Prevalence and Determinants of Antibiotic Self-Medication Among Adults in Hohoe Municipality, Ghana: A Community-Based Cross-Sectional Study

Prevalence and Determinants of Antibiotic Self-Medication Among Adults in Hohoe Municipality, Ghana: A Community-Based Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Determinants of Antibiotic Self-Medication Among Adults in Hohoe Municipality, Ghana: A Community-Based Cross-Sectional Study Godwin Adjei Vechey, Millicent Edem Akpaka, Nana Serwaa Bonsu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8055937/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Antibiotics Self-medication (ASM), is a significant public health concern globally, leading to antibiotic resistance, prolonged hospital stays, and high mortality rates. In the Hohoe Municipality of Ghana, the practice is reported among the public; however, the extent of the problem remains unknown. Therefore, the study assessed the prevalence of self-medication with antibiotics and its associated factors among community members in the Hohoe Municipality. Methods A community-based cross-sectional design was employed in this study with a multi-stage sampling of 431 participants. Data was collected through interviews using a structured questionnaire and analyzed using Stata Version 17. Descriptive statistics such as frequencies and percentages were used to summarize the data. Logistic regression analysis was used to test the association between the dependent and independent variables with statistical significance determined at a p-value of 0.05 and a 95% confidence interval. Results The study found a 32.2% prevalence of ASM. Higher education levels were associated with reduced odds of ASM: secondary education (aOR = 0.08, 95% CI: 0.03–0.25) and tertiary education (aOR = 0.26, 95% CI: 0.07–0.97). In contrast, factors significantly associated with increased odds of ASM included perceived delays in hospital visits (aOR = 5.34, 95% CI: 2.70–10.55), the belief that the illness was mild (aOR = 11.87, 95% CI: 5.46–25.82), possession of leftover antibiotics (aOR = 3.07, 95% CI: 1.46–6.49), and the perception that buying antibiotics without hospital consultation is less costly (aOR = 0.46, 95% CI: 0.23–0.91). Conclusion This study identified a high prevalence of antibiotic self-medication (ASM). Key contributing factors included educational level, financial constraints, and prolonged waiting times at healthcare facilities. Effective interventions should address both socio-demographic determinants and systemic healthcare inefficiencies, particularly patient wait times. The findings reinforce the need for a multi-sectoral strategy to mitigate ASM. Antibiotics misuse self-medication hospital delays Hohoe Municipality Ghana Figures Figure 1 Figure 2 Figure 3 Introduction Antibiotic self-medication (ASM), a form of antibiotic misuse (AM), is a growing global concern and a major contributor to antimicrobial resistance (AMR). It occurs when individuals use antibiotics without the prescription or supervision of a qualified health professional [ 1 ]. This practice is particularly common in low- and middle-income countries, where access to healthcare services may be limited, and antibiotics are often readily available without prescriptions [ 1 , 2 ]. Antibiotics are chemical agents used to treat or prevent bacterial infections [ 3 ]. However, misuse—such as inappropriate dosing, incomplete courses, or using them for non-bacterial illnesses—reduces their effectiveness and drives resistance [ 4 ]. AM not only fuels AMR but is also associated with increased mortality, prolonged hospital stays, treatment failures, and delays in appropriate diagnosis and care [ 2 , 4 ]. Globally, the prevalence of ASM is estimated at 43.0%, with higher rates in sub-Saharan Africa (55.2%) and the Middle East and North Africa (48.3%), compared to lower rates in Europe (34.7%) and Asia (25.8%) [ 2 ]. In rural Malawi, ASM prevalence is alarmingly high at 69.5%, attributed to limited awareness of antimicrobial resistance [ 5 ]. Similarly, a systematic review across Africa reported ASM rates ranging from 12.1% to 93.9%, with a median of 55.7%, and the highest concentration in West Africa at 70.1% [ 6 ]. In Nigeria’s Abia State, nearly 46.5% of residents practised antibiotic self-medication, driven largely by perceptions of minor illnesses and the easy availability of antibiotics without prescriptions [ 7 ]. In Ghana, the situation reflects these worrying patterns. A study at Madina Polyclinic reported a 46.4% ASM rate among out-patient attendants [ 8 ]. Among traders in Accra’s central business district, the figure rose to 66.7% [ 9 ], while during the COVID-19 pandemic, a study in Tema found that 76% of adults had engaged in antibiotic self-medication [ 10 ]. These figures underscore a broader public health issue, with significant implications for treatment outcomes, healthcare costs, and the escalating threat of AMR. Factors such as misconceptions that antibiotics cure all infections, limited access to healthcare, high medical costs, and the inconvenience of hospital visits contribute significantly to ASM across Africa [ 2 , 3 , 11 ]. These issues are worsened by weak regulation of antibiotic sales, the widespread availability of medicines through informal vendors, and the activities of street peddlers [ 12 , 13 ]. In many communities, antibiotics are treated as over-the-counter remedies, used without proper medical advice. This unregulated practice not only accelerates AMR but also increases the risk of adverse drug reactions and can mask serious underlying conditions such as tuberculosis or cancer. To address this, Ghana has implemented several policy initiatives. The National Policy on Antimicrobial Use and Resistance (2017–2021) serves as a key framework for managing AMR through surveillance, public education, and stewardship [ 14 ]. Public awareness campaigns, notably the annual World Antibiotic Awareness Week, are jointly organised by the Ministry of Health, the Pharmaceutical Society of Ghana, and other stakeholders to promote responsible antibiotic use among health professionals and the general public [ 15 ]. In the Hohoe Municipality, anecdotal evidence points to increasing antibiotic self-medication, particularly due to the activities of drug peddlers. However, no documented study exists on the prevalence and associated factors of ASM in the area. Given the complex drivers and serious implications of ASM, this study aims to determine the prevalence and contributing factors of antibiotic self-medication among community members in Hohoe Municipality. Materials and Methods Study site The study was conducted in the Hohoe Municipality, one of the 18 districts/municipalities in Ghana’s Volta Region [ 16 ]. According to the 2021 Population and Housing Census, the municipality has a population of 114,472 [ 16 ]. It comprises five sub-municipalities and is served by various healthcare facilities, including health centres, Community-based Health Planning and Services (CHPS) compounds, and a municipal hospital that functions as the main referral centre. In addition to these public and private health providers, many community members—particularly those in rural areas—frequently rely on herbal medicine sellers and roadside drug peddlers for healthcare services [ 16 ]. Study design A community-based cross-sectional design was employed in this study involving 431 adult community members in the Hohoe municipality. Sample size determination . The non-prescribed antibiotics usage rate of 51.7% based on a study in the Greater Accra Metropolis, Ghana [ 17 ], was used. The required sample size was determined by using Cochran's (1977) formula: n= \(\:\frac{\varvec{Z}²\:\varvec{P}\varvec{q}}{\varvec{d}²}\) where, n = sample size to be determined Z = reliability of coefficient corresponding to a 95% confidence interval (1.96). P = proportion of antibiotic misuse q = the acceptable deviation from the assumed proportion (1-0.517 = 0.483). d = the margin of error around p estimated as 0.05 in this study. Therefore, n = \(\:\frac{{\left(1.96\right)}^{2}\times\:\left(0.517\right)\:\times\:\left(0.483\right)}{\left(0.05\right)²}\) = 391.5 Adjusting for an anticipated 10% non-response rate, a minimum sample size of 431 individuals were recruited for the study. Eligibility Criteria All adults aged 18 years and above residing within the Hohoe municipality for at least 3 months, who consented to participate in the study were recruited. To mitigate recall bias, only individuals taking antibiotics at the time of data collection and who could present it with the receptacle were included in the study. Sampling A multistage sampling technique was adopted, where the municipality was divided into five (5) strata, which corresponded to the existing five sub-districts within the structure of the healthcare system. Using the lottery method, two communities were randomly selected from the