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Table 1 General characteristics of studies about education level and misuse of antibiotics

From: Education level and misuse of antibiotics in the general population: a systematic review and dose–response meta-analysis

Source Country Age (years) Gender Population Type of misuse Dose N n OR (95% CI) Adjustment, restriction or matching factors
Cohort studies
Afari-Asiedu 2020 Ghana Adults
(< 20 to > 60)
M: 36.0%
F: 64%
General population Any misuse 0.0 283 27 1.00 Age, gender, marital status, occupation, place of residence, health insurance, type of drug supplier
3.5 176 19 0.90 (0.40, 1.70)
8.0 138 22 0.60 (0.30, 1.10)
13.0 164 34 0.40 (0.20, 0.70)
Ho 2010 Australia Adults (≥ 18)
≤ 30 to > 45
M: 43%
F: 57%
Emergency department attendants Non-adherence 3.0 16 4 1.00 Age, gender, marital status, employment status, having a regular general practitioner, number of usual medications, place of birth, use of herbal medicine
9.0 70 16 0.79 (0.46, 4.55)
12.0 35 10 0.39 (0.06, 2.78)
15.5 71 9 0.33 (0.08, 1.43)
Cross-sectional studies
Moktan 2021 India Adults (> 18) M: 61.3%
F: 38.7%
Attendants of primary care centers Use without prescription 0.0 28 12 1.00 Age, gender, marital status, income, public and private clinics, frequency of doctors’ consultation, family/friend influence (other family members self-medicating with antibiotics), symptoms (minor illness)
6.5 206 65 0.61 (0.28, 1.37)
14.5 158 59 0.79 (0.35, 1.80)
19.0 112 35 0.61 (0.26, 1.42)
Bianco 2020 Italy Adults
mean ± SD: 47.8 ± 16.7
M: 41.2%
F: 58.8%
Attendants of primary care centers Use without prescription 4.0 1.00 Age, gender, marital status, employment status, nationality, having a kid who had used antibiotics in the last year
11.0 1.38 (0.86, 2.21)
16.0 1.34 (0.78, 2.29)
Elmahi 2020 Sudan Adults (> 18) M: 52.8%
F: 47.2%
General population Use without prescription 6.0 35 23 1.00 Age
14.5 211 125 0.76 (0.36, 1.61)
Hallit 2020 Lebanon Adults
mean ± SD:
bad practice 33.33 ± 8.80
good practice 31.49 ± 6.68
M: 48.5%
F: 51.5%
Children caregivers Any misuse 3.0 48 40 1.00 Age
11.0 40 22 0.24 (0.09, 0.65)
14.5 116 41 0.11 (0.05, 0.26)
Mallah 2020 Lebanon Adults (> 18) M: 19.4%
F: 76.8%
Children caregivers Any misuse 6.0 252 31 1.00 Age, gender, income, area of residence, access to medical care facilities, frequency of telephone medical consultation
14.5 1157 62 0.40 (0.27, 0.64)
Nusair 2020 Jordan Unrestricted age group
> 60
M: 36.6%
F: 63.4%
General population Use without prescription 0.0 51 18 1.00
5.5 52 20 1.15 (0.51, 2.55)
11.5 273 104 1.13 (0.60, 2.11)
15.5 1505 632 1.33 (0.74, 2.38)
Rathish 2020 Sri Lanka Unrestricted age group
Mean ± SD: 36.0 ± 21.0
M: 47%
F: 53%
General population Use without prescription 11.0 252 247 1.00
