The General Population’s Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Review Framework
2.2. Search Strategy
2.3. Inclusion and Exclusion Criteria
2.4. Quality Assessment
2.5. Data Extraction
2.6. Statistical Analysis
3. Results
3.1. Study Selection and Characteristics
3.2. The Prevalence of Irrational Use Behaviors of the General Population
3.2.1. Demanding Antibiotic Prescription
3.2.2. Non–Prescription Antibiotic Purchasing
3.2.3. Non–Adherence to Antibiotic Prescription
3.2.4. Prophylactic Use of Antibiotics
3.2.5. Sensitivity Analysis
3.3. Prevalence of Potential Reasons of the General Population’s Irrational Use of Antibiotics
4. Discussion
4.1. Main Findings
4.2. Strengths and Limitations
4.3. Comparison with Existing Studies
4.4. Implications
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data
Heading | Yes | No | Unclear | Not Applicable |
1. Was the sample frame appropriate to address the target population? | ? | ? | ? | ? |
2. Were study participants sampled in an appropriate way? | ? | ? | ? | ? |
3. Was the sample size adequate? | ? | ? | ? | ? |
4. Were the study subjects and the setting described in detail? | ? | ? | ? | ? |
5. Was the data analysis conducted with sufficient coverage of the identified sample? | ? | ? | ? | ? |
6. Were valid methods used for the identification of the condition? | ? | ? | ? | ? |
7. Was the condition measured in a standard, reliable way for all participants? | ? | ? | ? | ? |
8. Was there appropriate statistical analysis? | ? | ? | ? | ? |
9. Was the response rate adequate, and if not, was the low response rate managed appropriately? | ? | ? | ? | ? |
- Was the sample frame appropriate to address the target population? The sampling frame should match with the purpose of the study, and can obtain the target population of the study;
- Were study participants sampled in an appropriate way? It is necessary to describe in detail what sampling method was used and how to gradually obtain our target population. For cluster and stratified sampling, you should describe the characteristics according to which participants are stratified and grouped. Non–probability sampling is not considered an appropriate survey research method;
- Was the sample size adequate? In addition to a comprehensive census, a detailed and reasonable sample size calculation process is required for sample surveys;
- Were the study subjects and the setting described in detail? The characteristics of the participants need to be described in detail, and demographic information, research time and research location need to be included at the same time;
- Was the data analysis conducted with sufficient coverage of the identified sample? It is necessary to describe whether the samples can adequately cover the structure of each subgroup;
- Were valid methods used for the identification of the condition? While using a self–made questionnaire as measurement tool, the reliability and validity test results of the questionnaire need to be provided; if a certain established standard or definition is applied in the research, its standard and source should be introduced in detail;
- Was the condition measured in a standard, reliable way for all participants? Introduce whether the questionnaire surveyor has been uniformly trained, and introduce the content of the uniform training, or describe in detail the distribution and quality control process of the questionnaire in the data collection process;
- Was there appropriate statistical analysis? The rate index should give the numerator, denominator, and rate with confidence interval;
- Was the response rate adequate, and if not, was the low response rate managed appropriately? The response rate of the research needs to be given. Generally, the response rate is >70%. If the response rate is less than 70%, the response rate is too low. The research needs to provide solutions for the response rate.
Appendix B. Data Extraction Form for Prevalence Studies
Citation Details | ||||||
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Author | Title | Journal | Year | Issue | Volume | Pages |
Generic Study Details | ||||||
Study Design | Country | Setting/Context | Year/Timeframe for Data Collection | Participants Characteristic (Study Inclusion/Exclusion Information) | Condition and Measurement | Description of Main Result (n/N) |
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# | Searches |
