The problem with antibiotic use and resistance has been a major challenge to the public health sectors. To overcome the problem of antibiotic resistance, the number of times antibiotics are taken within a specified time is crucial. The results of the survey on antibiotic use demonstrate how frequently antibiotics are taken, with a considerable majority of respondents confirming the consumption of antibiotics (2–5 times) within the last 12 months. This prevalence is highly relevant to public campaigns on antibiotic resistance—both because high levels of use contribute to the problem, and because it demonstrates just how many people it could impact in a short time frame if the antibiotics they are taking become increasingly ineffective.
Antibiotics and its resistance need to be given a much greater attention. From this study, approximately half of the respondents still believe that antibiotics can be saved for personal use and that, it is a good habit to acquire antibiotics from relatives without any thorough checkup by a physician. Various studies have confirmed that keeping leftover antibiotics results in poor compliance with antibiotic therapy [17], and this also contributes to antibiotic resistance [7, 17], however, the potential three-fold impact on antibiotic resistance has not yet been fully realized. Firstly, when one does not complete the full course of an antibiotic due to temporal recovery, surviving bacteria can proliferate which may lead to antibiotic resistance. According to the WHO, when a patient stops the intake of antibiotics too early, it favours the bacteria strains that have some natural intrinsic resistance and it is therefore advisable that patients always take the full course of antibiotics prescribed to them by a certified health professional. Secondly, leftover antibiotics may not be the right drug for new infections as various infections require various antibiotics. Thirdly, to treat any infection, one requires a sufficient quantum of drug for treatment duration. Therefore, if there is any leftover antibiotic, it may be insufficient for treatment duration [17]. Subsequently, the general public needs to be educated and made aware on the fact that, the effectiveness of an antibiotic can be preserved only when they are used with a valid prescription and also when the full course is completed [17, 18]. To minimize the problem of antibiotic resistance, healthcare workers can play a key role through communication. Appropriate usage of antibiotics by patients can be conveyed by healthcare providers through effective communication. Horne [19] reiterated this fact by stressing the importance of patient-healthcare provider interaction and communication. This interaction can help promote optimal adherence to antibiotic usage by patients. Yet results from this study revealed that, some respondents across gender, age, profession and educational status reported that; doctors and pharmacy staffs do not take time to communicate to them on how antibiotics should be used.
Furthermore, one contributor to misuse of antibiotics is the lack of understanding of which conditions can or cannot be treated with antibiotics and the lack of such knowledge can lead to the development of resistance. On average, only 14.2% (90/632) of the respondents across the various gender, age, educational status and profession, disagree to the statement that antibiotics make one recover faster when having a cold. This is because the respondents are not aware that common cold and flu are not caused by bacteria but viruses and does not need an antibiotic to treat it. About three quarters (75%) of respondents believed that, people can become resistant to antibiotics and that antibiotic resistant bacteria cannot spread from person to person. It should be noted that, antibiotic-resistant bacteria can spread from person to person, with the potential to affect anyone, of any age and in any country. The majority of respondents agreed to the fact that, the more antibiotics are used in a society, the higher are the risk that resistance develops and spreads.
Past and current public health campaigns on antimicrobial resistance have echoed a key assumption in the so-called ‘information deficit literature’ [20], that, the low levels of public acceptance on proper use of antibiotics are the reflection of low levels of awareness of antibiotic use and knowledge about the possibly disastrous effects of improper use. This study agrees to this in the sense that, there is still a great deficit in knowledge on the awareness on the dangers that comes with antibiotic misuse and its resistance. The current results are in agreement to a study by McNulty et al. [21], whose results suggested that there is a need to improve the status quo because there is still some minimal improvement in the knowledge level of the general public on antibiotic resistance. From the current study, it can be deduced that, employment in the heath sector had a positive significant effect on knowledge about antibiotic use and antibiotic resistance in the multivariable analysis. Healthcare professionals play an important role in tackling the problem of antibiotic resistant. Therefore, an up to date knowledge on the dangers of misuse and antibiotic resistance can help them educate their patients on the potential risks. Age, Educational level, and whether anyone in the respondent’s household is taking antibiotics at the moment had no association with their knowledge level on antibiotic resistance.
A lot of studies have proved that people with high level of education have much knowledge on antibiotic resistance compare to people with low level of education [22, 23]. This study however, is in contradiction with the above findings which shows that education on antibiotic resistance have gone down well on people with low educational background. On a second enquiry into the possible reason which may have accounting for the observed results in this municipality, it was realized that some level of education has been embarked on for the past two (2) years where people (especially people with low level of education) are educated on the use and misuse of antibiotic. The tremendous level of knowledge among the lower educational status group disagrees with studies conducted in Italy, United Kingdom, Hong Kong, Sweden and Poland which reported a lack of knowledge on antibiotic resistance among this group [21,22,23,24,25,26,27]. This great improvement may be as a result of the educational campaign embarked on by various associations (Ghana Science Association) and other organizations (Ghana Pharmaceutical association) in the Municipality. Although these educational campaigns were not the focus of this articles, it can be linked to the tremendous rise in the level of knowledge on antibiotic resistances by people with low educational status (no senior high school education). Eng et al. [28], concluded that people’s knowledge and attitude regarding antibiotic use and its resistance can be substantially improved through education which was realized in this study. This improved knowledge might be important efforts to reduce misconceptions and misguided expectations contributing to inappropriate antibiotic use. This study is also in agreement with Ayepola et al. [29] whose findings iterated the fact that lower level students had more knowledge on antibiotic resistance than their counterparts with higher level of education. This gives an indication that, people with high level of education are either saturated with knowledge or they do not pay much attention to educational campaigns on antibiotic resistance.
Strengths and limitations
This study fills the paucity of information on knowledge on antibiotic use and resistance. Our findings provides a repository of data which will help shape campaigns and policies addressing this problem. The strength of this study is the fact that it employed a reasonably large number of respondents considering the fact that this is the first known population base study within the municipality. Also, respondents were sampled from the general population and not from the hospital setting as most studies do. Limitations of this study were; 1. A possible bias towards respondents who may have a fair knowledge on the subject matter and 2. By using closed-ended questions to assess the level of knowledge on antibiotic resistance, respondents may have selected the most favourable answer instead of using qualitative methods to revel misconceptions.