13.5 132 127 3.95 (0.74, 21.10)
Shah 2020 Pakistan  ≥ 15 M: 33%
F: 67%
General population Use without prescription 0.0 45 25 1.00 Age
4.5 231 30 0.12 (0.06, 0.24)
10.5 198 54 0.30 (0.15, 0.58)
14.5 221 71 0.38 (0.20, 0.73)
Xu 2020 China Parents with children < 13 years old M: 21.5%
F: 78.5%
Children caregivers Use without prescription 4.5 1344 1.00 Age, gender, income, medical background, residential location
11.0 1771 0.85 (0.58, 1.25)
14.5 3164 0.77 (0.53, 1.14)
Antibiotic Storage 4.5 1344 1.00
11.0 1771 1.38 (1.19, 1.60)
14.5 3164 1.55 (1.33, 1.81)
Ateshim 2019 Eritrea Median (IQR): 37 (24) M: 41.2%
F: 58.8%
General population Use without prescription 0.0 32 11 1.00 Age, gender, income, marital status, occupational status, knowledge about antibiotics, attitudes towards antibiotics
3.0 64 22 1.96 (0.56, 6.88)
6.5 95 33 1.62 (0.46, 5.72)
9.5 246 111 1.92 (0.55, 6.69)
14.0 140 81 2.8 (0.74, 10.63)
Bogale 2019 Ethiopia 18 to > 60 M: 41.3%
F: 58.7%
General population Use without prescription 0.0 26 6.39 (1.45, 28.19) Age, gender, income, marital status, residential location, occupational status, healthcare profession
4.5 72 1.50 (0.82, 2.74)
10.5 75 1.46 (0.74, 2.87)
14.5   81 1.00
Bulabula 2019 South Africa Mean ± SD:
29 ± 6.1
F: 100% Pregnant women attending public hospital Use without prescription 5.0 14 1.00 Age, gender, income, residential location,, knowledge about antibiotics, attitudes towards antibiotics
11.0 228 1.25 (0.15, 10.10)
15.5 5 1.60 (1.03, 2.55)
Ekambi 2019 Cameroon ≥ 15
Mean ± SD: 35.02 ± 10.5
M: 52%
F: 48%
Attendants of pharmacies Use without prescription 3.0 25 8 1.00 Age, gender, marital status, occupation
10.0 86 28 1.02 (0.94, 2.66)
15.0 66 33 2.07 (1.10, 4.00)
Mate 2019 Mozambique Adults (> 18)
Median (IQR): 33 (25–47)
M: 26.9%
F: 73.1%
General population Use without prescription 0.0 69 17 1.00 Age
4.0 344 63 0.69 (0.37, 1.26)
11.5 555 119 0.83 (0.47, 1.50)
14.5 114 28 1.00 (0.50, 1.99)
Non-adherence 0.0 65 15 1.00
4.0 334 88 1.19 (0.64, 2.23)
11.5 531 177 1.67 (0.91, 3.05)
14.5 110 33 1.43 (0.70, 2.90)
Mukattash 2019 Jordan 20 to ≥ 50 M: 15.8%
F: 84.2%
Children caregivers Use without prescription 6.0 205 106 1.00 Age
18.0 1487 554 0.56 (0.42, 0.75)
Rajendran 2019 India Adults (> 18) M: 51%
F: 49%
General population Use without prescription 9.5 151 2 1.00 Age
11.0 60 2 2.57 (0.35, 18.67)
14.0 540 21 3.01 (0.70, 13.00)
Sun 2019 China Parents with children < 13 years old M: 23.5%
F: 76.5%
Children caregivers Antibiotic storage 5.0 2519 1026 1.00 Age, gender of the parents, gender of the child, socioeconomic characteristics (residential location and GDP per capita), health insurance, specialty (medical vs non-medical)
11.0 2765 1365 1.34 (1.20, 1.51)
14.5 4242 2189 1.50 (1.33, 1.70)
