients with Behcet's DiseaseMinistry of Health
Objective: To assess the quality of life in patients with Behçet's disease, and to address the factors impact the domains of Quality of Life.
Methods: We surveyed101 patients with Behcet's disease no less than 3 months before the study. Data were collected using Short Form 36 Quality of life Scale. Results: The quality of life scores in patients with Behçet's disease were low and were adversely influenced by socio-demographic characteristics such as gender, age, work status and education status. Furthermore, disease manifestations such as oral and genital ulcerations, arthritis, and skin lesions affected the quality of life scores. Moreover, patients who experienced pain, poor sleep and fatigue lower the quality of life scale and patients whose social relations were influenced by the disease had significantly lower the quality of life scores. Conclusion: Patients with Behcet's disease reported a low level of quality of life.
Keywords: Behcet's disease, Factors affecting, Quality of life, Jordan.
In India, Reproductive Tract Infection (RTI) including Sexually transmitted Diseases (STDs) produce a huge disease burden. Nursing staff plays a major role in prevention of STI/RTIs. So this study was conducted aimed to know the knowledge about STIs/RTIs of nursing personnel of a tertiary care hospital of Rajasthan. 100 nursing professionals were supervised for practice and interrogated for attitude and knowledge as per a semi- structured schedule. It was found that overall mean score of nurses was 56% and only 52% had scores passing marks (>50%). Although this knowledge about STI/RTI was not found to be associated religion, caste, type of family and socio-economic status but it was found to be associated with sex, marital status and education of nurses. It was also found in this study that gap of training decreases the knowledge and number of training increases the knowledge. It was found to be associated with department where the nurses were working. So all the nurses irrespective of place of posting should be given refresher trainings at regular intervals.
Client satisfaction towards quality of health services an assessment at prima...Zubia Qureshi
This survey designed to evaluate the satisfaction level and the factors that affect the patient satisfaction regarding health care delivery services with the aim to improve the services in the primary health care settings of Gujranwala. A Cross Sectional Study done on randomly selected patients attending the basic health units of Gujranwala, with more than18 years of age. Pretested structured “Liker scale questionnaire” was used for data collection. Out of total respondents, 62 (41.3%) clients were satisfied with the services provided by the basic health units of Gujranwala. The factors identified to determine patient satisfaction were accessibility of services, behavior of staff, health education, level of cleanliness, drug availability and miscellaneous services. Not a single ranked area of satisfaction noticed. Client’s occupation and income had significant relationship with the patient satisfaction level. Gender, age, and education of clients were not contributing factors; they not affect the client satisfaction level. Less than half clients were satisfied with the services provided by the basic health units. Management of health facilities needs to improve the services.
The issue of medical aliteracy has drawn both scholars and medical practitioners’ attention in the recent years. The negative cost of medical aliteracy has continued to constitute major threats to health related issue which has resulted in high mortality rate, high medical expenditure and medical underperformance among others. On this premise the study examined the influence of medical aliteracy among senior medical personnel. The study employed descriptive research design and Chi-Square to test the research hypotheses. A total number of 50 questionnaires were designed to collect information from the sampled population through a random sampling. From the result of the analysis it was revealed that factors such as ineffective supervision of medical personnel, low patient literacy level, lack of personnel-patients engagement could lead to medical aliteracy among senior medical personnel. Senior medical personnel have the knowledge of medical aliteracy and its implications on for medical personnel and the public. Medical aliteracy has an implication on health sector performance which includes increase in mortality rate, increase health expenditure, widening of the gap between patients – medical personnel communication among others. Perception of medical aliteracy has significant influence on medical personnel performance. The study concluded that, medical aliteracy is prevalent among medical personnel and patients and is associated with many poor medical outcomes in the health sector. It was however recommended that medical literacy training, schemes and programmes should be designed according to the needs of the different medical personnel and should therefore be included in medical professional training programs.
