Knowledge, attitudes, and practices of self-medication with antibiotics among rural elders in Anhui, China

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In the older adults, SMA could be more problematic and requires particular concern. Methods We conducted the study in Anhui, China among 788 rural older adults by using a questionnaire. Results We observed poor knowledge, attitudes and relatively high prevalence of SMA behavior among rural older adults. Common cold, cough and toothache were the top three reasons cited by the older adults for SMA. Logistic Regression indicated that age ≥ 80, knowledge score ≥ 3 were negatively associated with SMA behavior, while 0–6 years of education, family per capita monthly income>1000RMB, distance to the nearest hospital ≥ 1km, and stored antibiotics at home were apt to SMA behavior. Conclusion Proper education and guidance, enhanced oral health care, regulated and convenient pharmacy services may support to promote rational antibiotics use among rural older adults. antibiotics self-medication older adults knowledge attitudes practices Figures Figure 1 Introduction Antimicrobial resistance (AMR) is considered to be an important threat affecting the clinical efficacy of antibiotics and is becoming a global public health concern 1 , 2 . It causes treatment failures and leads to increased morbidity, mortality and huge economic burdens both in developed and developing countries 3 , 4 . Overuse and misuse of antibiotics, which exists not only in hospitals and primary care settings but also in the community 5 , is a great contributor to AMR 6 . Self-medication can be defined as the use of medicinal products by the consumer to treat self-recognized disorders or symptoms, or the intermittent or continued use of a medication prescribed by a physician 7 . Self-medication with antibiotics (SMA) is a dangerous behavior confirmed by the WHO 8 . SMA is often accompanied by overuse/abuse of antibiotics, inappropriate drug and dose choices, and incomplete/shorter treatment courses 9 , which can eventually increase AMR 10 . The prevalence of SMA is reported to vary widely across continents and countries. The highest rates recorded in European countries were in southern European countries such as Greece (20%), Romania (16%) and Cyprus (14%), compared with the lowest rates in other European countries such as Sweden (2%) and Slovakia (3%) 11 . In Africa, the prevalence of SMA range from 24–76%, including 50.3% in northern Nigeria, 68.9% in Sierra Leone, 70% in Ghana, 65.1% in Uganda, and 76% in Sudan 12 . A systematic review of 31 studies conducted in the US reported the prevalence of frequent use of over-the-counter antibiotics ranging from 1 to 66% 13 . In the older adult population, SMA could be more problematic and requires particular concern. First, older adults usually have reduced immune system, degenerated organ function, and chronic comorbidities, which put them at a relatively higher incidence of infections 14 , thus may expand the chance for antibiotics use. Secondly, evidence reported that self-medication behavior existed among older adults, ranging from 20–60% 15 , which may also increase the possibility of SMA. In a study of Spanish residents, it’s even estimated that older adults used around 50% more antibiotics per capita than youngers 16 . However, to our knowledge, few researches studied SMA and its potential influencing factors among Chinese older adults. China was estimated to be the second-largest consumer of antibiotics for human use 17 , and also among the countries with the most serious situation of antibiotic resistance in the world 18 . To tackle this problem, the Chinese government has issued a series of policies/regulations, which mainly focused on physicians, hospitals and other health service providers. However, the use of inappropriate antibiotics in community settings may also be an important part contributing to AMR 19 , 20 . In addition, older adults’ SMA behavior can lead to polypharmacy and increase the risk of adverse drug events 21 , 22 . Meanwhile, with the aging of the population increasing dramatically, people aged above 65 years old accounted for 13.5% of the whole population in China 23 . Studying SMA behavior of the older adults can provide evidence for promoting the rational use of antibiotics as well as be an important part of healthy aging. Evidence regarding SMA and its determinants is insufficient. In studies of the general population, Ramay 24 et al. found that women were more likely to engage in SMA practices than men while a study by Abdulraheem 25 et al. reported that in rural settings, male participants were more likely to use them than females. Besides, Bogale 26 et al. found that income was negatively associated with SMA, but Albawani 27 et al. had not found a correlation between them. In addition, several studies found that residents with better antibiotic-related knowledge were less likely to conduct SMA 28 , 29 , while other studies showed that SMA behavior was actually more frequent among those who have higher knowledge levels 30 , 31 . However, the influencing factors especially the relationship between knowledge/attitude and SMA behavior among the older adults have rarely been studied. Therefore, we conducted this study to assess knowledge, attitudes, and practices regarding SMA among rural older adults, with a particular interest in examining SMA and its determinants, using data from community-based