Voidăzan 2019 Romania Adults (20–80)
Mean ± SD:
45 ± 12.5
M: 36.5%
F: 63.5%
Attendants of primary care centers Use without prescription 2.5 200 11 1.00
9.0 564 94 3.43 (1.80, 6.56)
15.0 438 102 5.22 (2.73, 9.96)
22.5 790 77 1.86 (0.97, 3.56)
Adisa 2018 Nigeria Mothers of children under five F: 100% Mothers of children under five attending primary care centers Use without prescription 3.0 19 8 1.00 Gender
9.5 148 89 2.07 (0.79, 5.46)
14.5 160 73 1.15 (0.44, 3.02)
Al-Qahtani 2018 Saudi Arabia Adults (≥ 18) M: 43.4%
F: 56.6%
Attendants to primary care centers Use without prescription 0.0 13 4 1.00 Age, gender
3.5 39 13 1.13 (0.29, 4.35)
10.5 108 39 1.27 (0.37, 4.40)
15.5 281 119 1.65 (0.50, 5.49)
21.0 48 23 2.07 (0.56, 7.65)
Chang 2018 China Caregivers of children under seven M: 33.3%
F: 66.7%
Caregivers of children under seven Use without prescription 4.5 336 1.00 Gender, child gender and age, number of children, health insurance, residential location
11.0 1428 0.75 (0.57, 0.98)
14.5 1407 0.82 (0.62, 1.08)
19.0 187 0.86 (0.56, 1.32)
Cheng 2018 China 30 to ≥ 71 M: 41.4%
F: 68.3%
General rural population Use without prescription 0.0 135* 83* 1.00 Age, gender, household size, health insurance
3.5 165* 112* 1.19 (0.69, 2.05)
8.0 227* 139* 0.89 (0.50, 1.57)
13.0 97* 57* 0.84 (0.40, 1.74)
Dar-Odeh 2018 Saudi Arabia 15–64
Mean ± SD: 29.08 ± 9.32
M: 40.7%
F: 59.3%
Attendants of primary care centers Use without prescription 6.0 138 47 1.00 Age
15.5 333 81 0.63 (0.41, 0.97)
21.0 29 7 0.62 (0.25, 1.56)
El-Sherbiny 2018 Egypt Adults (≥ 18) M: 50.3%
F: 49.7%
Attendants of primary care centers Any misuse 6.0 419 1.00 Age, gender, income, occupation, residential location
14.5 181 0.52 (0.34, 0.79)
Horumpende 2018 Tanzania Median (IQR): 23 (20.5–36.5) M: 53.33%
F: 46.67%
General population Use without prescription 0.0 17 9 1.00 Age, gender, income, marital status, occupation
4.0 111 70 1.45 (0.46, 4.51)
10.0 172 95 1.02 (0.32, 3.25)
Kamata 2018 Japan 20–69 M: 51.2%
F: 48.8%
General population Antibiotic storage 5.0 111 18 1.00 Age
11.0 1265 115 0.52 (0.30, 0.89)
14.5 1932 254 0.78 (0.46, 1.32)
Non-adherence 5.0 111 26 1.00
11.0 1265 282 0.94 (0.59, 1.48)
14.5 1932 479 1.08 (0.69, 1.69)
Ngu 2018 Cameroon ≥ 21
Median (IQR): 35 (27—49)
M: 44.8%
F: 55.2%
Attendants of primary care centers Use without prescription 0.0 29 14 1.00 Age
6.5 279 115 0.75 (0.35, 1.62)
Redzick 2018 Croatia M: 26.1%
F: 73.9%
Attendants of primary care centers Use without prescription 4.5 32 8 1.00 Age
10.5 312 38 0.42 (0.17, 0.99)
14.5 60 4 0.21 (0.06, 0.78)
19.0 140 12 0.28 (0.10, 0.76)
Tong 2018 China < 45 to > 60 M: 47.6%
F: 52.4%
Attendants of primary care centers Non-adherence 6.5 323 286 1.00 Age, gender, income, residential location, occupation, employment status, knowledge about antibiotics