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1 | (antibacterial * or antibiotics * or antimicrobial *).af. |
2 | (application * or management * or use * or storage * or non-prescri * or self-medication * or irrational * or abuse * or behavior * or status quo *).af. |
3 | (determinants * or knowledge * or attitude * or belief * or expectation * or medical advice * or compliance *).af. |
4 | (residents * or population * or general population * or public * or respiratory infection patients * or middle-aged and elderly * or students * or outpatients *).af. |
5 | 1 and 2 and 3 and 4 |
First Author | Year | Region | Study Design | Type of Participants | Sample Size | Quality Assessment |
---|---|---|---|---|---|---|
Tian, X. [37] | 2006 | East | Cross-sectional | Students | 4980 | 4 |
Su, D. [38] | 2006 | East | Quasi-experimental | Rural residents | 420 | 5 |
Xie, J. [39] | 2006 | East | Quasi-experimental | Urban residents | 209 | 4 |
Luo, J. [40] | 2008 | Central | Cross-sectional | Pharmacy customers | 1490 | 7 |
Yin, T. [41] | 2008 | Central | Cross-sectional | Pharmacy customers | 396 | 7 |
Hu, L. [42] | 2008 | East | Cross-sectional | Urban residents | 209 | 5 |
Wang, Y. [43] | 2008 | East | Cross-sectional | Urban residents | 658 | 4 |
Li, B. [44] | 2008 | Central | Cross-sectional | Children’s parents | 266 | 4 |
Ye, L. [45] | 2009 | Central | Cross-sectional | Outpatients | 276 | 4 |
Sun, L. [46] | 2010 | East | Cross-sectional | Students | 853 | 4 |
Huang, W. [47] | 2011 | West | Cross-sectional | Outpatients | 956 | 5 |
Huang, Y. [48] | 2011 | East | Cross-sectional | Urban residents | 298 | 4 |
Ji, H. [49] | 2011 | West | Cross-sectional | Urban residents | 400 | 5 |
Shan, H. [50] | 2011 | East | Cross-sectional | Outpatients | 1236 | 4 |
Huang, C. [51] | 2012 | East | Cross-sectional | Rural residents | 400 | 5 |
Cheng, S. [52] | 2012 | East | Cross-sectional | Urban residents | 164 | 5 |
Zhao, L. [53] | 2012 | East | Cross-sectional | Rural residents | 1014 | 6 |
Wu, Y. [54] | 2012 | West | Cross-sectional | Urban and rural residents | 1200 | 5 |
Ma, X. [55] | 2012 | East | Cross-sectional | Urban residents | 4183 | 4 |
Yu, M. [56] | 2012 | Central | Cross-sectional | Children’s parents | 854 | 5 |
Liu, S. [57] | 2012 | East | Cross-sectional | Urban residents | 200 | 4 |
Du, X. [58] | 2012 | Central | Cross-sectional | Students | 905 | 4 |
Tao, G. [59] | 2013 | West | Quasi-experimental | Urban residents | 1000 | 6 |
Li, Y. [60] | 2013 | East | Cross-sectional | Rural residents | 1589 | 5 |
Jin, Y. [61] | 2013 | West | Cross-sectional | Urban residents | 2556 | 5 |
Ye, W. [62] | 2013 | East | Cross-sectional | Rural residents | 800 | 4 |
Tang, X. [63] | 2013 | East | Cross-sectional | Outpatients | 496 | 4 |
Zhang, Y. [64] | 2013 | East | Cross-sectional | Students | 1180 | 4 |
Xu, Y. [65] | 2013 | East | Cross-sectional | Urban residents | 106 | 5 |
Liu, M. [66] | 2013 | East | Cross-sectional | Children’s parents | 1046 | 7 |
Sun, W. [67] | 2014 | East | Quasi-experimental | Children’s parents | 593 | 6 |
Ding, L. [68] | 2014 | East | Cross-sectional | Children’s parents | 722 | 5 |
Tian, L. [69] | 2014 | East | Cross-sectional | Urban residents | 316 | 5 |
Han, F. [70] | 2014 | Central | Cross-sectional | Students | 4462 | 5 |
Yuan, J. [71] | 2014 | West | Cross-sectional | Rural residents | 435 | 6 |
Bian, C. [72] | 2014 | Central | Cross-sectional | Outpatients | 1214 | 4 |
Zhang, S. [73] | 2014 | Central | Cross-sectional | Urban residents | 500 | 5 |
Xiong, X. [74] | 2014 | East | Cross-sectional | Urban residents | 354 | 4 |
Lin, W. [75] | 2014 | East | Cross-sectional | Urban residents | 1784 | 5 |
Sun, Y. [76] | 2014 | Central | Cross-sectional | Students | 388 | 4 |
Liu, Y. [77] | 2015 | East | Quasi-experimental | Rural residents | 639 | 7 |
Diao, M. [78] | 2015 | Central | Cross-sectional | Rural residents | 2047 | 5 |
Chen, S. [79] | 2015 | East | Cross-sectional | Teachers | 84 | 8 |
Wang, X. [80] | 2015 | Central | Cross-sectional | Students | 11,192 | 5 |
Li, Y. [60] | 2015 | Central | Cross-sectional | Students | 692 | 5 |
Cheng, J. [81] | 2015 | Central | Cross-sectional | Rural residents | 2611 | 6 |
Zhang, Y. [82] | 2015 | East | Cross-sectional | Children’s parents | 250 | 6 |
Song, Y. [83] | 2015 | East | Cross-sectional | Students | 812 | 4 |