surveys. Methods Study design and setting A cross-sectional study was conducted in rural Anhui Province. Anhui Province is located in the Yangtze River Delta region of eastern China, with a population of 61.1 million and 40.6% living in rural areas. Per capita Gross Domestic Product (GDP) and the numbers of the population in Anhui rank in the middle level of China. The required sample size was estimated using single population proportion formula 32 with 95% CI, 0.04 marginal error, estimated 53.8% prevalence of SMA (previous investigation), and considered an 80% response rate. Finally, the total sample size was 746. Participants were selected by a multi-stage method. First, we divided Anhui province into three regions: northern (17 counties), central (15 counties) and southern (22 counties). Then 3, 3 and 4 counties were randomly selected from the northern, central and southern regions, respectively. After that 1 township from each of the selected counties and 1 administrative village from each of the townships were selected. In total 10 administrative villages in Anhui Province were recruited as study sites. In each administrative village, the first household to be investigated was randomly selected, and then two households were passed by and the third household would be invited to our study, until the sample size reached the minimum required number of 75 for each village. Citizens who met the following criteria were considered as our participants: (i) aged ≥ 65 years old; (ii)were living in the sampled village for more than one year till the survey was conducted; (iii) were willing to participate in this study; (iiii) were able to respond to the survey questions. When entering the house, the interviewer asked if there was anyone aged 65 or older in the house. If the answer was yes, the interviewer would talk with the older adults to check the inclusion criteria again and invite he/she to participate in our study. The informed consent from the respondents was obtained before the survey started. Questionnaire A questionnaire was developed based on previous literature 33 , 34 and adapted for rural settings in China. Final questionnaire comprised of sociodemographic characteristics of rural older adults, general knowledge and attitudes about antibiotics, and self-medication behaviors with antibiotics. Data collection and analysis The study was performed using face-to‐face interviews conducted at the older adults' households in July 2021, by 10 undergraduate students recruited from Anhui Medical University. Data were double-entered using EPI DATA 3.1 and analyzed via SPSS 22.0. Descriptive analysis included characteristics of respondents, distribution of older adults’ knowledge and attitudes, and frequencies and percentages of older adults’ self-medication behaviors for the past year. Univariate and multivariate Logistic Regression models were applied to identify predictors of the self-medication behaviors. Ethics approval The study was approved by the Ethical Committee of Anhui Medical University (reference number: 20170260). Results Social-demographic characteristics of participants A total of 788 rural older adults completed the questionnaire (98.5% response rate). Of 788 participants, 50.5% were women and the mean (SD) age of older adults was 72.62(5.5) years. (Table 1 ). Table 1 Demographic characteristics of the older adults (n = 788) Variables N(%) Gender Male 390(49.5) Female 398(50.5) Age, years (mean age = 72.62 ± 5.5) 65–80 691(87.7) ≥ 80 97(12.3) Education (year) 0 350(44.4) 0–6 290(36.8) >6 148(18.8) One of the family members employed in medical occupations No 735(93.3) Yes 53(6.7) Family per capita monthly income (RNB) ≤ 1000 631(80.1) >1000 157(19.9) Had commercial health insurance No 736(93.4) Yes 52(6.6) Had at least one kind of chronic disease No 163(20.7) Yes 625(79.3) Distance to the nearest hospital (including primary care clinics) <1km 500(77.8) ≥ 1km 143(22.2) Knowledge and attitudes about antibiotics among the older adults As shown in Table 2 , only 9.3% of the older adults thought that antibiotics cannot kill or control viruses. 40.7% responded that common cold, and 32.0% believed sore throat does not need antibiotics. Only 16.4% of the older adults reported that they know the difference between prescription and over-the-counter drugs, and 6.7% of them had heard of the phrase “antibiotic resistance”. Regarding attitudes, 28.7% of the older adults disagreed that combinations of antibiotics are generally more effective than a single antibiotic; 35.5% of older adults didn’t support that expensive antibiotics are more effective than cheap ones. Over 60% of the respondents would prefer not to medicate for minor physical discomfort. Regarding whether more antibiotics or longer use of antibiotics can shorten the duration of disease, 44.0% and 57.2% of participants voted disagree respectively. Table 2 Knowledge and attitudes about antibiotics among the older adults in rural Anhui, China Question Correct/desired responses(n,%) Knowledge 1. Antibiotics can kill or control bacteria 335(42.5) 2. Antibiotics can kill or control viruses 73(9.3) 3. Antibiotics are needed for most common colds 321(40.7) 4. Antibiotics are needed for most sore throat 252(32.0) 5. Have you ever heard of antibiotic resistance 53(6.7) 6. Do you know the difference between prescription and over-the-counter drugs 129(16.4) Attitudes 1. Combinations of antibiotics are generally more effective than a single