14.5 391 335 0.77 (0.50, 1.21)
Abdelrahman 2017 Saudi Arabia < 18 to > 65 M: 71.5%
F: 28.5%
General population Use without prescription 0.0 8 4 1.00 Age
5.0 58 21 0.57 (0.13, 2.51)
11.0 360 117 0.48 (0.12, 1.96)
15.5 602 248 0.70 (0.17, 2.83)
Albawani 2017 Yemen ≥ 18
Mean ± SD: 28.6 ± 7.7
M: 56.2%
F: 43.8%
Attendants of pharmacies Use without prescription 5.0 40 36 1.00 Age
11.0 71 68 2.52 (0.53, 11.87)
15.0 229 191 0.56 (0.19, 1.66)
Akici 2017 Turkey ≥ 15 M: 42.6%
F: 57.4%
Attendants of primary care centers Use without prescription 0.0 18 8 1.00
4.5 18 6 0.63 (0.16, 2.41)
10.5 18 8 1.11 (0.29, 4.20)
14.5 18 9 1.25 (0.34, 4.64)
Non-adherence 0.0 9 6 1.00
4.5 9 6 1.00 (0.14, 7.10)
10.5 9 7 1.75 (0.22, 14.22)
14.5 9 7 1.75 (0.22, 14.22)
Antibiotic storage 0.0 8 3 1
4.5 9 4 1.67 (0.23, 12.22)
10.5 8 5 2.78 (0.37, 21.03)
14.5 9 6 3.33 (0.45, 24.44)
Barber 2017 Philippines Adults (≥ 18)
Median (IQR): 32 (20)
M: 37.2%
F: 56.7%
General population Use without prescription 3.5 83 69 1.00 Age, gender, household size
10.5 186 143 0.77 (0.30, 1.67)
Erku 2017 Ethiopia < 29 to > 60
Mean ± SD: 33.19 ± 10.82
M: 25.9%
F: 74.9%
General population Use without prescription 0.0 182 125 5.01 (2.62, 9.34) Age, gender, income, marital status, household size, employment status, frequency of visiting health care institutions, satisfaction about healthcare service
4.5 201 180 2.81 (1.32, 6.15)
10.5 179 159 1.96 (0.91, 4.51)
14.5 88 71 1.00
Gebrekirstos 2017 Ethiopia Adults (≥ 18)
Median (IQR): 30 (16)
M: 60.6%
F: 39.4%
Attendants of pharmacies Use without prescription 0.0 152 75 1.00 Age, gender, income, marital status, employment status, household size, residential location, type of illness, healthcare insurance, previous experience with antibiotics, access to healthcare
4.5 149 71 0.93 (0.59, 1.47)
10.5 260 121 0.89 (0.60, 1.33)
14.5 219 100 0.86 (0.60, 1.31)
Hassali 2017 Malaysia Adults (≥ 18)
Mean ± SD: 28.7 ± 7.4
M: 42.75%
F: 57.25%
General population Any misuse 8.5 61 20 1.00 Age, gender, income, marital status, race, healthcare related occupation, employment status, health insurance
14.0 339 111 0.83 (0.53, 1.31)
Jamhour 2017 Lebanon Adults (≥ 18) M: 45.5%
F: 54.5%
General population Use without prescription 4.5 34 14 1.00 Age, gender, educational level, specialty (unrelated to health care)
11.0 151 76 1.45 (0.68, 3.08)
Kajeguka 2017 Tanzania Adults (≥ 18)
Mean ± SD: 35.4 ± 13.4
M: 48.0%
F: 52.0%
General population Use without prescription 0.0 26 16 1.00 Age, gender, income, marital status, employment status, self-treated condition
4.0 87 33 0.38 (0.12, 0.94)
11.0 74 46 1.03 (0.41, 2.57)
16.0 133 72 1.10 (0.46, 2.64)
Kurniawan 2017 Indonesia Adults (≥ 18)
Median (IQR): 45 (18–49)
M: 34.3%
F: 65.8%