Factors Affecting Non-Compliance among Psychiatric Patients in the Regional I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Background: The COVID-19 pandemic and control measures taken by countries around the worldcause stress and anxiety. The outbreak of corona virus not onlyhas a major impact on the physical health of the community, but also has a foremosteffect on thementalhealth of the public.Investigating the coping strategies to deal with this unique crisis is essential. Objective: The aim of this study was to assess the impact of covid-19 on stress and coping responses among general population. Methods: A descriptive cross-sectional study is adapted among 100 general populations. A convenient sampling technique was applied. The demographic data were collected using a structured questionnaire via interview method. The level of stress was measured by the perceived stress scale (PSS) and coping responses was evaluated by the brief cope scale. Result: The study outcomesdisplaysthat 53 (53%) had moderate stress, 28 (28%) had mild stress and 19 (19%) had severe stress during Covid-19. In respect to level of coping strategies among general population, 96% of the participants used planning coping strategy, 93% of them used religion coping strategy followed by 92% used self-distraction coping strategy. Conclusion: In our study, general population presented a moderate level of stress, in addition avoidance coping strategies was mostly used.Aiding the mental health care needs of public during these difficult times (pandemic) should be the top priority soadequate measures must be taken to promote the mental health of general public.
Abstract— If job satisfaction is there in employees, work done by these employees is usually of better quality in comparison where the employees are not satisfied with their jobe. So this study to assess job satisfaction and influence of demographic variables on job satisfaction, this study was carried out on 105 doctors of teaching hospitals. Questionnaire method of data collection was adopted. Job satisfaction was measured by six domains: Organizational functioning, Interpersonal relationship, Financial incentives, Non-financial incentives, Physical facilities and Working conditions. Study observed that over all, doctors were moderately satisfied with their job. Domains such as Interpersonal relationship and Working conditions, doctors were highly satisfied, whereas rest of the domains: Organizational functioning, Financial incentives, Non-financial incentives, and Physical facilities doctors were moderately satisfied. It is important to note that even though overall satisfaction is moderate, there were few components, where doctors were highly satisfied were - Communication system between patients and doctors, Involvement in decision making in the department, Rules and regulations of the institution, relationship between the department colleagues and other department colleagues, Provision for leave encashment, reward given for research work, workload of clinical aspect and workload of teaching aspect. Age and sex both shown significant association on level of satisfaction where as experience, designation and marital status of the doctors have not shown significant association.
A cross sectional and comparative study of attitudes in undergraduate medical...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
In India, Reproductive Tract Infection (RTI) including Sexually transmitted Diseases (STDs) produce a huge disease burden. Nursing staff plays a major role in prevention of STI/RTIs. So this study was conducted aimed to know the knowledge about STIs/RTIs of nursing personnel of a tertiary care hospital of Rajasthan. 100 nursing professionals were supervised for practice and interrogated for attitude and knowledge as per a semi- structured schedule. It was found that overall mean score of nurses was 56% and only 52% had scores passing marks (>50%). Although this knowledge about STI/RTI was not found to be associated religion, caste, type of family and socio-economic status but it was found to be associated with sex, marital status and education of nurses. It was also found in this study that gap of training decreases the knowledge and number of training increases the knowledge. It was found to be associated with department where the nurses were working. So all the nurses irrespective of place of posting should be given refresher trainings at regular intervals.
Client satisfaction towards quality of health services an assessment at prima...Zubia Qureshi
This survey designed to evaluate the satisfaction level and the factors that affect the patient satisfaction regarding health care delivery services with the aim to improve the services in the primary health care settings of Gujranwala. A Cross Sectional Study done on randomly selected patients attending the basic health units of Gujranwala, with more than18 years of age. Pretested structured “Liker scale questionnaire” was used for data collection. Out of total respondents, 62 (41.3%) clients were satisfied with the services provided by the basic health units of Gujranwala. The factors identified to determine patient satisfaction were accessibility of services, behavior of staff, health education, level of cleanliness, drug availability and miscellaneous services. Not a single ranked area of satisfaction noticed. Client’s occupation and income had significant relationship with the patient satisfaction level. Gender, age, and education of clients were not contributing factors; they not affect the client satisfaction level. Less than half clients were satisfied with the services provided by the basic health units. Management of health facilities needs to improve the services.