antibiotic 226(28.7) 2. Expensive antibiotics are definitely more effective than cheap ones 280(35.5) 3. More antibiotics you use, the shorter time the disease lasts 347(44.0) 4. The longer the course of medication, the shorter the disease lasts 451(57.2) 5. Medication is better than no medication for minor physical discomfort 533(67.6) Note : for knowledge item 1, the correct response is “true”; for knowledge item 2–4, the correct response is “false”; for knowledge item 5–6, the correct response is “yes”. For attitudes items 1–5, the desired response is “disagree”. Using a score of 1 for a correct/desired response and 0 for an incorrect/not desired or uncertain response. Practices regarding self-medication with antibiotics among the older adults Of the 788 respondents interviewed, 643(81.6%) participants reported they had at least one minor discomfort in the past year. Among the 643 older adults, 400(62.2%) reported that they had taken at least one kind of antibiotic to cure the discomfort, and 234(36.4%) of participants reported self-medication with antibiotics. Which also means more than half (58.5%) of the total antibiotics use decisions were not made by prescriptions in the past year. Among older adults who medicated themselves with antibiotics, 142(60.7%) used left-over antibiotics without consulting a doctor while 196(83.8%) bought antibiotics from drugstores without a prescription. One-third of the respondents reported that they had gotten antibiotics from both two ways in the past year. Among the older adults who had SMA behaviors for the past year, respondents reported a range of symptoms that they believed can be categorized as minor discomfort and treated with antibiotics. The top 3 most frequently reported minor discomforts were common cold (49.3%), toothache (28.2%), and cough (18.3%) (Fig. 1 ). In the past year 19.0% of older adults reported ≥ 3 minor discomforts and self-medicated with antibiotics. Factors associated with self-medication with antibiotics among the older adults Six potential factors which showed a p -value < 0.05 were included into multivariate regression (Table 3 ). The results showed that age ≥ 80 [OR = 0.450(95%CI 0.242–0.837)], knowledge score ≥ 3 [OR = 0.461(95%CI 0.282–0.752)] were negatively associated with SMA, while 0–6 years of education [OR = 1.558(95%CI 1.061–2.289)], family per capita monthly income>1000RMB [OR = 1.742(95%CI 1.127–2.693)], distance to the nearest hospital ≥ 1km [OR = 1.720(95%CI 1.151–2.571)], and stored antibiotics at home [OR = 2.216(95%CI 1.555–3.159)] were apt to SMA behaviors. Using the same method, factors related to using leftover antibiotics without consulting doctors and buying antibiotics in a drugstore without a prescription were also analyzed. The results showed that age ≥ 80 [OR = 0.354(95%CI 0.148–0.847)] was negatively associated with using left-over antibiotics without consulting doctors, while family per capita monthly income>1000RMB [OR = 1.820(95%CI 1.163–2.850)], had commercial health insurance [OR = 2.793(95%CI 1.360–5.739)] and stored antibiotics at home [OR = 2.783(95%CI 1.861–4.160)] were positively associated with such behavior. Regarding buying antibiotics in a drugstore without a prescription, the results showed that age ≥ 80 [OR = 0.518(95%CI 0.274–0.977)] and knowledge score ≥ 3 [OR = 0.441(95%CI 0.264–0.739)] were negatively associated with buying antibiotics in a drugstore without prescription, while family per capita monthly income>1000RMB [OR = 1.618(95%CI 1.063–2.463)] and stored antibiotics at home [OR = 2.092(95%CI 1.471–2.975)] were positively associated with such behavior. Table 3 Univariate and multivariate logistic regression of self-medication with antibiotics among the older adults (n = 643) Variables Self-medicated with antibiotics, (n = 234) n(%) Univariate Multivariate Use left-over antibiotics, (n = 142) n(%) Univariate Multivariate Buy antibiotics in a drugstore , (n = 196) n(%) Univariate Multivariate crude OR (95%CI) P adjusted OR (95%CI) P crude OR (95%CI) P adjusted OR (95%CI) P crude OR (95%CI) P adjusted OR (95%CI) P Gender Male 108(46.2) 1 65(45.8) 1 91(46.4) 1 Female 126(53.8) 1.063(0.770–1.467) 0.710 77(54.2) 1.072(0.738–1.558) 0.715 105(53.6) 1.041(0.743–1.457) 0.815 Age 65–80 220(94.0) 1 136(95.8) 1 183(93.4) 1 ≥ 80 14(6.0) 0.337(0.185–0.615) <0.001 0.450(0.242–0.837) 0.012 6(4.2) 0.259(0.110–0.608) 0.002 0.354(0.148–0.847) 0.020 13(6.6) 0.410(0.221–0.763) 0.005 0.518(0.274–0.977) 0.042 Education (year) 0 92(39.3) 1 53(37.3) 1 79(40.3) 1 0–6 98(41.9) 1.691(1.181–2.421) 0.004 1.558(1.061–2.289) 0.024 59(41.5) 1.617(1.064–2.460) 0.025 - - 79(40.3) 1.473(1.0013–2.143) 0.043 - - >6 44(18.8) 1.421(0.906–2.229) 0.126 0.975(0.579–1.644) 0.925 23(16.2) 1.664(0.998–2.776) 0.051 - - 28(19.4) 1.399(0.877–2.230) 0.159 - - One of the family members employed in medical occupations No 211(90.2) 1 127(89.4) 1 176(89.8) 1 Yes 23(9.8) 1.749(0.963–3.174) 0.066 15(11.6) 1.731(0.909–3.296) 0.095 20(10.2) 1.768(0.966–3.235) 0.065 Family per capita monthly income (RNB) ≤ 1000 174(74.4) 1 99(69.7) 1 145(74.0) 1 >1000 60(25.6) 1.859(1.250–2.764) 0.002 1.742(1.127–2.693) 0.013 43(30.3) 2.252(1.465–3.461) <0.01 1.820(1.163–2.850) 0.009 51(26.0) 1.802(1.201–2.704) 0.004 1.618(1.063–2.463) 0.025 Had commercial health insurance No 217(92.7) 1 127(89.4) 1 181(92.4) 1 Yes 17(7.3) 1.378(0.716–2.651) 0.337 15(10.6) 2.347(1.196–4.606) 0.013 2.793(1.360–5.739) 0.005 15(7.6) 1.461(0.749–2.849) 0.266 Had at least