Attendants of primary care centers Use without prescription 3.5 26 24 1.00 Age, gender, income, marital status, employment status, health insurance
8.0 44 37 0.44 (0.08, 2.30)
11.0 139 101 0.22 (0.05, 0.98)
14.5 31 18 0.12 (0.02, 0.58)
Senadheera 2017 Sri Lanka Adults (≥ 18) M: 31.30%
F: 68.70%
General population Use without prescription 11.0 362 14 1.00 Age, gender, income, employment status, health insurance, household size, receiving medical treatment in the last three months, knowledge of antibiotic name
13.5 245 37 0.32 (0.17, 0.63)
Torres 2017 Ecuador Adults (≥ 18)
range: 18—64
M: 45.6%
F: 54.4%
General population Use without prescription 3.5 51 22 1.00 Age
10.5 173 83 1.22 (0.65, 2.28)
14.5 195 102 1.45 (0.78, 2.69)
Abdulraheem 2016 Nigeria Adults (≥ 18)
Median (range): 25 (19–68)
M: 61.1%
F: 38.9%
Attendants of primary care centers Use without prescription 3.5 623 1.00 Age, gender, symptoms, occupation
9.5 390 1.24 (1.13, 1.87)
14.5 137 1.32 (1.18, 1.96)
Aleem 2016 Saudi Arabia < 25 to ≥ 55 M: 39.5%
F: 60.5%
Children caregivers Use without prescription 6.0 102 29 1.00 Age, gender, income, household size
15.0 508 42 0.23 (0.13, 0.39)
Al Rasheed 2016 Saudi Arabia Adults (> 18) M: 23.2%
F: 76.8%
Attendants of primary care centers Use without prescription 0.0 100 13 1.00 Age, gender, marital status, employment status, occupation, symptoms
3.5 186 16 1.59 (0.73, 3.45)
10.5 145 13 1.52 (0.67, 3.43)
15.5 145 50 0.28 (0.14, 0.59)
Bilal 2016 Pakistan Mean ± SD: 48.6 ± 4.4 M: 65.8%
F: 34.2%
Attendants of primary care centers Use without prescription 0.0 161 159 1.00 Age, residential location, specialty (non-medical related participants)
9.5 86 81 0.20 (0.04, 1.07)
11.5 65 49 0.04 (0.01, 0.17)
14.5 50 26 0.01 (0.003, 0.06)
19.5 38 10 0.004 (0.001, 0.02)
Nigigi 2016 Kenya Adults (≥ 18) M: 32.0%
F: 68.0%
Attendants of primary care centers Use without prescription 0.0 48 12 1.00
4.0 115 35 1.13 (0.90, 1.97)
9.5 179 61 1.31 (0.92, 2.40)
13.5 20 9 1.57 (1.20, 2.50)
Ding 2015 China Adults
≤ 29 to > 50
M: 9.7%
F: 90.3%
Children caregivers Non-adherence 3.0 198 68 1.00 Age, access to healthcare (number of clinics)
8.0 304 87 0.77 (0.52, 1.13)
13.0 120 47 1.23 (0.77, 1.97)
Gebeyehu 2015 Ethiopia Mean ± SD:
urban:
34.1 ± 12.9
rural:
34.5 ± 11.5
M: 24.3%
F: 75.7%
General population Use without prescription 0.0 137 56 4.21 (1.47, 12.07) Age, gender, educational level, marital status, employment status, residential location, household size, level of healthcare service satisfaction, knowledge on antibiotics use
4.5 145 40 2.01 (0.93, 4.34)
10.5 89 14 1.01 (0.34, 2.94)
14.5 35 10 1
Kusturica 2015 Serbia Adults (≥ 18) M: 20.1%
F: 79.9%
General population Antibiotic storage 4.5 27 9 1.00 Age
10.5 169 75 1.60 (0.68, 3.76)
14.0 25 10 2.53 (0.89, 7.23)