list of communities within each of the five sub-municipalities. In total, 10 communities were involved in this study. This was followed by a proportionate allocation to assign a sample size to each community based on the sample size that was calculated for each stratum and the total population of the communities that were selected. In each of the selected communities, the principal investigator stood at the center of the community and spun a bottle. Data collection began in the first house along the direction of the mouth of the bottle. In that house, another random sampling was done to select one household. In the selected household, the lottery method was again applied in selecting one eligible adult, if there were more than one eligible respondent. The principal investigator then moved to the next house. This process was repeated in each community until the proportionate sample calculated for that community was achieved. Data collection tool and procedure Data were collected by the principal investigator with the support of three trained research assistants. The study gathered information on the prevalence of antibiotic self-medication and its associated factors—namely socio-demographic, healthcare-related, and individual-related factors—through face-to-face interviews using a structured questionnaire. The questionnaire demonstrated good internal consistency, with a Cronbach’s alpha reliability coefficient of 0.7415. Antibiotic types were identified through direct inspection of drug containers presented by participants during the interviews and were subsequently categorised using the 2019 WHO AWaRe Classification Database. Prior to data collection, the questionnaire was pre-tested in the neighbouring Afadzato District to assess the clarity, relevance, and suitability of the items in achieving the study objectives. The pre-test also served to familiarise data collectors with the ethical procedures required for participant recruitment and data collection. In this study, self-medication of antibiotics was defined as using antibiotics without a prescription from qualified healthcare personnel [ 4 ]. Data analysis Data collected was compiled and entered using Epi data software version 4.0. After data entry, data were exported into STATA 16.0. for analysis. Data cleaning and validation were done to ensure data quality before analysis was carried out. Descriptive statistics such as frequencies, and proportions were performed on categorical variables whilst means and standard deviations were computed on continuous variables and presented in tables and charts. Logistic regression analyses were used to test the association between antibiotic misuse and the predictors of the misuse with statistical significance determined at a p-value of 0.05 and a 95% confidence interval. Results Socio-demographic characteristics of respondents A total of four hundred and thirty-one (431) participants were recruited for the study. The mean age of participants was 38.3 ± 12.3 years. Most (40.6%) were aged > 40 years, with 245 (56.8%) married at the time of the study. The majority, 358 (83.1%) of the respondents were Christians, whereas 30.2% had basic school education. Most, 312 (72.4%) were Ewes, and a few (31.8%) were unemployed. The majority of the participants earned more than GHS 300 ( $ 48.6) in a month (Table 1.0 ). Table 1.0 Sociodemographic characteristics of study participants (n = 431) Variable Frequency Percentage (%) Mean age (SD) 38.3(12.3) Age 18–20 24 5.57 21–30 108 25.06 31–40 124 28.06 ≥ 41 175 40.60 Sex Female 251 58.24 Male 180 41.76 Religion Christianity 358 83.06 Islam 66 15.31 Traditional Region 7 1.62 Ethnicity Akan 49 11.37 Ewe 312 72.39 Ga/Damgbe 26 6.03 Mole-Dabani 18 4.18 Kotokoli 26 6.03 Marital Status Single 119 27.61 Married 245 56.84 Divorced 52 12.06 Widow 15 3.48 Educational level None 60 13.92 Primary 30 6.96 JHS* 130 30.16 Secondary 128 29.70 Tertiary 83 19.26 Occupation Unemployed 137 31.79 Government employee 140 32.48 Self-employed 154 35.73 Income < 300 204 47.33 ≥ 300 227 52.67 *JHS-Junior High School Prevalence of antibiotics misuse The majority 292(67.8%) of the respondents purchased antibiotics by prescription while 139(32.2%) of them purchased antibiotics without prescription (Fig. 1 ). Types of antibiotics used Figure 2 shows that the most common antibiotic used was penicillin 110 (25.5%) while the least 20 (4.6%) was trimethoprim/sulfamethoxazole (Fig. 2 ). Indications for antibiotics misuse The majority (35.7/100) of the respondents used antibiotics for the treatment of conditions such as respiratory tract infections, sexually transmitted diseases, bone, and joint infections, ear, and eye problems while (5.6%) indicated that they used antibiotics for the treatment of cough (Fig. 3 ). Individual and Healthcare related factors on antibiotics misuse A majority (57.5/100) of the respondents sought care at the hospital when they were ill while (84.7%) of the respondents purchased antibiotics outside the hospital when they were ill. Most (51.7%) of them did not indicate delays in the hospital as a reason to misuse antibiotics. Further, more than half, (51.0%) of the respondents had leftovers of antibiotics in their homes (Table 3.0 ). Table 2.0 Individual and Healthcare factors on antibiotics misuse Variable Frequency [n = 431] Percentage (%) Healthcare seeking at the hospital during illness No 183 42.46 Yes 248 57.54 Experienced delay in the hospital as a reason for antibiotic misuse No 233 51.74 Yes 208 48.26 Friend’s recommendation as a reason for antibiotic misuse No 256 59.40 Yes 175 40.60 Less expensive without a hospital visit No 198 45.94 Yes 233 54.06 Belief that disease might be mild as reason for antibiotic misuse No 227 64.27 Yes 154 35.73 Possession of leftover antibiotics No 211 48.96 Yes 220 51.04 Factors associated with antibiotics misuse After adjusting for confounders, respondents who attained a secondary and tertiary level of education were less likely to misuse antibiotics than those with no formal education with a reduced odds of 92% and 74% [AOR = 0.08 (CI:0.03–0.25), p < 0.001] [AOR = 0.26 (CI:0.07 − 0.97), p = 0.045] respectively. Also, respondents who indicated that there are delays during hospital visits were 5.34 times more likely to misuse antibiotics than those who do not experience a delay in hospital [AOR = 5.34 (CI: 2.70-10.55), p < 0.001]. Respondents who had the notion that purchasing antibiotics without seeking healthcare was less expensive than seeking healthcare for prescription were 54% less likely to misuse antibiotics than those who did not have such a notion [AOR = 0.46 (CI: 0.23–0.91), p = 0.025]. Further, respondents who had thoughts that their disease was mild were 11.87 times more likely to misuse antibiotics than those who didn’t have such thoughts [AOR = 11.87 (CI: 5.46–25.82), p = p < 0.001], while respondents who had leftover antibiotics in their possessions were 3.07 times more likely to misuse antibiotics than those who didn’t have leftover antibiotics at homes [AOR = 3.07 (CI: 1.46–6.49), p = 0.003]. (Table 4.0) Table 3.0 Factors associated with antibiotics misuse Variable Antibiotic use Unadjusted Adjusted Do not misuse Misuse COR, (95% CI) p-value AOR, (95% CI) p-value Age 18–20 23(95.8) 1(4.2) Ref Ref 21–30 94(87.0) 14(13.0) 3.43(0.43–27.40)0.246 2.79(0.23–34.29)0.423 31–40 88(71.0) 36(29.0) 9.40(1.22–72.31)0.031 2.94(0.25–34.96)0.393 ≥ 41 87(49.7) 88(50.3) 23.26(3.07-176.06)0.002 4.07(0.34–48.62)0.267 Marital Status Single 107(89.9) 12(10.1) Ref Ref Married 138(56.3) 107(43.7) 6.91(3.62–13.22) < 0.001 2.58(0.92–7.22)0.072 Divorced 36(69.2) 16(30.8) 3.96(1.71–9.16)0.001 1.02(0.29–3.64)0.978 Widow 11(73.3) 4(26.7) 3.24(0.89–11.79)0.074 1.32(0.20–8.56)0.772 Educational level None 14(23.3) 46(76.7) Ref Ref Primary 14(46.7) 16(53.3) 0.34(0.13–0.89)0.027 1.25(0.27–5.88)0.778 JHS 82(63.1) 48(36.9) 0.18(0.09–0.38) < 0.001 0.48(0.16–1.43)0.187 Secondary 114(89.1) 14(10.9) 0.04(0.02–0.08) < 0.001 0.08(0.03–0.25) < 0.001 Tertiary 68(81.9) 15(18.1) 0.07(0.03–0.15) < 0.001 0.26(0.07–0.97)0.045 Income < 300 151(74.0) 53(25.98) Ref Ref ≥ 300 141(62.1) 86(37.9) 1.74(1.15–2.62)0.009 0.77(0.38–1.56)0.472 Experienced delays at hospital No 194(87.0) 29(13.0) Ref Ref Yes 98(47.1) 110(52.9) 7.51(4.67–12.08) < 0.001 5.34(2.70-10.55) < 0.001 The notion that antibiotic purchase without hospital visit was less expensive No 102(51.5) 96(48.5) Ref Ref Yes 190(81.6) 43(18.4) 0.24(0.16–0.37) < 0.001 0.46(0.23–0.91)0.025 Thought that the disease was mild No 241(87.0) 36(13.0) Ref Ref Yes 51(33.1) 103(66.9) 13.52(8.32–21.96) < 0.001 11.87(5.46–25.82) < 0.001 Possession of leftover antibiotics No 176(83.4) 35(16.6) Ref Ref Yes 116(52.7) 104(47.3) 4.51(2.88–7.06) < 0.001 3.07(1.46–6.49)0.003 Discussion This current study found that 32.2% of participants reported practicing antibiotic self-medication. This figure is consistent with findings from Donkor et al. [ 19 ], who