one kind of chronic disease No 43(18.4) 1 31(21.8) 1 36(18.4) 1 Yes 191(81.6) 0.917(0.603–1.395) 0.686 111(78.2) 0.701(0.441–1.114) 0.132 150(81.6) 0.925(0.597–1.432) 0.726 Distance to the nearest hospital <1km 171(73.1) 1 107(75.4) 1 143(73.0) 1 ≥ 1km 63(26.9) 1.515(1.038–2.212) 0.031 1.720(1.151–2.571) 0.008 26(24.6) 1.190(0.769–1.843) 0.435 37(27.0) 1.470(0.995–2.173) 0.053 Stored antibiotics at home No 203(86.8) 1 118(83.1) 1 172(87.8) 1 Yes 31(13.2) 2.295(1.653–3.187) 0.004 2.216(1.555–3.159) <0.001 24(16.9) 2.881(1.961–4.233) <0.001 2.783(1.861–4.160) <0.001 24(12.2) 2.180(1.550–3.067) 0.048 2.092(1.471–2.975) <0.001 Knowledge score <3 206(88.0) 1 119(83.8) 1 174(88.8) 1 ≥ 3 28(12.0) 0.518(0.327–0.822) 0.005 0.461(0.282–0.752) 0.002 23(16.2) 0.883(0.535–1.457) 0.625 22(11.2) 0.495(0.300-0.815) 0.006 0.441(0.264–0.739) 0.002 Attitudes score <3 171(73.1) 1 101(71.1) 1 141(71.9) 1 ≥ 3 63(26.9) 1.080(0.750–1.556) 0.677 41(28.9) 1.208(0.798–1.830) 0.372 55(18.1) 1.167(0.800–1.730) 0.424 Note : OR, odds ratio; CI, confidence interval. “-” represents this variable was not included in the multivariate logistic regression. For all of the dependent variables, no response to the behavior was recorded as 0, yes response to the behavior was recorded as 1. Discussion The present study confirmed that self-medication was an important way in which the older adult population in rural areas use antibiotics. In addition, other inappropriate practices regarding antibiotic use, such as keeping leftover antibiotics for future use and buying antibiotics without a prescription were also identified among older adult. To our knowledge, this is the first study to investigate the self-medication of antibiotics among rural older adults in Anhui, China. The results showed that the prevalence of SMA among rural older adults was relatively high, compared with older adults of Malaysia (3.5%) 14 and general population of France (18.0%) 35 . Considering more than half (58.8%) of the antibiotics use decisions in the past year were made by self-decision, SMA behaviors needs to be addressed in this population. To be specifically, SMA mainly came from left-over antibiotics and bought from pharmacies. Left-over antibiotics from previous illness episodes are likely to indicate over-prescription by physicians or poor compliance by patients 36 . It can be solved by limiting the number of antibiotics dispensed at a single time, selling an accurate number of antibiotic tablets, and increasing the coverage and accessibility of pharmaceutical services. To tackle the issue of purchasing over-the‐counter antibiotics, China Food and Drug Administration have released Provisions for Supervision of Drug Distribution Regulation, in which forbidding the sale of antibiotics without prescription 37 . However, the findings suggested that buying antibiotics from pharmacies was still an access of antibiotics for citizens. Future strategies should put more effort on strengthening regulation of selling antibiotics. The top three reasons cited for taking antibiotics during the past year were common cold, cough and toothache. SMA regarding upper respiratory tract infections was consistent with results of other review 38 . However, using antibiotics to relieve toothache was the first time reported by the current study. Toothache was usually presented as “red, swollen and pain”, which older adults believe were signs of inflammation. Therefore they need to be treated with anti-inflammatory drugs, which were the common name for antibiotics among rural older adults. To address such concept confusion, anti-inflammatory drugs and antibiotics are different types of medicine need to be included as an essential knowledge item regarding knowledge improvement. The result also indicated that enhanced oral health care in the older adults can also reduce SMA behaviors. The study suggested a poor knowledge level and not optimistic attitudes among rural older adults. A very small part (9.3%) of older adults believed that antibiotics cannot kill viruses. This percentage is far more lower than that in European populations (40%) 38 and that from Chinese university students (68.2%) 39 . Our results also showed that only 6.7% of participants had heard of antibiotic resistance. This percentage accounted only half of the data from a study conducted in Nepal 40 . Regarding attitudes toward antibiotics, our findings were consistent with previous studies. Nearly 70% of participants believed combinations of antibiotics are more effective than a single antibiotic, similar with the study conducted among adult residents in Anhui Province 34 . Furthermore, although the relationship between attitudes and SMA was not identified, our findings confirmed that higher knowledge scores were linked with less SMA behaviors. This indicated that it is beneficial to reinforce antibiotics education among the older adult population. And some essential information such as differentiation between anti-inflammatory drugs and antibiotics need to be included combined with the above findings. Previous studies had indicated that the older adults have a high prevalence of storing drugs at home 41 , 42 , while the present study found approximately 40% of participants stored antibiotics at home. Older adults can store some kinds of medicine at home such as drugs for controlling chronic diseases, but inappropriate storage is more likely occurring in the population 43 . It’s worth noting that the current