16.5 162 84 2.15 (0.91, 5.08)
Pavyde 2015 Lithuania Adults (≥ 18)
Mean ± SD: 38.6 ± 13.9
M: 42.1%
F: 57.9%
Attendants of pharmacies Use without prescription 6.0 298 1.00 Age, gender, residential location, parenthood, knowledge of antibiotics, occupation
14.5 707 1.39 (0.90, 2.16)
Yousif 2015 Saudi Arabia Adults (≥ 18) M: 57.0%
F: 43.0%
General population Use without prescription 6.0 96 80 1.00 Age, gender, income, marital status, employment status, residential location
15.5 295 235 1.25 (0.71, 2.50)
Cheaito 2014 Lebanon Adults (≥ 18)
Mean ± SD: 38.24 ± 13.7
M: 44.8%
F: 55.2%
Attendants of pharmacies Use without prescription 3.0 67 34 1.00 Age, gender, income, marital status, employment status, health insurance, having a reference doctor and frequency of consultation
10.5 96 42 0.75 (0.40, 1.41)
17.5 156 58 0.57 (0.32, 1.02)
Vásquez 2014 Ecuador ≥ 65 M: 45.8%
F: 54.2%
General population Use without prescription 3.0 463 52 1.00 Age
11.5 205 26 1.15 (0.69, 1.90)
Hu 2014 Australia ≥ 14
Mean ± SD:
33 ± 8.2
M: 45.0%
F: 55.0%
General population Use without prescription 6.0 67 14 1.00 Age, gender, income, residential location, employment status, marital status, parental status, language proficiency, main language spoken at home, health insurance
14.5 402 134 1.89 (1.01, 3.53)
Mihretie 2014 Ethiopia ≥ 17
Mean ± SD: 37.8 ± 12.2
M: 4.4%
F: 95.6%
General population Use without prescription 4.0 29 27 1.00 Age
10.5 7 3 0.06 (0.01, 0.44)
14.5 9 4 0.06 (0.01, 0.42)
Ramalhinho 2014 Portugal Adults (≥ 18) M: 48.7%
F: 51.3%
General population Use without prescription 4.5 308* 268* 0.84 (1.41, 11.78) Age, gender, marital status, employment status, residential location, access to healthcare, chronic disease, easy access to unprescribed antibiotics, occupation
11.0 445* 340* 1.25 (0.66, 5.45)
15.5 293* 223* 1.00
Yu 2014 China Adults
≤ 20 to > 40
M: 25.6%
F: 74.4%
Children caregivers Use without prescription 3.5 16 0.19 (0.05, 0.75) Age, gender, child age, number of children, medical insurance
8.0 371 1.07 (0.64, 1.81)
11.0 258 1.01 (0.62, 1.65)
14.5 203 1.00
Abobotain 2013 Saudi Arabia < 25 to ≥ 55 M: 39.5%
F: 60.5%
Children caregivers Use without prescription 6.0 102 29 1.00 Age, income, marital status, household size, number of children, healthcare related profession
14.5 508 42 0.23 (0.13, 0.39)
Ecker 2013 Peru Mean ± SD: 31.4 ± 10.8 F: > 94.9% Children caregivers Use without prescription 3.5 188 1.00 Age, gender, caregiver-child relatedness, age of the child, access to healthcare
9.0 781 1.2 (0.7, 1.9)
14.5 232 1.0 (0.5, 1.7)
Ekwochi 2013 Nigeria M: 59.0%
F: 41.0%
Children caregivers Use without prescription 3.0 31 19 1.00
9.5 83 45 0.75 (0.32, 1.74)
14.5 96 34 0.35 (0.15, 0.80)
Ivanovska 2013 Macedonia Adults (≥ 18) M: 31.3%
F: 68.7%