reported a similar prevalence of 33.3% among patients in two Ghanaian hospitals. However, this rate is notably lower compared to other settings. A systematic review documented a prevalence of 43.0% [ 2 ], while significantly higher rates have been observed in various African contexts: 69.5% in rural Malawi [ 5 ], 46.5% in Abia State, Nigeria [ 7 ], 45.1% in the Asmara community of Eritrea [ 18 ], 46.4% in Medina [ 8 ], and as high as 76% in Tema, Ghana [ 9 ]. These discrepancies in prevalence can likely be attributed to variations in socio-cultural norms, accessibility to healthcare, and health-seeking behaviours specific to each population. The prevalence of antibiotic misuse recorded in the present study was however marginally higher compared to what was found by Owusu-Asare [ 20 ] in Ghana, (28.9%), Mallah, et al., [21] in Lebanon (22.5%), and Pereira, Silva & Galvão (2018) in Brazil (19.0%) [ 22 ][ 23 ][ 24 ]. Further reasons for the observed differences could be attributed to the study setting (hospital, pharmacy, and community), the structure of healthcare services, and level of implementation of antibiotic regulatory bodies in countries. Self-medicating with antibiotics, a common antibiotic misuse practice by the community is frequently practiced in developing countries. Various reasons documented include proximity of pharmacies to respondent’s homes or a long distance to a healthcare facility, lack of money, ignorance, mild/minor illness, poor attitude of health workers (rude or corrupt), re-treatment of similar illnesses, and a shortage of health personnel [ 2 ][ 4 ]. This could have led to selective pressure, favoring the development of antibiotic resistance. Given the rise of antimicrobial-resistant infections in Ghana, surveillance of antimicrobial resistance using an integrated approach coupled with multifaceted research on antibiotic misuse is urgent [ 14 ]. This would provide evidence to guide antibiotic consumption regulation and antibiotic stewardship strategies. In this present study, respondents with secondary or tertiary education were significantly less likely to misuse antibiotics compared to those with no formal education. This finding is in line with previous research by Alex et al. in Malawi [ 25 ] and Effah et al. in Ghana [ 26 ], both of which reported that individuals with higher educational attainment were less prone to antibiotic misuse. A plausible explanation for this trend is that educated individuals are more capable of independently accessing, reading, and understanding health-related information. Given that most educational materials on antibiotic use are disseminated in English rather than in local languages, this disparity in comprehension is not unexpected [ 4 ]. This highlights the need for tailored health education interventions that effectively reach individuals with lower levels of formal education. Strategies may include translating content into local dialects, using visual aids, and leveraging culturally appropriate communication channels. Evidence suggests that when individuals are well-informed about the risks associated with inappropriate antibiotic use, they are more likely to seek medical consultation and avoid self-medication, recognising it as a safer and more effective practice [ 15 ]. Enhancing educational outreach on antibiotic misuse, particularly among vulnerable populations, is therefore essential to narrowing the knowledge gap and reducing inappropriate antibiotic use. Further, respondents who cited delays at health facilities as a reason for purchasing antibiotics were significantly more likely to misuse them than those who did not report such delays. This finding is consistent with studies conducted in Mozambique [ 27 ] and Ghana [ 19 , 20 ], which identified prolonged waiting times during hospital visits as a key driver of antibiotic misuse within communities. These insights underscore the urgent need for structural reforms aimed at improving the efficiency of healthcare service delivery—particularly by minimising patient wait times. According to the sociological theory of social structure reproduction, when individuals encounter systemic barriers that hinder expected behaviours, alternative practices may emerge, often reinforced by societal incentives [ 2 , 10 ]. Respondents with the notion that antibiotics are less expensive when purchased without seeking care, were less likely to misuse antibiotics than those who did not have such a notion. This finding disagrees with that of [ 28 ] and [ 29 ], who found that antibiotic misuse was a result of access to cheap antibiotics on the market. Some respondents have the impression that, purchasing antibiotics outside the health facility is less expensive, probably due to low economic status and lack of health insurance. This usually is due to making out-of-pocket payments for other services in addition to medication purchases during hospital visits. In this regard, persons lacking health insurance or those who have low income tend to purchase antibiotics directly from over-the-counter drug stores and drug peddlers, to avoid the trouble and costs [ 30 ]. However, in our study, persons with this notion were less likely to practice misuse probably due to the level of awareness of the consequences of their action, nonetheless it requires further research. Moreover, respondents who believed their disease was mild were more likely to misuse antibiotics. This study's findings are similar to those of [ 31 ] in Saudi Arabia, whose results showed that patients are more likely to misuse antibiotics due to a lack of willingness to consult a physician for a non-serious infection. This attitude among community members contributes significantly to antibiotic resistance. Often, self-medication may miss the actual cause of the health condition hence, resistance develops, leading to treatment failure [ 2 ][ 3 ]. Furthermore, respondents who possessed leftover antibiotics were more likely to misuse antibiotics. This finding is consistent with the results of [ 32 ] in China and [ 31 ] in Saudi Arabia. A possible explanation may be related to respondents’ previous experience of similar symptoms for which the leftover antibiotics were prescribed. The belief that if such symptoms reoccur, leftover antibiotics could be useful must be addressed. The consequences, however, are severe, including the development of antibiotic resistance [ 3 ][ 5 ]. Strengthening the implementation of country-level action plans on antibiotic stewardship programs is more urgent than before to promote efforts toward sustained availability of antimicrobials in the present and the future. Limitation and strength The major limitation of our study is the use of a cross-sectional design that impeded the establishment of a cause-and-effect relationship between antibiotic misuse and its predictors. However, our study is community-based and the reported antibiotic usage by respondents was verified by data collectors through antibiotic receptacles inspection. Conclusion A high prevalence of self-medication with antibiotics was reported in the current study. Educational level, financial capacity and patient time at health facilities were significant factors of misuse. Strategies to address ASM should therefore consider both socio-demographic factors and health system reforms toward improving patient waiting time. The national AMR committee together with the Ghana Health Service should ensure continuous health education programs aimed at informing the public, particularly the less educated, on antimicrobial resistance and its dangers. Furthermore, the government and regulatory bodies must enforce policies on curbing irrational dispensing of antibiotics. Abbreviations AM Antibiotic Misuse AMR Antimicrobial Resistance M.O.H Ministry of Health STG Standard Treatment Guidelines of Ghana EML Essential Medicine List LMICs Low Middle-Income Countries UHAS SPH-the University of Health and Allied Sciences-School of Public Health UHAS REC-the University of Health and Allied Sciences-Research Ethics Committee W.H.O World Health Organization. Declarations Ethics approval and consent to participate Approval for the study was obtained from the University of Health and Allied Science Research Ethics Committee with approval number UHAS-REC A.9[ 22 ] 20–21. Written permission was sought from the Hohoe Municipal Assembly and written informed consent was sought from the respondents before data collection. All questionnaires were coded to avoid tracing information to respondents in ensuring anonymity. Additionally, questionnaires were kept safe under lock and key; they were accessible only to the research team to ensure confidentiality. All processes and procedures in this study were performed in accordance with the relevant guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding No funding was received for this study. Author Contribution GAV and NSB conceptualized the study and contributed to data collection. GAV contributed to data analysis, interpretation. GAV NSB and MEA contributed to writing the manuscript. All authors read, reviewed, and approved the final manuscript **.