study found that stored antibiotics at home increased the possibility of SMA behaviors. Antibiotics should not be included in the home storage medicine list. Therefore, pharmacy service including what and how medicine can home reserved should be provided to the older adults to reduce home storage of antibiotics thus reduce SMA behaviors eventually. Interpretation of the findings of this study should consider certain potential limitations. Firstly, recall bias regarding self-medication behaviors for the last year is possible. Secondly, the generalizability of this study might be prudent since the study was conducted in one province of China. Thirdly, this was a cross-sectional study and had limited ability to confirm the causality of different variables. Despite these limitations, the results provide important information for understanding the SMA behaviors among the aged population and indicate strategies to promote rational use of antibiotics among them. Conclusions This study has revealed that the prevalence of self-medication with antibiotics was relatively high among the rural older adults in Anhui, China. Common cold, cough and toothache were the top three reasons cited by the older adults for self-medication with antibiotics. The research findings indicated the importance of both prudent prescriptions by physicians and strengthened antibiotics sale rules implemented by pharmacies. A low level of knowledge about antibiotics and incorrect beliefs were observed among the rural older adults. A higher knowledge score was associated with less SMA behaviors among the rural older adults. Our findings suggest that it’s beneficial to educate the rural older adult population and some key messages should be included when designing educational projects. In addition, pharmacy services including proper home storage guidance should be promoted for older adults’ convenience. Although several limitations exist, we believe that the current study helps understand rural older adults’ knowledge and beliefs regarding antibiotic and their relationships with SMA among rural older adults. The findings may help to develop intervention strategies to reduce SMA behaviors in the community. Declarations Acknowledgments We thank the all study participants who have contributed to the procedure of data collection. Funding This study was supported by the National Natural Science Foundation of China (grant number: 71704003). Author information Authors and Affiliations Contributions Conceptualization: ZPL and CYX. Methodology: ZPL and WJD. Software: CYX Xu and ZPL. Formal analysis: ZPL, JC and CYX. Writing-original draft preparation:ZPL and CYX. Writing-review and editing: all authors. Supervision:JC. Project administration:JC. Funding acquisition: JC. All authors have read and agreed upon the final version of the manuscript. Corresponding author Correspondence to Jing Cheng. Ethics declarations Ethics approval and consent to participate This study was conducted according to the guideline laid down in the Declaration of Helsinki. 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Don't wear me out–the public's knowledge of and attitudes to antibiotic use. J Antimicrob Chemother Apr. 2007;59(4):727–38. Gillani AH, Chang J, Aslam F, et al. Public knowledge, attitude, and practice regarding antibiotics use in Punjab, Pakistan: a cross-sectional study. Expert Rev anti-infective therapy Mar. 2021;19(3):399–411. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol bed bench Winter. 2013;6(1):14–7. Muras M, Krajewski J, Nocun M, Godycki-Cwirko M. A survey of patient behaviours and beliefs regarding antibiotic self-medication for respiratory tract infections in Poland. Archives Med science: AMS Oct. 2013;31(5):854–7. Cheng J, Coope C, Chai J et al. Jun. Knowledge and behaviors in relation to antibiotic use among rural residents in Anhui, China. Pharmacoepidemiology and drug safety . 2018;27(6):652–9. Demoré B, Mangin L, Tebano G, Pulcini C, Thilly N. Public knowledge and behaviours concerning antibiotic use and resistance in France: a cross-sectional survey. Infect Aug. 2017;45(4):513–20. Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JG, et al. Self-medication with antimicrobial drugs in Europe. Emerg Infect Dis Mar. 2006;12(3):452–9. Administration NMP. Notice on strengthening supervision of antimicrobial drug sales in retail pharmacies to promote rational drug use. Eurobarometer S. Antimicrobial resistance . 2013. Accessed 3 Sept 2022. Pan H, Cui B, Zhang D, Farrar J, Law F, Ba-Thein W. Prior knowledge, older age, and higher allowance are risk factors for self-medication with antibiotics among university students in southern China. PLoS ONE. 2012;7(7):e41314. Rijal KR, Banjara MR, Dhungel B, et al. Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey. Sci Rep Jun. 2021;2(1):11554. Amoako EP, Richardson-Campbell L, Kennedy-Malone L. Self-medication with over-the-counter drugs among elderly adults. J gerontological Nurs Aug. 2003;29(8):10–5. Jafari F, Khatony A, Rahmani E. Prevalence of self-medication among the elderly in Kermanshah-Iran. Global J health Sci Jan. 2015;21(2):360–5. Martins RR, Farias AD, Oliveira Y, Diniz RDS, Oliveira AG. Prevalence and risk factors of inadequate medicine home storage: a community-based study. Revista de saude publica Nov. 2017;17:51:95. Additional Declarations No competing interests reported. 