General population Use without prescription 0.0 11 4 1.00 Age, occupation
5.0 41 21 1.83 (0.47, 7.25)
11.5 256 112 1.36 (0.39, 4.77)
16.0 94 37 1.14 (0.31, 4.15)
Antibiotic storage 0.0 11 6 1.00
5.0 41 28 1.79 (0.46, 6.97)
11.5 256 187 2.26 (0.67, 7.64)
16.0 94 66 1.96 (0.55, 6.97)
Khalil 2013 Saudi Arabia ≥ 15 M: 80.8%
F: 19.1%
Attendants of primary care centers Use without prescription 4.5 107 93 1.00
11.0 435 350 0.62 (0.34, 1.14)
15.5 233 180 0.51 (0.27, 0.97)
21.0 18 14 0.53 (0.15, 1.83)
Moradi 2013 Iran Mean ± SD: 29.2 ± 8.05 M: 33.3%
F: 66.7%
Attendants of pharmacies and primary care centers Non-adherence 2.5 23 16 1.00
11.0 50 36 1.13 (0.38, 3.32)
15.5 19 6 0.20 (0.05, 0.75)
Chan 2012 Hong Kong, China Adults (≥ 18) M: 46.0%
F: 54.0%
General population Non-adherence 3.0 47 1.00 Age, gender, antibiotic knowledge
9.5 165 1.77 (0.76, 4.11)
14.5 150 2.18 (0.85, 5.55)
Elberry 2012 Saudi Arabia ≥ 20 F: 100% Mothers Use without prescription 6.0 34 2 1.00 Gender
15.5 116 11 1.68 (0.35, 7.96)
21.0 49 6 2.23 (0.42, 11.79)
Grosso 2012 Italy < 25 to > 65 M: 43.1%
F: 56.9%
Attendants of primary care centers Use without prescription 4.0 489 82 0.39 (0.26, 0.61) Age, gender, occupation
11.0 268 61 0.41 (0.26, 0.64)
16.0 176 74 1.00
Non-adherence 4.0 502 169 1.77 (1.13, 2.75)
11.0 276 45 0.79 (0.48, 1.31)
16.0 178 33 1.00
Clark 2011 Azerbaijan Adults (≥ 18) M: 43.6%
F: 56.4%
General population Use without prescription 0.0 35 8 1.00 Age, gender, ethnicity, household size
7.0 646 123 1.23 (0.45, 3.36)
10.5 74 14 1.25 (0.37, 4.17)
13.5 37 9 1.48 (0.37, 5.93)
Widayati 2011 Indonesia Adults (≥ 18) M: 38.3%
F: 61.7%
General population Use without prescription 3.5 8 5 1.00 Age, gender, income, marital status, household size, employment status, healthcare insurance
8.0 8 3 0.36 (0.05, 2.73)
11.0 31 17 0.73 (0.15, 3.60)
14.5 21 8 0.37 (0.07, 1.98)
Barah 2010 Syria Adults (≥ 18) M: 52%
F: 48%
General population Use without prescription 5.0 80 54 1.00 Age
11.0 83 66 1.87 (0.92, 3.80)
15.5 89 55 0.78 (0.42, 1.47)
21.0 90 57 0.83 (0.44, 1.57)
Landers 2010 United States Mean ± SD: 33.7 ± 8.7 F: 100% General population Use without prescription 4.5 31 11 1.00 Age, gender
13.0 42 18 1.36 (0.52, 3.55)
Sawalha 2010 Palestine NA General population Antibiotic Storage 3.5 239 86 1.00
10.0 591 162 0.67 (0.49, 0.93)
Togoobaatar 2010 Mongolia Mean ± SD: 35.4 ± 11.9 F: 100% General population Use without prescription 5.0 183 1.20 (0.70, 2.20) Gender, occupation
12.0 320 1.00
Abasaeed 2009 United Arab Emirates Adults
 ≤ 20 to > 50
M: 65.8%
F: 34.2%
Attendants of a book fair Antibiotic storage 3.5 163 37 1.00 Age
11.0 191 48 1.14 (0.70, 1.87)
15.5 496 166 1.71 (1.14, 2.58)
Ilhan 2009 Turkey Adults (≥ 18)
Mean ± SD: 39.5 ± 15.2
M: 38.7%
F: 61.3%