** Acknowledgement The authors wish to thank all participants for their contributions to our study through the time spent. Furthermore, we would like to thank the Hohoe municipal Health directorate, for the permission granted to conduct this study. 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Association of knowledge and beliefs with the misuse of antibiotics in parents: A study in Beirut (Lebanon). PLoS One [Internet]. 2020;15(7 July):1–12. Available from: http://dx.doi.org/10.1371/journal.pone.0232464 Pereira JQ, Silva MT, Galvão TF. Use of antibiotics by adults: A population-based cross-sectional study. Sao Paulo Med J. 2018;136(5):407–13. Ekambi GAE, Ebongue CO, Penda C, Nga EN, Mpondo EM, Moukokoid CEE. Knowledge, practices and attitudes on antibiotics use in Cameroon: Self-medication and prescription survey among children, adolescents and adults in private pharmacies. PLoS ONE. 2019;14(2):1–17. Alex IO. Knowledge of antibiotic use and resistance among students of a medical school in Nigeria. Malawi Med J. 2019;31(2):133–7. Effah CY, Amoah AN, Liu H, Agboyibor C, Miao L, Wang J, Wu Y. A population-base survey on knowledge, attitude and awareness of the general public on antibiotic use and resistance. Antimicrob Resist Infect Control. 2020;9:1–9. Cambaco O, Alonso Menendez Y, Kinsman J, Sigaúque B, Wertheim H, Do N, et al. Community knowledge and practices regarding antibiotic use in rural Mozambique: where is the starting point for prevention of antibiotic resistance? BMC Public Health. 2020;20(1):1–15. Aslam A, Gajdács M, Zin CS, Ab Rahman NS, Ahmed SI, Zafar MZ, Jamshed S. Evidence of the practice of self-medication with antibiotics among the lay public in low-and middle-income countries: a scoping review. Antibiotics. 2020;9(9):597. Bu-Khamsin AY, Fabella E, Al Abdullah AH, Albather MR, Al-Hassan YT, Alramadan HA, Al Moweshy AA, Al Abdullah AJ, Al Hassan HI. Association between awareness on antibiotic resistance and antibiotic misuse among Saudi university students. Open Public Health J. 2021;14(1):545–54. Afari-Asiedu S, Oppong FB, Tostmann A, Ali Abdulai M, Boamah-Kaali E, Gyaase S, Agyei O, Kinsman J, Hulscher M, Wertheim HF, Asante KP. Determinants of inappropriate antibiotics use in rural central Ghana using a mixed methods approach. Front Public Health. 2020;8:90. Alhomoud F, Aljamea Z, Basalelah L. Antibiotics kill things very quickly - consumers’ perspectives on non-prescribed antibiotic use in Saudi Arabia. BMC Public Health. 2018;18(1):1–12. Wang X, Lin L, Xuan Z, Li L, Zhou X. Keeping antibiotics at home promotes self-medication with antibiotics among Chinese university students. Int J Environ Res Public Health. 2018;15(4):1–13. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8055937","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542727927,"identity":"eb9ba23e-f4c2-436d-90d2-7436b9c3a31e","order_by":0,"name":"Godwin Adjei Vechey","email":"data:image/png;base64,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","orcid":"","institution":"KAAF University, Central Region","correspondingAuthor":true,"prefix":"","firstName":"Godwin","middleName":"Adjei","lastName":"Vechey","suffix":""},{"id":542727931,"identity":"11a6a6fc-2c74-4bda-8ccc-c596aaef9aca","order_by":1,"name":"Millicent Edem Akpaka","email":"","orcid":"","institution":"KAAF University, Central 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17:13:01","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":119034,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8055937/v1/5215582eba93133ba486434e.html"},{"id":95669661,"identity":"d8ba277b-a613-4d68-afc3-155c09909476","added_by":"auto","created_at":"2025-11-11 17:13:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":82290,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of antibiotics misuse\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8055937/v1/ae4c60e59ddb218bea8539ea.jpg"},{"id":95669659,"identity":"e1bd5b13-e950-4be2-b965-67e532188801","added_by":"auto","created_at":"2025-11-11 17:13:01","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":27001,"visible":true,"origin":"","legend":"\u003cp\u003eTypes of antibiotics used by respondents\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8055937/v1/cba0e85131366feabb668ee3.jpg"},{"id":95669656,"identity":"8923504c-1a02-4dd2-900a-94b616544270","added_by":"auto","created_at":"2025-11-11 17:13:01","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":16541,"visible":true,"origin":"","legend":"\u003cp\u003eIndication for antibiotics use\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8055937/v1/1f923cbe07111a01dcd97dab.jpg"},{"id":96239469,"identity":"cdd36acf-184c-40f5-9bc8-9cc469183933","added_by":"auto","created_at":"2025-11-19 07:06:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1582235,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8055937/v1/23c7c120-717e-49a1-9938-6c5d5a3ccb74.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Determinants of Antibiotic Self-Medication Among Adults in Hohoe Municipality, Ghana: A Community-Based Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAntibiotic self-medication (ASM), a form of antibiotic misuse (AM), is a growing global concern and a major contributor to antimicrobial resistance (AMR). It occurs when individuals use antibiotics without the prescription or supervision of a qualified health professional [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This practice is particularly common in low- and middle-income countries, where access to healthcare services may be limited, and antibiotics are often readily available without prescriptions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Antibiotics are chemical agents used to treat or prevent bacterial infections [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, misuse\u0026mdash;such as inappropriate dosing, incomplete courses, or using them for non-bacterial illnesses\u0026mdash;reduces their effectiveness and drives resistance [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. AM not only fuels AMR but is also associated with increased mortality, prolonged hospital stays, treatment failures, and delays in appropriate diagnosis and care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGlobally, the prevalence of ASM is estimated at 43.0%, with higher rates in sub-Saharan Africa (55.2%) and the Middle East and North Africa (48.3%), compared to lower rates in Europe (34.7%) and Asia (25.8%) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In rural Malawi, ASM prevalence is alarmingly high at 69.5%, attributed to limited awareness of antimicrobial resistance [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Similarly, a systematic review across Africa reported ASM rates ranging from 12.1% to 93.9%, with a median of 55.7%, and the highest concentration in West Africa at 70.1% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In Nigeria\u0026rsquo;s Abia State, nearly 46.5% of residents practised antibiotic self-medication, driven largely by perceptions of minor illnesses and the easy availability of antibiotics without prescriptions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Ghana, the situation reflects these worrying patterns. A study at Madina Polyclinic reported a 46.4% ASM rate among out-patient attendants [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Among traders in Accra\u0026rsquo;s central business district, the figure rose to 66.7% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], while during the COVID-19 pandemic, a study in Tema found that 76% of adults had engaged in antibiotic self-medication [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These figures underscore a broader public health issue, with significant implications for treatment outcomes, healthcare costs, and the escalating threat of AMR.\u003c/p\u003e\u003cp\u003eFactors such as misconceptions that antibiotics cure all infections, limited access to healthcare, high medical costs, and the inconvenience of hospital visits contribute significantly to ASM across Africa [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These issues are worsened by weak regulation of antibiotic sales, the widespread availability of medicines through informal vendors, and the activities of street peddlers [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In many communities, antibiotics are treated as over-the-counter remedies, used without proper medical advice. This unregulated practice not only accelerates AMR but also increases the risk of adverse drug reactions and can mask serious underlying conditions such as tuberculosis or cancer.