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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-6249071","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":448763330,"identity":"8cf00829-47c4-4e50-a688-5fedac1f100a","order_by":0,"name":"Zhiping Liu","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhiping","middleName":"","lastName":"Liu","suffix":""},{"id":448763331,"identity":"2ef450a1-85bd-48a0-b003-9054c2ac25fd","order_by":1,"name":"Chenyun Xu","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chenyun","middleName":"","lastName":"Xu","suffix":""},{"id":448763332,"identity":"952ccf01-1b0a-4f81-9240-22b120833df6","order_by":2,"name":"Wenjun Dai","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenjun","middleName":"","lastName":"Dai","suffix":""},{"id":448763333,"identity":"f92a54e0-e50c-47d4-beab-56367f1a7146","order_by":3,"name":"Jing Cheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYDACCRDBAyTZG9ggIgeI1sJzgCQtYEYCkVr4Zzcfe/hFxiJPPvLxs0c32xjk+G4kMH4uwGfJnWPpxjI8EsWGt9PMjXPbGIwlbyQwS8/Ao8VAIsdMWoJHInHj7AQzaaCWxA03EtiYefBqyf8G0TLz+DeQlnoitOSwSX4AapkvwQO2JcGAkBaJG2lm0sBATtzAk1MmnXNOwnDmmYfN0vi08M9Ifib5s6cucX778W3SOWU28nzHkw9+xqcFBJh5e4AuPACxFYgZGwhoACr58YOBQZ6wulEwCkbBKBipAAABUkcReTy25AAAAABJRU5ErkJggg==","orcid":"","institution":"Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jing","middleName":"","lastName":"Cheng","suffix":""}],"badges":[],"createdAt":"2025-03-18 03:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6249071/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6249071/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81649850,"identity":"a02d4daa-45f2-4bef-bdb3-749cb2e86228","added_by":"auto","created_at":"2025-04-29 15:51:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22225,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of reported symptoms self-medicated with antibiotics in the past year\u003c/p\u003e","description":"","filename":"figure13.png","url":"https://assets-eu.researchsquare.com/files/rs-6249071/v1/8810037b2d671bf9c428ac11.png"},{"id":81650576,"identity":"2bd101b9-c423-4415-a9b6-b77251216646","added_by":"auto","created_at":"2025-04-29 16:07:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1079508,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6249071/v1/f58220fc-a072-4682-8dc6-d849ee5d2a25.pdf"},{"id":81650405,"identity":"8caff88f-3515-406a-969e-e6e38d419775","added_by":"auto","created_at":"2025-04-29 15:59:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":24376,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6249071/v1/96dc678f0a6e2510babcaafb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, attitudes, and practices of self-medication with antibiotics among rural elders in Anhui, China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAntimicrobial resistance (AMR) is considered to be an important threat affecting the clinical efficacy of antibiotics and is becoming a global public health concern\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. It causes treatment failures and leads to increased morbidity, mortality and huge economic burdens both in developed and developing countries\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Overuse and misuse of antibiotics, which exists not only in hospitals and primary care settings but also in the community\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, is a great contributor to AMR\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSelf-medication can be defined as the use of medicinal products by the consumer to treat self-recognized disorders or symptoms, or the intermittent or continued use of a medication prescribed by a physician\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Self-medication with antibiotics (SMA) is a dangerous behavior confirmed by the WHO\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. SMA is often accompanied by overuse/abuse of antibiotics, inappropriate drug and dose choices, and incomplete/shorter treatment courses\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, which can eventually increase AMR\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. The prevalence of SMA is reported to vary widely across continents and countries. The highest rates recorded in European countries were in southern European countries such as Greece (20%), Romania (16%) and Cyprus (14%), compared with the lowest rates in other European countries such as Sweden (2%) and Slovakia (3%)\u003csup\u003e11\u003c/sup\u003e. In Africa, the prevalence of SMA range from 24\u0026ndash;76%, including 50.3% in northern Nigeria, 68.9% in Sierra Leone, 70% in Ghana, 65.1% in Uganda, and 76% in Sudan\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. A systematic review of 31 studies conducted in the US reported the prevalence of frequent use of over-the-counter antibiotics ranging from 1 to 66%\u003csup\u003e13\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the older adult population, SMA could be more problematic and requires particular concern. First, older adults usually have reduced immune system, degenerated organ function, and chronic comorbidities, which put them at a relatively higher incidence of infections\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, thus may expand the chance for antibiotics use. Secondly, evidence reported that self-medication behavior existed among older adults, ranging from 20\u0026ndash;60%\u003csup\u003e15\u003c/sup\u003e, which may also increase the possibility of SMA. In a study of Spanish residents, it\u0026rsquo;s even estimated that older adults used around 50% more antibiotics per capita than youngers\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. However, to our knowledge, few researches studied SMA and its potential influencing factors among Chinese older adults.