Cui, B. [84] | 2015 | East | Cross-sectional | Students | 528 | 4 |
Ding, L. [85] | 2015 | East | Cross-sectional | Rural residents | 769 | 6 |
Wang, G. [86] | 2015 | East | Cross-sectional | Urban residents | 1718 | 5 |
Yu, Y. [87] | 2015 | East | Cross-sectional | Urban residents | 267 | 5 |
Lei, Z. [88] | 2015 | Central | Cross-sectional | Pharmacy customers | 282 | 4 |
Chen, C. [89] | 2016 | East | Cross-sectional | Civil servants | 400 | 5 |
Tang, Z. [90] | 2016 | West | Cross-sectional | Children’s parents | 766 | 5 |
Wang, Z. [91] | 2016 | East | Cross-sectional | Urban and rural residents | 438 | 5 |
Jiang, H. [92] | 2016 | East | Cross-sectional | Urban residents | 449 | 6 |
Wang, Q. [93] | 2016 | West | Cross-sectional | Students | 1584 | 4 |
Jiang, Y. [94] | 2017 | East | Cross-sectional | Urban and rural residents | 651 | 4 |
Luo, Y. [95] | 2017 | West | Cross-sectional | Students | 368 | 5 |
Yang, Q. [96] | 2017 | East | Cross-sectional | Children’s parents | 713 | 4 |
Wang, P. [97] | 2017 | East | Cross-sectional | Students | 1957 | 4 |
Li, X. [98] | 2017 | East | Cross-sectional | Children’s parents | 658 | 4 |
Piao, S. [99] | 2018 | East | Cross-sectional | Urban residents | 181 | 4 |
Qin, Z. [100] | 2018 | West | Cross-sectional | Urban residents | 518 | 4 |
Jiang, Y. [101] | 2019 | Central | Cross-sectional | Urban and rural residents | 657 | 6 |
Cao, L. [102] | NA | East | Cross-sectional | Children’s parents | 1080 | 4 |
Tan, Y. [103] | NA | West | Cross-sectional | Rural residents | 800 | 4 |
Ye, L. [104] | NA | East | Cross-sectional | Students | 152 | 6 |
Yao, X. [105] | NA | East | Cross-sectional | Students | 270 | 6 |
Zhao, Y. [106] | NA | West | Cross-sectional | Students | 363 | 4 |
Li, J. [107] | NA | West | Cross-sectional | Rural residents | 286 | 4 |
Huang, C. [108] | NA | East | Quasi-experimental | Urban residents | 400 | 4 |
Wu, C. [109] | NA | East | Quasi-experimental | Students | 337 | 4 |
Wen, W. [110] | NA | Central | Cross-sectional | Urban residents | 315 | 4 |
Lu, Z. [111] | NA | East | Cross-sectional | Students | 600 | 5 |
Rong, J. [112] | NA | East | Cross-sectional | Urban residents | 2000 | 4 |
Zhang, Y. [113] | NA | West | Cross-sectional | Children’s parents | 205 | 4 |
Subgroup | Demanding Antibiotic Prescription | Non-Prescription Antibiotic Purchasing | Non-Adherence to Antibiotic Prescription | Prophylactic Use of Antibiotics |
---|---|---|---|---|
Geographical region | ||||
Eastern China | 34 (26–43) | 34 (25–44) | 49 (39–60) | 35 (25–46) |
Central China | 26 (17–37) | 51 (36–65) | 45 (35–56) | 27 (18–37) |
Western China | 65 (50–78) | 70 (51–86) | 47 (43–52) | 47 (43–51) |
Study period | ||||
<2010 | 51 (35–67) | 49 (15–83) | 53 (51–56) | 35 (31–39) |
2010–2015 | 37 (20–56) | 57 (43–70) | 51 (43–59)) | 32 (24–40) |
≥2015 | 32 (24–41) | 44 (31–58) | 40 (27–53) | 38 (24–53) |
NA | 33 (20–47) | 29 (15–45) | 70 (51–86) | 42 (36–50) |
Type of participant | ||||
Rural residents | 28 (13–45) | 32 (15–52) | 67 (48–84) | 27 (16–39) |
Urban residents | 48 (33–64) | 54 (32–76) | 45 (36–55) | 39 (26–54) |
Students | 23 (13–34) | 49 (35–62) | 43 (27–61) | 34 (25–44) |
Pharmacy’s customer | 49 (47–51) | 73 (71–75) | – | – |
Children’s parents | 20 (12–29) | 17 (15–21) | 22 (18–25) | – |
Urban and rural residents | – | 54 (51–58) | 39 (35–43) | – |
Others | 38 (35–41) | 40 (7–80) | 61 (53–68) | 41 (12–74) |
Quality score | ||||
4–6 | 38 (29–47) | 48 (37–58) | 47 (40–54) | 36 (29–43) |
7–9 | 35 (10–64) | 45 (18–75) | 63 (61–65) | 40 (3–44) |
Study size | ||||
<400 | 41 (28–55) | 40 (27–53) | 44 (34–55) | 38 (26–51) |
400–800 | 37 (24–51) | 42 (26–58) | 54 (31–76) | 40 (16–67) |
800–1200 | 88 (86–90) | 70 (41–93) | 51 (30–72) | 32 (30–34) |
≥1200 | 28 (16–42) | 54 (34–74) | 48 (37–58) | 28 (21–34) |
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Duan, L.; Liu, C.; Wang, D. The General Population’s Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis. Antibiotics 2021, 10, 497. https://doi.org/10.3390/antibiotics10050497
Duan L, Liu C, Wang D. The General Population’s Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis. Antibiotics. 2021; 10(5):497. https://doi.org/10.3390/antibiotics10050497
Chicago/Turabian StyleDuan, Lixia, Chenxi Liu, and Dan Wang. 2021. "The General Population’s Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis" Antibiotics 10, no. 5: 497. https://doi.org/10.3390/antibiotics10050497