The issue of medical aliteracy has drawn both scholars and medical practitioners’ attention in the recent years. The negative cost of medical aliteracy has continued to constitute major threats to health related issue which has resulted in high mortality rate, high medical expenditure and medical underperformance among others. On this premise the study examined the influence of medical aliteracy among senior medical personnel. The study employed descriptive research design and Chi-Square to test the research hypotheses. A total number of 50 questionnaires were designed to collect information from the sampled population through a random sampling. From the result of the analysis it was revealed that factors such as ineffective supervision of medical personnel, low patient literacy level, lack of personnel-patients engagement could lead to medical aliteracy among senior medical personnel. Senior medical personnel have the knowledge of medical aliteracy and its implications on for medical personnel and the public. Medical aliteracy has an implication on health sector performance which includes increase in mortality rate, increase health expenditure, widening of the gap between patients – medical personnel communication among others. Perception of medical aliteracy has significant influence on medical personnel performance. The study concluded that, medical aliteracy is prevalent among medical personnel and patients and is associated with many poor medical outcomes in the health sector. It was however recommended that medical literacy training, schemes and programmes should be designed according to the needs of the different medical personnel and should therefore be included in medical professional training programs.
Factors Affecting Non-Compliance among Psychiatric Patients in the Regional I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Background: The COVID-19 pandemic and control measures taken by countries around the worldcause stress and anxiety. The outbreak of corona virus not onlyhas a major impact on the physical health of the community, but also has a foremosteffect on thementalhealth of the public.Investigating the coping strategies to deal with this unique crisis is essential. Objective: The aim of this study was to assess the impact of covid-19 on stress and coping responses among general population. Methods: A descriptive cross-sectional study is adapted among 100 general populations. A convenient sampling technique was applied. The demographic data were collected using a structured questionnaire via interview method. The level of stress was measured by the perceived stress scale (PSS) and coping responses was evaluated by the brief cope scale. Result: The study outcomesdisplaysthat 53 (53%) had moderate stress, 28 (28%) had mild stress and 19 (19%) had severe stress during Covid-19. In respect to level of coping strategies among general population, 96% of the participants used planning coping strategy, 93% of them used religion coping strategy followed by 92% used self-distraction coping strategy. Conclusion: In our study, general population presented a moderate level of stress, in addition avoidance coping strategies was mostly used.Aiding the mental health care needs of public during these difficult times (pandemic) should be the top priority soadequate measures must be taken to promote the mental health of general public.
Abstract— If job satisfaction is there in employees, work done by these employees is usually of better quality in comparison where the employees are not satisfied with their jobe. So this study to assess job satisfaction and influence of demographic variables on job satisfaction, this study was carried out on 105 doctors of teaching hospitals. Questionnaire method of data collection was adopted. Job satisfaction was measured by six domains: Organizational functioning, Interpersonal relationship, Financial incentives, Non-financial incentives, Physical facilities and Working conditions. Study observed that over all, doctors were moderately satisfied with their job. Domains such as Interpersonal relationship and Working conditions, doctors were highly satisfied, whereas rest of the domains: Organizational functioning, Financial incentives, Non-financial incentives, and Physical facilities doctors were moderately satisfied. It is important to note that even though overall satisfaction is moderate, there were few components, where doctors were highly satisfied were - Communication system between patients and doctors, Involvement in decision making in the department, Rules and regulations of the institution, relationship between the department colleagues and other department colleagues, Provision for leave encashment, reward given for research work, workload of clinical aspect and workload of teaching aspect. Age and sex both shown significant association on level of satisfaction where as experience, designation and marital status of the doctors have not shown significant association.