\u003c/p\u003e \u003cp\u003eChina was estimated to be the second-largest consumer of antibiotics for human use\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, and also among the countries with the most serious situation of antibiotic resistance in the world\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. To tackle this problem, the Chinese government has issued a series of policies/regulations, which mainly focused on physicians, hospitals and other health service providers. However, the use of inappropriate antibiotics in community settings may also be an important part contributing to AMR\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. In addition, older adults\u0026rsquo; SMA behavior can lead to polypharmacy and increase the risk of adverse drug events\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Meanwhile, with the aging of the population increasing dramatically, people aged above 65 years old accounted for 13.5% of the whole population in China\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Studying SMA behavior of the older adults can provide evidence for promoting the rational use of antibiotics as well as be an important part of healthy aging.\u003c/p\u003e \u003cp\u003eEvidence regarding SMA and its determinants is insufficient. In studies of the general population, Ramay\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e et al. found that women were more likely to engage in SMA practices than men while a study by Abdulraheem\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e et al. reported that in rural settings, male participants were more likely to use them than females. Besides, Bogale\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e et al. found that income was negatively associated with SMA, but Albawani\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e et al. had not found a correlation between them. In addition, several studies found that residents with better antibiotic-related knowledge were less likely to conduct SMA\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, while other studies showed that SMA behavior was actually more frequent among those who have higher knowledge levels\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. However, the influencing factors especially the relationship between knowledge/attitude and SMA behavior among the older adults have rarely been studied.\u003c/p\u003e \u003cp\u003eTherefore, we conducted this study to assess knowledge, attitudes, and practices regarding SMA among rural older adults, with a particular interest in examining SMA and its determinants, using data from community-based surveys.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted in rural Anhui Province. Anhui Province is located in the Yangtze River Delta region of eastern China, with a population of 61.1\u0026nbsp;million and 40.6% living in rural areas. Per capita Gross Domestic Product (GDP) and the numbers of the population in Anhui rank in the middle level of China.\u003c/p\u003e \u003cp\u003eThe required sample size was estimated using single population proportion formula\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e with 95% CI, 0.04 marginal error, estimated 53.8% prevalence of SMA (previous investigation), and considered an 80% response rate. Finally, the total sample size was 746.\u003c/p\u003e \u003cp\u003eParticipants were selected by a multi-stage method. First, we divided Anhui province into three regions: northern (17 counties), central (15 counties) and southern (22 counties). Then 3, 3 and 4 counties were randomly selected from the northern, central and southern regions, respectively. After that 1 township from each of the selected counties and 1 administrative village from each of the townships were selected. In total 10 administrative villages in Anhui Province were recruited as study sites. In each administrative village, the first household to be investigated was randomly selected, and then two households were passed by and the third household would be invited to our study, until the sample size reached the minimum required number of 75 for each village.\u003c/p\u003e \u003cp\u003eCitizens who met the following criteria were considered as our participants: (i) aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years old; (ii)were living in the sampled village for more than one year till the survey was conducted; (iii) were willing to participate in this study; (iiii) were able to respond to the survey questions. When entering the house, the interviewer asked if there was anyone aged 65 or older in the house. If the answer was yes, the interviewer would talk with the older adults to check the inclusion criteria again and invite he/she to participate in our study. The informed consent from the respondents was obtained before the survey started.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cp\u003eA questionnaire was developed based on previous literature \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e and adapted for rural settings in China. Final questionnaire comprised of sociodemographic characteristics of rural older adults, general knowledge and attitudes about antibiotics, and self-medication behaviors with antibiotics.