\u003c/p\u003e\u003cp\u003eTo address this, Ghana has implemented several policy initiatives. The National Policy on Antimicrobial Use and Resistance (2017\u0026ndash;2021) serves as a key framework for managing AMR through surveillance, public education, and stewardship [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Public awareness campaigns, notably the annual World Antibiotic Awareness Week, are jointly organised by the Ministry of Health, the Pharmaceutical Society of Ghana, and other stakeholders to promote responsible antibiotic use among health professionals and the general public [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the Hohoe Municipality, anecdotal evidence points to increasing antibiotic self-medication, particularly due to the activities of drug peddlers. However, no documented study exists on the prevalence and associated factors of ASM in the area. Given the complex drivers and serious implications of ASM, this study aims to determine the prevalence and contributing factors of antibiotic self-medication among community members in Hohoe Municipality.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy site\u003c/h2\u003e\u003cp\u003eThe study was conducted in the Hohoe Municipality, one of the 18 districts/municipalities in Ghana\u0026rsquo;s Volta Region [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. According to the 2021 Population and Housing Census, the municipality has a population of 114,472 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. It comprises five sub-municipalities and is served by various healthcare facilities, including health centres, Community-based Health Planning and Services (CHPS) compounds, and a municipal hospital that functions as the main referral centre. In addition to these public and private health providers, many community members\u0026mdash;particularly those in rural areas\u0026mdash;frequently rely on herbal medicine sellers and roadside drug peddlers for healthcare services [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eA community-based cross-sectional design was employed in this study involving 431 adult community members in the Hohoe municipality.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size determination\u003c/b\u003e. The non-prescribed antibiotics usage rate of 51.7% based on a study in the Greater Accra Metropolis, Ghana [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], was used. The required sample size was determined by using Cochran's (1977) formula:\u003c/p\u003e\n\u003cdiv class=\"Heading\"\u003en= \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{\\varvec{Z}\u0026sup2;\\:\\varvec{P}\\varvec{q}}{\\varvec{d}\u0026sup2;}\\)\u003c/span\u003e\u003c/span\u003e\u003c/div\u003e\u003cp\u003ewhere,\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;sample size to be determined\u003c/p\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;reliability of coefficient corresponding to a 95% confidence interval (1.96).\u003c/p\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;proportion of antibiotic misuse\u003c/p\u003e\u003cp\u003eq\u0026thinsp;=\u0026thinsp;the acceptable deviation from the assumed proportion (1-0.517\u0026thinsp;=\u0026thinsp;0.483).\u003c/p\u003e\u003cp\u003ed\u0026thinsp;=\u0026thinsp;the margin of error around p estimated as 0.05 in this study.\u003c/p\u003e\u003cp\u003eTherefore, n = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{{\\left(1.96\\right)}^{2}\\times\\:\\left(0.517\\right)\\:\\times\\:\\left(0.483\\right)}{\\left(0.05\\right)\u0026sup2;}\\)\u003c/span\u003e\u003c/span\u003e = 391.5\u003c/p\u003e\u003cp\u003eAdjusting for an anticipated 10% non-response rate, a minimum sample size of 431 individuals were recruited for the study.\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003eAll adults aged 18 years and above residing within the Hohoe municipality for at least 3 months, who consented to participate in the study were recruited. To mitigate recall bias, only individuals taking antibiotics at the time of data collection and who could present it with the receptacle were included in the study.\u003c/p\u003e\n\u003ch3\u003eSampling\u003c/h3\u003e\n\u003cp\u003eA multistage sampling technique was adopted, where the municipality was divided into five (5) strata, which corresponded to the existing five sub-districts within the structure of the healthcare system. Using the lottery method, two communities were randomly selected from the list of communities within each of the five sub-municipalities. In total, 10 communities were involved in this study. This was followed by a proportionate allocation to assign a sample size to each community based on the sample size that was calculated for each stratum and the total population of the communities that were selected. In each of the selected communities, the principal investigator stood at the center of the community and spun a bottle. Data collection began in the first house along the direction of the mouth of the bottle. In that house, another random sampling was done to select one household. In the selected household, the lottery method was again applied in selecting one eligible adult, if there were more than one eligible respondent. The principal investigator then moved to the next house. This process was repeated in each community until the proportionate sample calculated for that community was achieved.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData collection tool and procedure\u003c/h2\u003e\u003cp\u003eData were collected by the principal investigator with the support of three trained research assistants. The study gathered information on the prevalence of antibiotic self-medication and its associated factors\u0026mdash;namely socio-demographic, healthcare-related, and individual-related factors\u0026mdash;through face-to-face interviews using a structured questionnaire. The questionnaire demonstrated good internal consistency, with a Cronbach\u0026rsquo;s alpha reliability coefficient of 0.7415. Antibiotic types were identified through direct inspection of drug containers presented by participants during the interviews and were subsequently categorised using the 2019 WHO AWaRe Classification Database. Prior to data collection, the questionnaire was pre-tested in the neighbouring Afadzato District to assess the clarity, relevance, and suitability of the items in achieving the study objectives. The pre-test also served to familiarise data collectors with the ethical procedures required for participant recruitment and data collection. In this study, self-medication of antibiotics was defined as using antibiotics without a prescription from qualified healthcare personnel [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData collected was compiled and entered using Epi data software version 4.0. After data entry, data were exported into STATA 16.0. for analysis. Data cleaning and validation were done to ensure data quality before analysis was carried out. Descriptive statistics such as frequencies, and proportions were performed on categorical variables whilst means and standard deviations were computed on continuous variables and presented in tables and charts. Logistic regression analyses were used to test the association between antibiotic misuse and the predictors of the misuse with statistical significance determined at a p-value of 0.05 and a 95% confidence interval.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic characteristics of respondents\u003c/h2\u003e\u003cp\u003eA total of four hundred and thirty-one (431) participants were recruited for the study. The mean age of participants was 38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3 years. Most (40.6%) were aged\u0026thinsp;\u0026gt;\u0026thinsp;40 years, with 245 (56.8%) married at the time of the study. The majority, 358 (83.1%) of the respondents were Christians, whereas 30.2% had basic school education. Most, 312 (72.4%) were Ewes, and a few (31.8%) were unemployed. The majority of the participants earned more than GHS 300 (\u003cspan\u003e$\u003c/span\u003e48.6) in a month (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1.0\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1.0\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics of study participants (n\u0026thinsp;=\u0026thinsp;431)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean age (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.3(12.3)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e251\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChristianity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraditional Region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAkan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEwe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGa/Damgbe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMole-Dabani\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKotokoli\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJHS*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovernment employee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIncome\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e*JHS-Junior High School\u003c/h2\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003ePrevalence of antibiotics misuse\u003c/h2\u003e\u003cp\u003eThe majority 292(67.8%) of the respondents purchased antibiotics by prescription while 139(32.2%) of them purchased antibiotics without prescription (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eTypes of antibiotics used\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that the most common antibiotic used was penicillin 110 (25.5%) while the least 20 (4.6%) was trimethoprim/sulfamethoxazole (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eIndications for antibiotics misuse\u003c/h2\u003e\u003cp\u003eThe majority (35.7/100) of the respondents used antibiotics for the treatment of conditions such as respiratory tract infections, sexually transmitted diseases, bone, and joint infections, ear, and eye problems while (5.6%) indicated that they used antibiotics for the treatment of cough (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eIndividual and Healthcare related factors on antibiotics misuse\u003c/h2\u003e\u003cp\u003eA majority (57.5/100) of the respondents sought care at the hospital when they were ill while (84.7%) of the respondents purchased antibiotics outside the hospital when they were ill. Most (51.7%) of them did not indicate delays in the hospital as a reason to misuse antibiotics. Further, more than half, (51.0%) of the respondents had leftovers of antibiotics in their homes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3.0\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2.0\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIndividual and Healthcare factors on antibiotics misuse\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency [n\u0026thinsp;=\u0026thinsp;431]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthcare seeking at the hospital during illness\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperienced delay in the hospital as a reason for antibiotic misuse\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFriend\u0026rsquo;s recommendation as a reason for antibiotic misuse\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLess expensive without a hospital visit\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBelief that disease might be mild as reason for antibiotic misuse\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePossession of leftover antibiotics\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with antibiotics misuse\u003c/h2\u003e\u003cp\u003eAfter adjusting for confounders, respondents who attained a secondary and tertiary level of education were less likely to misuse antibiotics than those with no formal education with a reduced odds of 92% and 74% [AOR\u0026thinsp;=\u0026thinsp;0.08 (CI:0.03\u0026ndash;0.25), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001] [AOR\u0026thinsp;=\u0026thinsp;0.26 (CI:0.07 \u0026minus;\u0026thinsp;0.97), p\u0026thinsp;=\u0026thinsp;0.045] respectively. Also, respondents who indicated that there are delays during hospital visits were 5.34 times more likely to misuse antibiotics than those who do not experience a delay in hospital [AOR\u0026thinsp;=\u0026thinsp;5.34 (CI: 2.70-10.55), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001]. Respondents who had the notion that purchasing antibiotics without seeking healthcare was less expensive than seeking healthcare for prescription were 54% less likely to misuse antibiotics than those who did not have such a notion [AOR\u0026thinsp;=\u0026thinsp;0.46 (CI: 0.23\u0026ndash;0.91), p\u0026thinsp;=\u0026thinsp;0.025]. Further, respondents who had thoughts that their disease was mild were 11.87 times more likely to misuse antibiotics than those who didn\u0026rsquo;t have such thoughts [AOR\u0026thinsp;=\u0026thinsp;11.87 (CI: 5.46\u0026ndash;25.82), p\u0026thinsp;=\u0026thinsp;p\u0026thinsp;\u0026lt;\u0026thinsp;0.001], while respondents who had leftover antibiotics in their possessions were 3.07 times more likely to misuse antibiotics than those who didn\u0026rsquo;t have leftover antibiotics at homes [AOR\u0026thinsp;=\u0026thinsp;3.07 (CI: 1.46\u0026ndash;6.49), p\u0026thinsp;=\u0026thinsp;0.003]. (Table\u0026nbsp;4.0)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3.0\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors associated with antibiotics misuse\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAntibiotic use\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnadjusted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAdjusted\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo not misuse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMisuse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCOR, (95% CI) p-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAOR, (95% CI) p-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23(95.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e94(87.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14(13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.43(0.43\u0026ndash;27.40)0.246\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.79(0.23\u0026ndash;34.29)0.423\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88(71.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36(29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e9.40(1.22\u0026ndash;72.31)0.031\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.94(0.25\u0026ndash;34.96)0.393\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e87(49.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88(50.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e23.26(3.07-176.06)0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.07(0.34\u0026ndash;48.62)0.267\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107(89.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12(10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e138(56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e107(43.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e6.91(3.62\u0026ndash;13.22)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.58(0.92\u0026ndash;7.22)0.072\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36(69.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16(30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e3.96(1.71\u0026ndash;9.16)0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.02(0.29\u0026ndash;3.64)0.978\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11(73.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(26.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.24(0.89\u0026ndash;11.79)0.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.32(0.20\u0026ndash;8.56)0.772\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14(23.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46(76.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14(46.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16(53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.34(0.13\u0026ndash;0.89)0.027\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.25(0.27\u0026ndash;5.88)0.778\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82(63.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48(36.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.18(0.09\u0026ndash;0.38)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48(0.16\u0026ndash;1.43)0.187\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e114(89.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14(10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.04(0.02\u0026ndash;0.08)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.08(0.03\u0026ndash;0.25)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e68(81.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15(18.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.07(0.03\u0026ndash;0.15)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.26(0.07\u0026ndash;0.97)0.045\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIncome\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e151(74.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53(25.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e141(62.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86(37.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.74(1.15\u0026ndash;2.62)0.009\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.77(0.38\u0026ndash;1.56)0.472\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperienced delays at hospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e194(87.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29(13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e98(47.