Attendants of primary care centers Use without prescription 4.0 906 141 1.00 Age, gender, income, marital status, employment status, household size, healthcare insurance (social security), perceived health status, presence of chronic diseases
12.5 1787 373 1.43 (1.15, 1.78)
Sawair 2009 Jordan 16–65 M: 46.1%
F: 53.9%
Attendants of primary care centers Use without prescription 0.0 14 7 1.00 Age, gender, income, marital status, employment status, healthcare insurance, smoking habits, self-reported health status, chronic comorbidities
5.5 37 15 0.68 (0.20, 2.35)
11.5 203 77 0.61 (0.21, 1.81)
15.5 198 85 0.75 (0.25, 2.23)
21.0 25 10 0.67 (0.18, 2.49)
Hadi 2008 Indonesia Adults (≥ 18) M: 37.4%
F: 62.6%
Attendants of primary care centers Use without prescription 2.5 63 26 1.00 Age, gender, income, residential location, ethnicity, household size, healthcare insurance
6.0 402 192 1.30 (0.76, 2.22)
Mistretta 2008 Italy  ≥ 10
Mean ± SD: 53.7 ± 17.7
M: 41.3%
F: 58.7%
Attendants of primary care centers Use without prescription 2.5 144 124 1.00 Age, gender, occupation, family size
7.0 165 142 0.73 (0.36, 1.46)
11.0 195 160 0.62 (0.30, 1.28)
16.0 132 86 1.37 (0.65, 2.86)
Al-Azzam 2007 Jordan Unrestricted age category
> 17 to < 60
M: 48.8%
F: 51.2%
General population Use without prescription 0.0 315 86 1.00
5.5 396 143 1.51 (1.09, 2.08)
11.5 709 313 2.10 (1.58, 2.81)
15.5 713 300 1.93 (1.45, 2.58)
Grigoryan 2006 19 European countries Adults (≥ 18) M: 46.8%
F: 53.2%
General population Use without prescription 6.0 1.00 Age, gender, country, chronic diseases
14.0 1.36 (1.10, 1.68)
Antibiotic storage 6.0 1.00
14.0 1.69 (1.47, 1.94)
Awad 2005 Sudan  ≤ 20 to > 60 M: 45.1%
F: 54.9%
General population Use without prescription 0.0 156 63 1.00 Age, gender, income
3.5 285 155 1.76 (1.18, 2.61)
7.5 392 262 2.98 (2.03, 4.36)
10.0 474 413 9.99 (6.58, 15.18)
14.5 443 400 13.73 (8.77, 21.51)
Parimi 2002 Trinidad
and Tobago
Adults (≥ 18) M: 33.3%
F: 66.7%
General population Use without prescription 3.5 126 34 1.00 Age
9.5 323 71 0.76 (0.47, 1.22)
14.5 147 25 0.55 (0.31, 0.99)
Antibiotic storage 3.5 124 26 1.00
9.5 308 74 1.19 (0.72, 1.98)
14.5 147 28 0.89 (0.49, 1.61)
Bi 2000 China F: 100% Children caregivers Use without prescription 3.5 140 65 1.00 Gender
8.0 442 259 1.63 (1.11, 2.39)
11.0 780 478 1.83 (1.27, 2.62)
14.5 97 65 2.34 (1.37, 4.01)
Saradamma 2000 India > 6 M: 48.5%
F: 51.5%
General population Use without prescription 4.0 87 38 1.00
10.5 136 24 0.28 (0.15, 0.51)
14.5 137 8 0.08 (0.04, 0.18)
19.0 45 3 0.09 (0.03, 0.32)
  1. CI, confidence interval; F, female; IQR, interquartile range; M, male; n, number of participants who misused antibiotics; N, total number of participants per education level; OR, odds ratio; SD, standard deviation; *, data provided by author; –, not reported