Effectiveness of an educational intervention in promoting antibiotic awareness among 8th to 10th grade students in Kerala, India

Parvathy Balachandran; Venkitachalam Ramanarayanan; Anju James

doi:10.7126/cumudj.1233563

Research Article

Effectiveness of an educational intervention in promoting antibiotic awareness among 8th to 10th grade students in Kerala, India

Year 2023, Volume: 26 Issue: 2, 173 - 179, 23.06.2023

Parvathy Balachandran Venkitachalam Ramanarayanan , Anju James

https://doi.org/10.7126/cumudj.1233563

Abstract

Objectives: To assess the effectiveness of a training program on the knowledge, attitude, and behavior of antimicrobial resistance determinants among high school students in Kerala, India.
Methods: This quasi-experimental study was conducted among 8th – 10th grade students for six months in a high school in Kerala, India . This study consisted of a baseline assessment of consenting participants, educational intervention using PowerPoint slides, and post-intervention assessment. Assessments were done using a validated Knowledge, Attitude, and Behavior questionnaire.
Results: Among the 223 eligible students in the selected school, 159 (71.3%) participated in the study. The follow-up rate was 93.08%. Considering a p-value of less than 0.05 to be statistically significant, there was a statistically significant difference in the knowledge (pre-intervention mean score = 6.26 ± 2.06, post-intervention mean score = 7.44 ± 1.81), attitude (pre-intervention mean score = 2.51 ± 1.13, post-intervention mean score = 3.29 ± 1.19), and behavior (pre-intervention score = 4.27 ± 1.40, post-intervention score = 4.74 ± 1.38) of study participants.
Conclusion: Educational intervention based on improving the knowledge, attitude, and practice of school children is an effective strategy to address the growing threat of antimicrobial resistance.

Keywords

antimicrobial resistance, school, behavior, knowledge, attitude, antibiotics

Supporting Institution

Kerala State Council for Science, Technology and Environment

Project Number

00625/SPS 65/2021/KSCSTE

Thanks

The authors wish to thank the Headmaster Rev. Fr. Sebastian Managalam CMI, Mrs Bini (Science Club Secretary) and all teachers and students of KTJM High School, Pala, Kottayam, Kerala for their support in the conduct of the study.