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110(52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e7.51(4.67\u0026ndash;12.08)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e5.34(2.70-10.55)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThe notion that antibiotic purchase without hospital visit was less expensive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e102(51.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e96(48.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e190(81.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43(18.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.24(0.16\u0026ndash;0.37)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.46(0.23\u0026ndash;0.91)0.025\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThought that the disease was mild\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e241(87.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36(13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51(33.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103(66.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e13.52(8.32\u0026ndash;21.96)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e11.87(5.46\u0026ndash;25.82)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePossession of leftover antibiotics\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e176(83.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35(16.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e116(52.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e104(47.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e4.51(2.88\u0026ndash;7.06)\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.07(1.46\u0026ndash;6.49)0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis current study found that 32.2% of participants reported practicing antibiotic self-medication. This figure is consistent with findings from Donkor et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], who reported a similar prevalence of 33.3% among patients in two Ghanaian hospitals. However, this rate is notably lower compared to other settings. A systematic review documented a prevalence of 43.0% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], while significantly higher rates have been observed in various African contexts: 69.5% in rural Malawi [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], 46.5% in Abia State, Nigeria [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], 45.1% in the Asmara community of Eritrea [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], 46.4% in Medina [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and as high as 76% in Tema, Ghana [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These discrepancies in prevalence can likely be attributed to variations in socio-cultural norms, accessibility to healthcare, and health-seeking behaviours specific to each population.\u003c/p\u003e\u003cp\u003eThe prevalence of antibiotic misuse recorded in the present study was however marginally higher compared to what was found by Owusu-Asare [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] in Ghana, (28.9%), Mallah, et al., [21] in Lebanon (22.5%), and Pereira, Silva \u0026amp; Galv\u0026atilde;o (2018) in Brazil (19.0%) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e][\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e][\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Further reasons for the observed differences could be attributed to the study setting (hospital, pharmacy, and community), the structure of healthcare services, and level of implementation of antibiotic regulatory bodies in countries. Self-medicating with antibiotics, a common antibiotic misuse practice by the community is frequently practiced in developing countries. Various reasons documented include proximity of pharmacies to respondent\u0026rsquo;s homes or a long distance to a healthcare facility, lack of money, ignorance, mild/minor illness, poor attitude of health workers (rude or corrupt), re-treatment of similar illnesses, and a shortage of health personnel [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This could have led to selective pressure, favoring the development of antibiotic resistance. Given the rise of antimicrobial-resistant infections in Ghana, surveillance of antimicrobial resistance using an integrated approach coupled with multifaceted research on antibiotic misuse is urgent [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This would provide evidence to guide antibiotic consumption regulation and antibiotic stewardship strategies.\u003c/p\u003e\u003cp\u003eIn this present study, respondents with secondary or tertiary education were significantly less likely to misuse antibiotics compared to those with no formal education. This finding is in line with previous research by Alex et al. in Malawi [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and Effah et al. in Ghana [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e], both of which reported that individuals with higher educational attainment were less prone to antibiotic misuse. A plausible explanation for this trend is that educated individuals are more capable of independently accessing, reading, and understanding health-related information. Given that most educational materials on antibiotic use are disseminated in English rather than in local languages, this disparity in comprehension is not unexpected [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This highlights the need for tailored health education interventions that effectively reach individuals with lower levels of formal education. Strategies may include translating content into local dialects, using visual aids, and leveraging culturally appropriate communication channels. Evidence suggests that when individuals are well-informed about the risks associated with inappropriate antibiotic use, they are more likely to seek medical consultation and avoid self-medication, recognising it as a safer and more effective practice [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Enhancing educational outreach on antibiotic misuse, particularly among vulnerable populations, is therefore essential to narrowing the knowledge gap and reducing inappropriate antibiotic use.\u003c/p\u003e\u003cp\u003eFurther, respondents who cited delays at health facilities as a reason for purchasing antibiotics were significantly more likely to misuse them than those who did not report such delays. This finding is consistent with studies conducted in Mozambique [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and Ghana [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], which identified prolonged waiting times during hospital visits as a key driver of antibiotic misuse within communities. These insights underscore the urgent need for structural reforms aimed at improving the efficiency of healthcare service delivery\u0026mdash;particularly by minimising patient wait times. According to the sociological theory of social structure reproduction, when individuals encounter systemic barriers that hinder expected behaviours, alternative practices may emerge, often reinforced by societal incentives [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRespondents with the notion that antibiotics are less expensive when purchased without seeking care, were less likely to misuse antibiotics than those who did not have such a notion. This finding disagrees with that of [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e], who found that antibiotic misuse was a result of access to cheap antibiotics on the market. Some respondents have the impression that, purchasing antibiotics outside the health facility is less expensive, probably due to low economic status and lack of health insurance. This usually is due to making out-of-pocket payments for other services in addition to medication purchases during hospital visits. In this regard, persons lacking health insurance or those who have low income tend to purchase antibiotics directly from over-the-counter drug stores and drug peddlers, to avoid the trouble and costs [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, in our study, persons with this notion were less likely to practice misuse probably due to the level of awareness of the consequences of their action, nonetheless it requires further research.