A cross sectional and comparative study of attitudes in undergraduate medical...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
2. Deo, et al.: Antibiotic stewardship in medical students
IJPBA/Jul-Sep-2020/Vol 11/Issue 3 118
prescribing to curtail antimicrobial resistance.
There is a paucity of data on knowledge, attitude,
and perception among undergraduate medical
students in Nepal. This study aims to examine
this gap.
MATERIALS AND METHODS
This cross-sectional study was conducted among
the medical students, the bachelor of medicine
and bachelor of surgery (MBBS) students, of
Maharajgunj Medical Campus (MMC), Institute of
Medicine (IOM), Maharajgunj, Kathmandu, Nepal,
affiliated to Tribhuvan University. This study was
conducted for 3 months from July to September
2018 after getting the ethical approval from the
Institutional Review Board of IOM.
The inclusion criteria included the students of
both the basic sciences (first 2 years) and clinical
sciences (3rd
year onward) enrolled in the MBBS
program at MMC, IOM. Those medical students
who were unwilling to participate or sign an
informed consent were excluded from the study.
The structure and content of the pro forma were
adapted for our setting from the questionnaires
used in the previous similar studies.[10,11]
The
questionnaire was pre-tested among 20 medical
students from different medical colleges inside
Kathmandu. No major changes were required
after the pretesting. Depending on the category,
there were single answer responses and five-point
Likert scale was used. No additional training was
provided and no changes to the curriculum were
made before or during the survey period. For data
collection, convenience sampling was utilized and
questionnaires were distributed to all 450 medical
students, of which 231 agreed to participate in the
study by signing the consent form.
The first question of the questionnaire assessed
the perception of antibiotic resistance between
the undergraduates; the second to sixth questions
assessed knowledge on antibiotic stewardship
and the seventh question weighed their attitude.
The respondents answered the questionnaire
independently in 15 min using no reference
materials, notes, or assistance. Each participant
was provided a unique code number to maintain
the confidentiality. Responses for the different
questions were coded to facilitate data entry and
data analysis. Responses from the five-point Likert
scale were condensed into three categories: Agree/
good, neutral/average, and disagree/poor. The
data were then entered into Microsoft Excel and
analyzed using Statistical Package for the Social
Sciences (SPSS) for Windows version 20.0.
Armonk, NY: IBM Corp., SPSS Statistics. The
level of significance was set at 0.05. Pearson’s Chi-
square test was utilized for categorical attributes
and Student’s Independent t-test was used for
numerical variables.
Scoring
There were five questions for knowledge
evaluation. Correct answer was scored “1” while
wrong answer was scored as “0.” Each question in
the knowledge section had only one correct answer
and three wrong answers. This way, a respondent
could score a maximum of “5” and a minimum
of “0” in this section. For attitude and perception
questions, a score of “1” was given to “disagree,”
a score of “2” was given to “neutral,” and a score
of “3” was given to “agree.” There were two
negatively framed statements in perception section
for which reverse scoring was done which meant
a score of “1” was given to “agree,” “2” to “do
not know,” and “3” to “disagree.” There were
two questions for attitude and five for perception,
therefore, the maximum scores for attitude and
perception equaled to “6” and “15,” respectively,
while the minimum score equaled to “2” and “5,”
respectively. The total knowledge score, attitude
score, and perception score were calculated and
analyzed by statistical test for their significance.
Those who scored more than or equal to 50%
were considered to have “Adequate” knowledge,
“Positive” attitude, and “Good” perception. In
addition, for the attitude and perception section,
the total percentage of students who were neutral,
who agreed or who disagreed was evaluated for
each statement and the same was also calculated
for basic sciences and clinical sciences phase and
whether the gap seen among basic and clinical
science phase was statistically significant.
3. Deo, et al.: Antibiotic stewardship in medical students
IJPBA/Jul-Sep-2020/Vol 11/Issue 3 119
RESULTS
A total of 231 out of 450 undergraduate medical
students (response rate = 51.33%) participated in
the study.Among them, 113 (48.9%) were studying
the basic sciences (first 2 years) and 118 (51.1%)
were in clinical sciences (3rd
year onward). The
mean age of the participants was 21.18 ± 1.948
years (SEM = 0.128) with ages ranging from 18
to 26 years. There were 170 (73.6%) males and 61
(26.4%) female.