References

1. Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, et al. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist. 2018;11:1645–1658.
2. Byrne MK, Miellet S, McGlinn A, Fish J, Meedya S, Reynolds N, et al. The drivers of antibiotic use and misuse: the development and investigation of a theory driven community measure. BMC Public Health. 2019;19(1):1–11.
3. Technical Note on Antimicrobial Resistance.pdf [Internet]. [cited 2022 Apr 10]. Available from: https://www.unicef.org/media/62221/file/Technical%20Note%20on%20Antimicrobial%20Resistance.pdf
4. Hofer U. The cost of antimicrobial resistance. Nat Rev Microbiol. 2019;17(1):3.
5. Smith R, Coast J. The true cost of antimicrobial resistance. BMJ. 2013;346:1–5.
6. Cuevas C, Batura N, Wulandari LPL, Khan M, Wiseman V. Improving antibiotic use through behaviour change: a systematic review of interventions evaluated in low- and middle-income countries. Health Policy Plan. 2021;36(5):594–605.
7. Yam ELY, Hsu LY, Yap EPH, Yeo TW, Lee V, Schlundt J, et al. Antimicrobial Resistance in the Asia Pacific region: a meeting report. Antimicrobial Resistance & Infection Control. 2019 Dec 18;8(1):202.
8. Chatterjee S, Poonawala H, Jain Y. Drug-resistant tuberculosis: is India ready for the challenge? BMJ Global Health. 2018;3(4):1–3.
9. Holmes AH, Sharland M. The Chennai Declaration: India’s landmark national commitment to antibiotic stewardship demonstrates that ‘truth alone triumphs’†. Journal of Antimicrobial Chemotherapy. 2013;68(7):1453–1454.
10. Voss A, Ghafur A. “The Chennai declaration” - Indian doctors’ fight against antimicrobial resistance. Antimicrobial Resistance and Infection Control. 2013;2(1):1–3.
11. Lohiniva AL, Heweidy I, Girgis S, Abouelata O, Ackley C, Samir S, et al. Developing a theory-based behavior change intervention to improve the prescription of surgical prophylaxis. Int J Clin Pharm. 2022;44(1):227–234.
12. Kaplan NM, Khader YS, Alfaqih MA, Saadeh R, Al Sawalha L. Implementation of the WHO Approved “Tailoring Antimicrobial Resistance Programs (TAP)” Reduces Patients’ Request for Antibiotics. Antibiotics (Basel). 2020;9(8):1–12.
13. Azevedo MM, Pinheiro C, Yaphe J, Baltazar F. Assessing the Impact of a School Intervention to Promote Students’ Knowledge and Practices on Correct Antibiotic Use. Int J Environ Res Public Health. 2013;10(7):2920–2931.
14. Woodhead M, Finch R, on behalf of the Public Education Subgroup of SACAR. Public education—a progress report. Journal of Antimicrobial Chemotherapy. 2007;60(suppl_1):53-55.
15. Lecky DM, McNulty CAM. Current initiatives to improve prudent antibiotic use amongst school-aged children. J Antimicrob Chemother. 2013;68(11):2428-2430.
16. Aidasani B, Solanki M, Khetarpal S, Ravi Pratap S. Antibiotics: their use and misuse in paediatric dentistry. A systematic review. Eur J Paediatr Dent. 2019 Jun;20(2):133-138.
17. Technical Note on Antimicrobial Resistance.pdf [Internet]. [cited 2022 Apr 10]. Available from: https://www.unicef.org/media/62221/file/Technical%20Note%20on%20Antimicrobial%20Resistance.pdf
18. Lee CR, Lee JH, Kang LW, Jeong BC, Lee SH. Educational Effectiveness, Target, and Content for Prudent Antibiotic Use. Biomed Res Int. 2015;2015:1–13.
19. Haxton E, Lindberg A, Troell K, Redican KJ. One Health education meets science. Infect Ecol Epidemiol. 2015;5:10.3402/iee.v5.30264.
20. Fernandes R, Naik S, Bhat AG, Shetty R, Hande MH, Ghafur A, et al. Knowledge Assessment of E-Bug Assisted Antimicrobial Resistance Education Module in Class VII School Students of South Indian Coastal Town of Manipal. J Clin Med. 2019;8(1):1-9.
21. Huang Y, Gu J, Zhang M, Ren Z, Yang W, Chen Y, et al. Knowledge, attitude and practice of antibiotics: a questionnaire study among 2500 Chinese students. BMC Medical Education. 2013 Dec 9;13(1):163.
22. e-Bug | England Home [Internet]. [cited 2022 Apr 13]. Available from: https://www.e-bug.eu/
23. Jifar Al, Ayele Y. Assessment of Knowledge, Attitude, and Practice toward Antibiotic Use among Harar City and Its Surrounding Community, Eastern Ethiopia. Interdiscip Perspect Infect Dis. 2018;2018:1–6.