\u003c/p\u003e\u003cp\u003eMoreover, respondents who believed their disease was mild were more likely to misuse antibiotics. This study's findings are similar to those of [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e] in Saudi Arabia, whose results showed that patients are more likely to misuse antibiotics due to a lack of willingness to consult a physician for a non-serious infection. This attitude among community members contributes significantly to antibiotic resistance. Often, self-medication may miss the actual cause of the health condition hence, resistance develops, leading to treatment failure [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, respondents who possessed leftover antibiotics were more likely to misuse antibiotics. This finding is consistent with the results of [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e] in China and [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e] in Saudi Arabia. A possible explanation may be related to respondents\u0026rsquo; previous experience of similar symptoms for which the leftover antibiotics were prescribed. The belief that if such symptoms reoccur, leftover antibiotics could be useful must be addressed. The consequences, however, are severe, including the development of antibiotic resistance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Strengthening the implementation of country-level action plans on antibiotic stewardship programs is more urgent than before to promote efforts toward sustained availability of antimicrobials in the present and the future.\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eLimitation and strength\u003c/h2\u003e\u003cp\u003eThe major limitation of our study is the use of a cross-sectional design that impeded the establishment of a cause-and-effect relationship between antibiotic misuse and its predictors. However, our study is community-based and the reported antibiotic usage by respondents was verified by data collectors through antibiotic receptacles inspection.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA high prevalence of self-medication with antibiotics was reported in the current study. Educational level, financial capacity and patient time at health facilities were significant factors of misuse. Strategies to address ASM should therefore consider both socio-demographic factors and health system reforms toward improving patient waiting time. The national AMR committee together with the Ghana Health Service should ensure continuous health education programs aimed at informing the public, particularly the less educated, on antimicrobial resistance and its dangers. Furthermore, the government and regulatory bodies must enforce policies on curbing irrational dispensing of antibiotics.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAntibiotic Misuse\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAMR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAntimicrobial Resistance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eM.O.H\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMinistry of Health\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSTG\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e Standard Treatment Guidelines of Ghana\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEML\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEssential Medicine List\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow Middle-Income Countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUHAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSPH-the University of Health and Allied Sciences-School of Public Health\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUHAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eREC-the University of Health and Allied Sciences-Research Ethics Committee\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eW.H.O\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eApproval for the study was obtained from the University of Health and Allied Science Research Ethics Committee with approval number UHAS-REC A.9[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e] 20\u0026ndash;21. Written permission was sought from the Hohoe Municipal Assembly and written informed consent was sought from the respondents before data collection. All questionnaires were coded to avoid tracing information to respondents in ensuring anonymity. Additionally, questionnaires were kept safe under lock and key; they were accessible only to the research team to ensure confidentiality. All processes and procedures in this study were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eGAV and NSB conceptualized the study and contributed to data collection. GAV contributed to data analysis, interpretation. GAV NSB and MEA contributed to writing the manuscript. All authors read, reviewed, and approved the final manuscript **.**\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors wish to thank all participants for their contributions to our study through the time spent. Furthermore, we would like to thank the Hohoe municipal Health directorate, for the permission granted to conduct this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAfari-Asiedu S, Kinsman J, Boamah-Kaali E, Abdulai MA, Gyapong M, Sankoh O, et al. To sell or not to sell; The differences between regulatory and community demands regarding access to antibiotics in rural Ghana. 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Open Public Health J. 2021;14(1):545\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAfari-Asiedu S, Oppong FB, Tostmann A, Ali Abdulai M, Boamah-Kaali E, Gyaase S, Agyei O, Kinsman J, Hulscher M, Wertheim HF, Asante KP. Determinants of inappropriate antibiotics use in rural central Ghana using a mixed methods approach. Front Public Health. 2020;8:90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlhomoud F, Aljamea Z, Basalelah L. Antibiotics kill things very quickly - consumers\u0026rsquo; perspectives on non-prescribed antibiotic use in Saudi Arabia. BMC Public Health. 2018;18(1):1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang X, Lin L, Xuan Z, Li L, Zhou X. Keeping antibiotics at home promotes self-medication with antibiotics among Chinese university students. Int J Environ Res Public Health. 2018;15(4):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antibiotics, misuse, self-medication, hospital delays, Hohoe Municipality, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-8055937/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8055937/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAntibiotics Self-medication (ASM), is a significant public health concern globally, leading to antibiotic resistance, prolonged hospital stays, and high mortality rates. In the Hohoe Municipality of Ghana, the practice is reported among the public; however, the extent of the problem remains unknown. Therefore, the study assessed the prevalence of self-medication with antibiotics and its associated factors among community members in the Hohoe Municipality.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e A community-based cross-sectional design was employed in this study with a multi-stage sampling of 431 participants. Data was collected through interviews using a structured questionnaire and analyzed using Stata Version 17. Descriptive statistics such as frequencies and percentages were used to summarize the data. Logistic regression analysis was used to test the association between the dependent and independent variables with statistical significance determined at a p-value of 0.05 and a 95% confidence interval.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe study found a 32.2% prevalence of ASM. Higher education levels were associated with reduced odds of ASM: secondary education (aOR\u0026thinsp;=\u0026thinsp;0.08, 95% CI: 0.03\u0026ndash;0.25) and tertiary education (aOR\u0026thinsp;=\u0026thinsp;0.26, 95% CI: 0.07\u0026ndash;0.97). In contrast, factors significantly associated with increased odds of ASM included perceived delays in hospital visits (aOR\u0026thinsp;=\u0026thinsp;5.34, 95% CI: 2.70\u0026ndash;10.55), the belief that the illness was mild (aOR\u0026thinsp;=\u0026thinsp;11.87, 95% CI: 5.46\u0026ndash;25.82), possession of leftover antibiotics (aOR\u0026thinsp;=\u0026thinsp;3.07, 95% CI: 1.46\u0026ndash;6.49), and the perception that buying antibiotics without hospital consultation is less costly (aOR\u0026thinsp;=\u0026thinsp;0.46, 95% CI: 0.23\u0026ndash;0.91).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study identified a high prevalence of antibiotic self-medication (ASM). Key contributing factors included educational level, financial constraints, and prolonged waiting times at healthcare facilities. Effective interventions should address both socio-demographic determinants and systemic healthcare inefficiencies, particularly patient wait times. The findings reinforce the need for a multi-sectoral strategy to mitigate ASM.\u003c/p\u003e","manuscriptTitle":"Prevalence and Determinants of Antibiotic Self-Medication Among Adults in Hohoe Municipality, Ghana: A Community-Based Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 17:12:56","doi":"10.21203/rs.3.rs-8055937/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"82ac73c1-96d3-4d51-af3a-1a97f8122798","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T17:12:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 17:12:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8055937","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8055937","identity":"rs-8055937","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}