The knowledge score of all the participants was
2.41 ± 1.103 with a minimum score of 0 and a
maximum score of 5, attitude score was 5.69 ±
0.917 with a minimum score of 2 and a maximum
score of 6, and perception score was found to be
13.10 ± 1.328 with a minimum score of 7 and
maximum of 15 [Table 1].
The difference in all the scores among basic and
clinical science students was seen to be statistically
significant [Table 1]. Similarly, significant
differences were noted between the basic and
clinical science medical students who correctly
answered the questions [Table 2]. The responses
on Likert scale are presented in Table 3 and the
adequate knowledge, positive attitude, and good
perception percentages are stated in Table 4.
DISCUSSION
The irrational prescription and unchecked over-
the-counter sales are the major contributors and
antimicrobial resistance is directly related to
the usage of antimicrobial agents. Thus, making
inappropriate antimicrobial usage as the one of
the most common causes to be associated with
the emergence of antimicrobial resistance.[12-15]
Antimicrobialresistance has limited the physicians’
liberty of antimicrobial selection, making it an issue
of global concern and one of the biggest threats to
human health.[16]
Programs that teach about effective AMS are
should be included in trainings for all prescribing
clinicians. Similarly, education about antimicrobial
resistance and stewardship should be incorporated
into curriculum requirements for medical students,
Table 1: Knowledge, attitude, and practice scores among basic and clinical science students
Academic group Mean±SD SEM Minimum Maximum P value
Knowledge scores (0–5)
Basic science (113) 2.04±0.995 0.094 0 5 0.001
Clinical phase (118) 2.76±1.091 0.100 0 4
Total (231) 2.41±1.103 0.073 0 5
Attitude scores (2–6)
Basic science (113) 5.39±1.228 0.116 2 6 0.001
Clinical phase (118) 5.97±0.205 0.019 4 6
Total (231) 5.69±0.917 0.060 2 6
Perception scores (5–15)
Basic science (113) 12.75±1.455 0.137 7 15 0.001
Clinical phase (118) 13.44±1.098 0.101 10 15
Total (231) 13.10±1.328 0.087 7 15
Independent t‑test
Table 2: Knowledge‑based questions answered correctly
Questions Proportion of students who answered correctly n (%) P value
Total (231) Basic (113) Clinical (118)
Meaning of antibiotic stewardship 161 (69.7) 70 (61.9) 91 (77.1) 0.019
Benefits of antibiotic stewardship 110 (47.6) 45 (39.8) 65 (55.1) 0.020
Correct approaches for antibiotic stewardship 94 (40.7) 35 (31) 59 (50) 0.003
Who was appropriate supervisor? 76 (32.9) 38 (33.6) 38 (32.2) 0.818
Organism used for monitoring antibiotic stewardship program 116 (50.2) 43 (38.1) 73 (61.9) 0.001
4. Deo, et al.: Antibiotic stewardship in medical students
IJPBA/Jul-Sep-2020/Vol 11/Issue 3 120
postgraduate residents, and fellows.[14]
There have
been recommendations to adopt AMS programs in
all healthcare facilities.[17-19]
The major objectives
of AMS are to achieve the best clinical outcomes
related to antimicrobial use while minimizing
toxicity and other adverse events, limiting the
selective pressure on bacterial populations that
drive the emergence of antimicrobial-resistant
strains. AMS may also reduce excessive costs
because of suboptimal antimicrobial use.[18-20]
Thus, it is essential for medical students to receive
a proper education on AMS. However, there is lack
of data on the knowledge, attitude, and perception of
undergraduate students about antibiotic stewardship.
