Parental Knowledge, Attitudes and Practices on Antibiotics Use for Childhood Upper Respiratory Tract Infections in Kicukiro District, Rwanda

Research Article

Austin Public Health. 2022; 6(1): 1018.

Parental Knowledge, Attitudes and Practices on Antibiotics Use for Childhood Upper Respiratory Tract Infections in Kicukiro District, Rwanda

Nshimiyimana M¹*, Habtu FM², Manishimwe F², Ndayisenga J² and Murekatete A²

¹Postgraduate Student, Department of Public Health, Mount Kenya University, Rwanda

²Mount Kenya University, Kigali, Rwanda

*Corresponding author: Nshimiyimana M, Postgraduate Student, Department of Public Health, Mount Kenya University, Rwanda

Received: May 11, 2022; Accepted: June 10, 2022; Published: June 17, 2022


Parents’ attitudes and expectations towards antibiotics use for children’s Upper Respiratory Tract Infections are among major causes of antibiotics misuse and the latter leads to the antimicrobial resistance. Thus, this study aimed at assessing parents’ knowledge, attitude and practices on antibiotics use for childhood URTIs in Kicukiro District. A cross-sectional study was conducted and a questionnaire was used to collect data from a sample size of 384 parents with under 12 years of age attending selected Health Centers in Kicukiro District. (SPPS) version 21 was used for data analysis; Chi-square test and regression analysis were used to examine the association between variables. The study findings indicated that 88.5% of parents were female, 39.6% aged from 25 to 34 years, 81.8% were married, 42.2% completed secondary education, 50% had 2 to 4 children and 57% of them were in economic class 2. The study revealed that 40.4% of parents had low level of knowledge of antibiotics use towards antibiotics use and 62% of them had poor practices regarding antibiotics use for childhood URTIs. Parents with increased level of education, higher economic position, with high knowledge and positive attitude use were more likely to have good practices towards antibiotics use than their corresponding counterparts. In conclusion, parents from Kicukiro District had poor knowledge and poor practices regarding antibiotics use for children’s URTIs. Hence, the study recommended that educational interventions for parents are needed to reduce antibiotics misuse by raising awareness on indications of antibiotics, their side effects and the emergence of antimicrobial resistance.

Keywords: Antibiotics Use; Attitudes and Knowledge; Children, Parents


AB: Antibiotic; AMR: Antimicrobial Resistance; AOR: Adjusted Odds Ratio; CI: Confidence Interval; SPSS: Statistical Package for Social Sciences; StD: Standard Deviation; URTIs: Upper Respiratory Tract Infections.


Childhood Upper Respiratory Tract Infections (URTIs) are prevalent occurrence in primary health care settings [1]. These illnesses are taught to be the leading cause of children’s or parents’ absenteeism from school or from work, consequently posing a financial burden on parents and the health systems [2]. Children become infected as a result of their exposure to a range of ailments and, in general, acquire 6 to 8 URTIs episodes yearly [3]. Evidence from literature showed that bacteria are responsible for less than 10% of URTI cases, yet antibiotics are frequently used to treat them and children get more antibiotics than any other age group, respiratory tract infections accounting for over 20% of pediatric antibiotic prescriptions [4]. It is believed that ten million needless antibiotics are provided each year, with broad-spectrum antibiotics being utilized in the majority of situations; this translates to over forty million US$ for antibiotic expenditures for treating the URTIs [5].

Excessive usage or misuse of antibacterial has resulted in higher health-care costs, greater adverse reactions such as diarrhea, and emergence of Antibacterial Resistance (AMR) [6]. According to the World Health Organization (WHO), 20-50% of antibiotic prescriptions are erroneous, which is a substantial contributor to the imminence of AMR universally [7].

Prescription of antibiotics too frequently, for too long or at too low a dose, stopping medication before it is completed are among human factors that have contributed to the development of AMR in bacteria [8]. Resistance to antibiotics is a severe and an increasing public health concern worldwide [9], severely in countries with increased rate of antibiotic consumption [10]. Literature estimates that ten million deaths will occur each year as a result of AMR [11] and 40% of these deaths will happen in Africa [12]. As a result, the WHO has classified drug resistance as being one of the world’s top ten public health threats that human society has been facing over the last decade [13].

A study that aimed at assessing the prevalence of AMR among common bacterial isolates in a tertiary healthcare facilities in Rwanda, revealed that AMR rates were high, posing a great therapeutic challenge in managing common infectious diseases [14]. According to a recent analysis, 1 out of 3 people in Low Middle Income Countries (LMICs) has serious gaps in knowledge of antibiotics utilization [18]. Physicians’ doubt about diagnosis, parental preferences, misperceptions, unrestricted access to antibiotics, knowledge deficit regarding antibiotic indications, and an unawareness of AMR were all linked to greater rates of antibiotic prescriptions [16,17]. The views and expectations of parents play a big role in whether or not an antibiotic is prescribed. Fear of acute illnesses among parents results in many pediatrician visits for URTIs and, as a result, inappropriate antimicrobial utilization [15]. According to numerous studies conducted in African and beyond, factors that influence antibacterial use include parental educational level, age, economic position, number of children, gender, residence location among others [19,20]. Literature also revealed a correlation between parental knowledge, attitudes and practices regarding antibiotics use [21].

Studies conducted in Rwanda were mainly focused on AMR and the suitability of antibiotic prescription. A study conducted in 3 Health Centers in Gisagara District that was assessing found that 54.2% of medication prescription was antibiotics, main indication was URTIs at 40.6% and only 38.6% of these antibiotics were rational. This study indicated that children took numerous antibiotics for URTIs at 21.4% compared to others [22]. A very little is known about parents’ awareness, attitudes and practices towards antibiotics use for Rwandan children’s URTIs, specifically in Kicukiro District. Therefore, this study looked at the relationships among socioeconomic characteristics and parents’ knowledge, attitudes, and practices on antibiotic usage and childhood URTIs. The findings of this study will be beneficial for decision makers to design strategies for health education especially for susceptible parents for antimicrobial abuse. It will also be used to improve parents’ understanding on URTIs and antibiotic use, thus, elements that influence long-term behavior changes regarding antibiotic usage.

Materials and Methods

The study was based on cross-sectional research design and quantitative data were obtained from parents with under 12 years old children attending who attended selected Health Centers, namely Masaka and Kabuga Kicukiro and Gikondo in Kicukiro District, Rwanda. A sample size of 384 respondents was obtained using Fisher formula and convenience sampling technique was used. A structured questionnaire was used for data collection; It was initially written in English and then translated into Kinyarwanda in order to facilitate better understanding and easy use by respondents.

Data Analysis was performed using SPSS software version 21, using descriptive statistics and presented as associated frequencies, mean and standard deviation. Chi-square test was used to test for association between variables and regression analysis was used to test the strengths of association between dependent and independent variables which were previously identified by Chi-square test. The level of significance (α) was set at 0.05 for all statistical tests and data were presented using tables and figures. For ethical aspects, researchers obtained approval letters from Mount Kenya University and from each of selected Health Centers as a permission for data collection and researchers received signed consent from each participant before participating in the study.


Socio-demographic data presented in the (Table 1) were obtained from 384 respondents who were reached and completed research questionnaires.