24. Fonseca MJ, Santos CL, Costa P, Lencastre L, Tavares F. Increasing Awareness about Antibiotic Use and Resistance: A Hands-On Project for High School Students. PLOS ONE. 2012;7(9):e44699.
25. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014;14(13):1–25.
26. Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrobial Resistance & Infection Control. 2017;6(1):47–55.
27. Chan YH, Fan MM, Fok CM, Lok ZL, Ni M, Sin CF, et al. Antibiotics nonadherence and knowledge in a community with the world’s leading prevalence of antibiotics resistance: implications for public health intervention. Am J Infect Control. 2012;40(2):113–117.
28. Lecky DM, McNulty CAM, Touboul P, Herotova TK, Beneš J, Dellamonica P, et al. Evaluation of e-Bug, an educational pack, teaching about prudent antibiotic use and hygiene, in the Czech Republic, France and England. Journal of Antimicrobial Chemotherapy. 2010;65(12):2674–84.
29. Hayes C, Young V, Brown C, Touboul Lundgren P, Gennimata D, Holt J, et al. International promotion of e-Bug, an infection prevention and control educational intervention: survey of partners across 14 countries. JAC Antimicrob Resist. 2020;2(1):dlaa003.
30. Ancillotti M, Eriksson S, Veldwijk J, Nihlen Fahlquist J, Andersson D, Godskesen T. Public awareness and individual responsibility needed for judicious use of antibiotics: a qualitative study of public beliefs and perceptions. BMC Public Health. 2018;18(1153):1–9.
31. Fairbrother H, Curtis P, Goyder E. Making health information meaningful: Children’s health literacy practices. SSM - Population Health. 2016;2:476–84.
32. Lindsay G. Baseline assessment: What purpose, and for whose benefit? Education 3-13. 2001;29:47–52.
33. Adolescent health [Internet]. [cited 2023 May 19]. Available from: https://www.who.int/health-topics/adolescent-health
34. Ayaz S, Açıl D. Comparison of peer education and the classic training method for school aged children regarding smoking and its dangers. J Pediatr Nurs. 2015;30(3):e3-12.
35. Foley BC, Shrewsbury VA, Hardy LL, Flood VM, Byth K, Shah S. Evaluation of a peer education program on student leaders’ energy balance-related behaviors. BMC Public Health. 2017;17:695–703.
36. McNulty CAM, Syeda RB, Brown CL, Bennett CV, Schofield B, Allison DG, et al. Peer-Education as a Tool to Educate on Antibiotics, Resistance and Use in 16–18-Year-Olds: A Feasibility Study. Antibiotics (Basel). 2020;9(4):146–162.
37. Bönecker M, Abanto J, Tello G, Oliveira LB. Impact of dental caries on preschool children’s quality of life: an update. Braz Oral Res. 2012;26 Suppl 1:103–107.
38. CDC. Hand Hygiene at School [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2022 Jul 13]. Available from: https://www.cdc.gov/handwashing/handwashing-school.html
39. Jones G, Gardner GE, Lee T, Poland K, Robert S. The Impact of Microbiology Instruction on Students’ Perceptions of Risks Related to Microbial Illness. International Journal of Science Education, Part B. 2013;3(3):199–213.
40. McNulty CAM, Swan AV, Boland D. Schools’ antimicrobial resistance: National Advice to the Public campaign – a pilot study. Health Education. 2001;101(5):235–242.
41. McNulty CAM, Bowen J, Gelb D, Charlett A. “The Bug Investigators”: Assessment of a School Teaching Resource to Improve Hygiene and Prudent Use of Antibiotics. Health Education. 2007;107(1):10–26.
42. Appiah B, Anum-Hagin D, Gyansa-Luterrodt M, Samman E, Agyeman FKA, Appiah G, et al. Children against antibiotics misuse and antimicrobial resistance: assessing effectiveness of storytelling and picture drawing as public engagement approaches. Wellcome Open Res. 2021;6:202–222.
43. Cebotarenco N, Bush PJ. Reducing antibiotics for colds and flu: a student-taught program. Health Educ Res. 2008;23(1):146-57.
44. Farrell D, Kostkova P, Weinberg J, Lazareck L, Weerasinghe D, Lecky DM, et al. Computer games to teach hygiene: an evaluation of the e-Bug junior game. J Antimicrob Chemother. 2011;66 Suppl 5:39–44.