Studies testing medical students about antimicrobial
use and resistance have been done in different parts
of the world.[18]
They have consistently shown
that medical students recognize the importance
of antibiotic prescribing knowledge, but feel
inadequately prepared and require more education
on how to make antibiotic choices. The proportion
of medical students who are acquainted with the
term “antibiotic stewardship” is low in this study.
Thereisapaucityofstudiestoassesstheknowledge,
attitude, and perception regarding antibiotic
stewardship among medical students in Nepal. In
our study, the students from clinical sciences scored
more than basic sciences’, possibly because of a
curricular advantage. However, only 45.5% of total
students had adequate knowledge scores implying
that curriculum was unsubstantial to raise their
knowledge about AMS. About 96.5% had positive
attitude and 99.6% had good perception regarding
AMS and antimicrobial resistance suggesting a
better scenario compared to their knowledge levels.
Regarding antibiotics overused in Nepal, 88.7% of
our respondents agreed with it which was similar
to the findings from other countries.[18]
Only
50.2% of the students in this study could recognize
Clostridioides difficile as the infective organism
secondary to the use of antimicrobials compared to
59% in other studies.[18,19]
Table 3: Three‑point Likert table measuring attitude and perception responses
Statements Total (n=231)
Responses as n (%)
Basic science (n=113)
Responses as n (%)
Clinical science (n=118)
Responses as n (%)
Disagree Neutral Agree Disagree Neutral Agree Disagree Neutral Agree
Good knowledge of antibiotics is
important to my work as a doctor
18 (7.8) 5 (2.2) 208 (90) 17 (15) 4 (3.5) 92 (81.4) 1 (0.8) 1 (0.8) 116 (98.3)
I would like to have more
education on antibiotic stewardship
13 (5.6) 5 (2.2) 213 (92.2) 13 (11.5) 5 (4.4) 95 (84.1) ‑ ‑ 118 (100)
Antibiotic resistance is not a
significant problem in Nepal
215 (93.1) 2 (0.9) 14 (6.1) 105 (92.9) 1 (0.9) 7 (6.2) 110 (93.2) 1 (0.8) 7 (5.9)
Antibiotics are overused in Nepal 16 (6.9) 10 (4.3) 205 (88.7) 13 (11.5) 9 (8) 91 (80.5) 3 (2.5) 1 (0.8) 114 (96.6)
Inappropriate use of antibiotics
causes antibiotic resistance
4 (1.7) 2 (0.9) 225 (97.4) 3 (2.7) 2 (1.8) 108 (95.6) 1 (0.8) ‑ 117 (99.2)
New antimicrobials will be
developed in the future that will
keep up with the problem of
“resistance”
53 (22.9) 63 (27.3) 115 (49.8) 27 (23.9) 20 (17.7) 66 (58.4) 26 (22) 43 (36.4) 49 (41.5)
Poor infection control practices
by health care professional cause
spread of antimicrobial resistance
21 (9.1) 21 (9.1) 189 (81.8) 16 (14.2) 12 (10.6) 85 (75.2) 5 (4.2) 9 (7.6) 104 (88.1)
Table 4: Knowledge, attitude, and perception in basic and clinical science students
Academic group Knowledge n (%) Attitude n (%) Perception n (%)
Adequate Inadequate Positive Negative Good Lacking
Basic science 32 (28.3) 81 (71.7) 105 (92.9) 8 (7.1) 112 (99.1) 1 (0.9)
Clinical science 73 (61.9) 45 (38.1) 118 (100) ‑ 118 (100) ‑
Total 105 (45.5) 126 (54.5) 223 (96.5) 8 (3.5) 230 (99.6) 1 (0.4)
P value 0.001 0.003 0.489
Chi‑square test
5. Deo, et al.: Antibiotic stewardship in medical students
IJPBA/Jul-Sep-2020/Vol 11/Issue 3 121
In a similar study by Abbo et al. in American
medical students’, it was found that only 40% of
the participants had ever heard the term “antibiotic
stewardship” and 20% of participants believed
that new antibiotics will be available in the near
future to tackle the problem of antimicrobial
resistance. Similarly, 94% of the participants felt
that antimicrobials were overused nationally,
98% believed antimicrobial resistance was a
significant problem nationally. Nearly nine out of
ten medical students regarded strong knowledge
of antimicrobials to be important in their medical
careers.[18,19]
In the current study, 92.2% of the
students responded that they would like to have
more knowledge on antibiotic stewardship,
compared to the other two studies where only 79%
and 70% of students responded accordingly.[19]
On a positive note, all the students (100% of the
respondents) from the clinical science phase agreed
on the need for more knowledge on AMS.
Another notable difference, we found in their
attitude toward antibiotic resistance was in the
belief whether new antibiotics will always keep
up with the problem of resistance. Half of the
respondents (49.8%) in this study believed that new
antibiotics could always keep up with the problem
of resistance which is much higher than 20% and
10% as seen in other studies.[17]
This alarms us
about the lack of awareness about the severity of
the problem. Such a large gap in the responses
should well be taken care of.
A study by Wasserman et al. to test South African
medical students’ KAP about antimicrobial use and
resistance showed that only 64% of the participants
had ever heard the term “antibiotic stewardship.”
Similarly, 15% of the participants believed that new
antibiotics were available to deal with the problem of
resistance. Likewise, 90% of the participants felt that
antimicrobials were overused nationally while the
same proportion (90%) believed that inappropriate
use of antimicrobials causes antimicrobial resistance.
Regarding antimicrobial resistance, 80% believed
that it was a significant problem nationally. Almost
all the participants regarded a sound knowledge of
antimicrobialsimportanttotheirworkasadoctor.[21,22]
A study by Pulcini et al. to assess knowledge
and perceptions about antibiotic resistance and
prescribing among junior doctors in France and
Scotland showed that only 23% of the participants
at one center (Dundee, Scotland) and 64% of
participantsattheothercenter(Nice,France)agreed
that drug advertising can lead to antimicrobial
resistance. About 95% of participants agreed that
antimicrobial resistance was a significant problem
nationally. In both the centers, more than 90% of
the participants believed antimicrobial resistance
could be caused by too many prescriptions.[23]
Antibiotic resistance is now an established threat
to global health, and inappropriate prescribing
behaviors by clinicians have been implicated as a
key contributing factor.[24]
Antibiotic stewardship is a
key intervention to improve prescribing practices at
individualandfacilitylevels.Itisessentialformedical
studentsaboutantibioticstewardshipbecausefirst,this
is the critical time period which forms the foundation
of future prescribing patterns. Second, it is mostly left
up to the junior doctors to choose antibiotics. This
topic has not been dealt with separately in the medical
curriculum in our country. Under such circumstances,
it is essential to have baseline information regarding
the knowledge and attitudes of medical students on
antibiotic stewardship.[25]
The major strength of the current study was the
evaluation and comparison among both basic
as well as clinical level undergraduate medical
students. However, the inclusion of students from
only a single medical college in Nepal remained
the major limitation of this study.
CONCLUSION
Our study suggests that though students have an
overall positive attitude and perception toward
antibiotic resistance and wish to know more about
stewardship and resistance, the average knowledge
scores of the participants were below 50%. This
suggests that students need to have more knowledge
on antibiotic resistance and the stewardship programs
need to be revised to prepare the future doctors
well enough to tackle this burgeoning threat. The
average knowledge, attitude, and perception scores
were comparatively better in the clinical sciences’
phase than basic science suggesting that students
are receiving certain knowledge about antibiotic
6. Deo, et al.: Antibiotic stewardship in medical students
IJPBA/Jul-Sep-2020/Vol 11/Issue 3 122
resistance and stewardship in the clinical levels.
The low knowledge scores suggest that the situation
can be ameliorated if antibiotic resistance and
stewardship is incorporated in the curriculum right
at the basic science levels so that when students enter
the clinical, they get to look at the infectious diseases,
intensive care, surgery, and similar practices with
prior preparedness about antibiotic resistance.
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