Year 2023, Volume: 26 Issue: 2, 173 - 179, 23.06.2023

Parvathy Balachandran Venkitachalam Ramanarayanan , Anju James

https://doi.org/10.7126/cumudj.1233563

Abstract

Keywords

antimicrobial resistance; school; behavior; knowledge; attitude; antibiotics, behavior

Project Number

00625/SPS 65/2021/KSCSTE

References

1. Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, et al. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist. 2018;11:1645–1658.
2. Byrne MK, Miellet S, McGlinn A, Fish J, Meedya S, Reynolds N, et al. The drivers of antibiotic use and misuse: the development and investigation of a theory driven community measure. BMC Public Health. 2019;19(1):1–11.
3. Technical Note on Antimicrobial Resistance.pdf [Internet]. [cited 2022 Apr 10]. Available from: https://www.unicef.org/media/62221/file/Technical%20Note%20on%20Antimicrobial%20Resistance.pdf
4. Hofer U. The cost of antimicrobial resistance. Nat Rev Microbiol. 2019;17(1):3.
5. Smith R, Coast J. The true cost of antimicrobial resistance. BMJ. 2013;346:1–5.
6. Cuevas C, Batura N, Wulandari LPL, Khan M, Wiseman V. Improving antibiotic use through behaviour change: a systematic review of interventions evaluated in low- and middle-income countries. Health Policy Plan. 2021;36(5):594–605.
7. Yam ELY, Hsu LY, Yap EPH, Yeo TW, Lee V, Schlundt J, et al. Antimicrobial Resistance in the Asia Pacific region: a meeting report. Antimicrobial Resistance & Infection Control. 2019 Dec 18;8(1):202.
8. Chatterjee S, Poonawala H, Jain Y. Drug-resistant tuberculosis: is India ready for the challenge? BMJ Global Health. 2018;3(4):1–3.
9. Holmes AH, Sharland M. The Chennai Declaration: India’s landmark national commitment to antibiotic stewardship demonstrates that ‘truth alone triumphs’†. Journal of Antimicrobial Chemotherapy. 2013;68(7):1453–1454.
10. Voss A, Ghafur A. “The Chennai declaration” - Indian doctors’ fight against antimicrobial resistance. Antimicrobial Resistance and Infection Control. 2013;2(1):1–3.
11. Lohiniva AL, Heweidy I, Girgis S, Abouelata O, Ackley C, Samir S, et al. Developing a theory-based behavior change intervention to improve the prescription of surgical prophylaxis. Int J Clin Pharm. 2022;44(1):227–234.
12. Kaplan NM, Khader YS, Alfaqih MA, Saadeh R, Al Sawalha L. Implementation of the WHO Approved “Tailoring Antimicrobial Resistance Programs (TAP)” Reduces Patients’ Request for Antibiotics. Antibiotics (Basel). 2020;9(8):1–12.
13. Azevedo MM, Pinheiro C, Yaphe J, Baltazar F. Assessing the Impact of a School Intervention to Promote Students’ Knowledge and Practices on Correct Antibiotic Use. Int J Environ Res Public Health. 2013;10(7):2920–2931.
14. Woodhead M, Finch R, on behalf of the Public Education Subgroup of SACAR. Public education—a progress report. Journal of Antimicrobial Chemotherapy. 2007;60(suppl_1):53-55.
15. Lecky DM, McNulty CAM. Current initiatives to improve prudent antibiotic use amongst school-aged children. J Antimicrob Chemother. 2013;68(11):2428-2430.
16. Aidasani B, Solanki M, Khetarpal S, Ravi Pratap S. Antibiotics: their use and misuse in paediatric dentistry. A systematic review. Eur J Paediatr Dent. 2019 Jun;20(2):133-138.
17. Technical Note on Antimicrobial Resistance.pdf [Internet]. [cited 2022 Apr 10]. Available from: https://www.unicef.org/media/62221/file/Technical%20Note%20on%20Antimicrobial%20Resistance.pdf
18. Lee CR, Lee JH, Kang LW, Jeong BC, Lee SH. Educational Effectiveness, Target, and Content for Prudent Antibiotic Use. Biomed Res Int. 2015;2015:1–13.
19. Haxton E, Lindberg A, Troell K, Redican KJ. One Health education meets science. Infect Ecol Epidemiol. 2015;5:10.3402/iee.v5.30264.
20. Fernandes R, Naik S, Bhat AG, Shetty R, Hande MH, Ghafur A, et al. Knowledge Assessment of E-Bug Assisted Antimicrobial Resistance Education Module in Class VII School Students of South Indian Coastal Town of Manipal. J Clin Med. 2019;8(1):1-9.
21. Huang Y, Gu J, Zhang M, Ren Z, Yang W, Chen Y, et al. Knowledge, attitude and practice of antibiotics: a questionnaire study among 2500 Chinese students. BMC Medical Education. 2013 Dec 9;13(1):163.
22. e-Bug | England Home [Internet]. [cited 2022 Apr 13]. Available from: https://www.e-bug.eu/
23. Jifar Al, Ayele Y. Assessment of Knowledge, Attitude, and Practice toward Antibiotic Use among Harar City and Its Surrounding Community, Eastern Ethiopia. Interdiscip Perspect Infect Dis. 2018;2018:1–6.
24. Fonseca MJ, Santos CL, Costa P, Lencastre L, Tavares F. Increasing Awareness about Antibiotic Use and Resistance: A Hands-On Project for High School Students. PLOS ONE. 2012;7(9):e44699.
25. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014;14(13):1–25.
26. Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrobial Resistance & Infection Control. 2017;6(1):47–55.
27. Chan YH, Fan MM, Fok CM, Lok ZL, Ni M, Sin CF, et al. Antibiotics nonadherence and knowledge in a community with the world’s leading prevalence of antibiotics resistance: implications for public health intervention. Am J Infect Control. 2012;40(2):113–117.
28. Lecky DM, McNulty CAM, Touboul P, Herotova TK, Beneš J, Dellamonica P, et al. Evaluation of e-Bug, an educational pack, teaching about prudent antibiotic use and hygiene, in the Czech Republic, France and England. Journal of Antimicrobial Chemotherapy. 2010;65(12):2674–84.
29. Hayes C, Young V, Brown C, Touboul Lundgren P, Gennimata D, Holt J, et al. International promotion of e-Bug, an infection prevention and control educational intervention: survey of partners across 14 countries. JAC Antimicrob Resist. 2020;2(1):dlaa003.
30. Ancillotti M, Eriksson S, Veldwijk J, Nihlen Fahlquist J, Andersson D, Godskesen T. Public awareness and individual responsibility needed for judicious use of antibiotics: a qualitative study of public beliefs and perceptions. BMC Public Health. 2018;18(1153):1–9.
31. Fairbrother H, Curtis P, Goyder E. Making health information meaningful: Children’s health literacy practices. SSM - Population Health. 2016;2:476–84.
32. Lindsay G. Baseline assessment: What purpose, and for whose benefit? Education 3-13. 2001;29:47–52.
33. Adolescent health [Internet]. [cited 2023 May 19]. Available from: https://www.who.int/health-topics/adolescent-health
34. Ayaz S, Açıl D. Comparison of peer education and the classic training method for school aged children regarding smoking and its dangers. J Pediatr Nurs. 2015;30(3):e3-12.
35. Foley BC, Shrewsbury VA, Hardy LL, Flood VM, Byth K, Shah S. Evaluation of a peer education program on student leaders’ energy balance-related behaviors. BMC Public Health. 2017;17:695–703.
36. McNulty CAM, Syeda RB, Brown CL, Bennett CV, Schofield B, Allison DG, et al. Peer-Education as a Tool to Educate on Antibiotics, Resistance and Use in 16–18-Year-Olds: A Feasibility Study. Antibiotics (Basel). 2020;9(4):146–162.
37. Bönecker M, Abanto J, Tello G, Oliveira LB. Impact of dental caries on preschool children’s quality of life: an update. Braz Oral Res. 2012;26 Suppl 1:103–107.
38. CDC. Hand Hygiene at School [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2022 Jul 13]. Available from: https://www.cdc.gov/handwashing/handwashing-school.html
39. Jones G, Gardner GE, Lee T, Poland K, Robert S. The Impact of Microbiology Instruction on Students’ Perceptions of Risks Related to Microbial Illness. International Journal of Science Education, Part B. 2013;3(3):199–213.
40. McNulty CAM, Swan AV, Boland D. Schools’ antimicrobial resistance: National Advice to the Public campaign – a pilot study. Health Education. 2001;101(5):235–242.
41. McNulty CAM, Bowen J, Gelb D, Charlett A. “The Bug Investigators”: Assessment of a School Teaching Resource to Improve Hygiene and Prudent Use of Antibiotics. Health Education. 2007;107(1):10–26.
42. Appiah B, Anum-Hagin D, Gyansa-Luterrodt M, Samman E, Agyeman FKA, Appiah G, et al. Children against antibiotics misuse and antimicrobial resistance: assessing effectiveness of storytelling and picture drawing as public engagement approaches. Wellcome Open Res. 2021;6:202–222.
43. Cebotarenco N, Bush PJ. Reducing antibiotics for colds and flu: a student-taught program. Health Educ Res. 2008;23(1):146-57.
44. Farrell D, Kostkova P, Weinberg J, Lazareck L, Weerasinghe D, Lecky DM, et al. Computer games to teach hygiene: an evaluation of the e-Bug junior game. J Antimicrob Chemother. 2011;66 Suppl 5:39–44.

There are 44 citations in total.

Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Original Research Articles
Authors	Parvathy Balachandran 0000-0003-4815-5223 Venkitachalam Ramanarayanan 0000-0002-5587-3453 Anju James 0000-0003-4298-6464
Project Number	00625/SPS 65/2021/KSCSTE
Publication Date	June 23, 2023
Submission Date	January 13, 2023
Published in Issue	Year 2023Volume: 26 Issue: 2

Cite

EndNote	Balachandran P, Ramanarayanan V, James A (June 1, 2023) Effectiveness of an educational intervention in promoting antibiotic awareness among 8th to 10th grade students in Kerala, India. Cumhuriyet Dental Journal 26 2 173–179.

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