\u003c/p\u003e\n\u003ch3\u003eData collection and analysis\u003c/h3\u003e\n\u003cp\u003eThe study was performed using face-to‐face interviews conducted at the older adults' households in July 2021, by 10 undergraduate students recruited from Anhui Medical University. Data were double-entered using EPI DATA 3.1 and analyzed via SPSS 22.0. Descriptive analysis included characteristics of respondents, distribution of older adults\u0026rsquo; knowledge and attitudes, and frequencies and percentages of older adults\u0026rsquo; self-medication behaviors for the past year. Univariate and multivariate Logistic Regression models were applied to identify predictors of the self-medication behaviors.\u003c/p\u003e\n\u003ch3\u003eEthics approval\u003c/h3\u003e\n\u003cp\u003e The study was approved by the Ethical Committee of Anhui Medical University (reference number: 20170260).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSocial-demographic characteristics of participants\u003c/h2\u003e \u003cp\u003eA total of 788 rural older adults completed the questionnaire (98.5% response rate). Of 788 participants, 50.5% were women and the mean (SD) age of older adults was 72.62(5.5) years. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\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\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the older adults (n\u0026thinsp;=\u0026thinsp;788)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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\u003e390(49.5)\u003c/p\u003e \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\u003e398(50.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years (mean age\u0026thinsp;=\u0026thinsp;72.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e691(87.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97(12.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e350(44.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e290(36.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e148(18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne of the family members employed in medical occupations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\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\u003e735(93.3)\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\u003e53(6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily per capita monthly income (RNB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e631(80.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e157(19.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHad commercial health insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\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\u003e736(93.4)\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\u003e52(6.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHad at least one kind of chronic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\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\u003e163(20.7)\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\u003e625(79.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to the nearest hospital (including primary care clinics)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;1km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e500(77.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143(22.2)\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\n\u003ch3\u003eKnowledge and attitudes about antibiotics among the older adults\u003c/h3\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, only 9.3% of the older adults thought that antibiotics cannot kill or control viruses. 40.7% responded that common cold, and 32.0% believed sore throat does not need antibiotics. Only 16.4% of the older adults reported that they know the difference between prescription and over-the-counter drugs, and 6.7% of them had heard of the phrase \u0026ldquo;antibiotic resistance\u0026rdquo;.\u003c/p\u003e \u003cp\u003eRegarding attitudes, 28.7% of the older adults disagreed that combinations of antibiotics are generally more effective than a single antibiotic; 35.5% of older adults didn\u0026rsquo;t support that expensive antibiotics are more effective than cheap ones. Over 60% of the respondents would prefer not to medicate for minor physical discomfort. Regarding whether more antibiotics or longer use of antibiotics can shorten the duration of disease, 44.0% and 57.2% of participants voted disagree respectively.\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\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge and attitudes about antibiotics among the older adults in rural Anhui, China\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrect/desired responses(n,%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Antibiotics can kill or control bacteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e335(42.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Antibiotics can kill or control viruses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73(9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Antibiotics are needed for most common colds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e321(40.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Antibiotics are needed for most sore throat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e252(32.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Have you ever heard of antibiotic resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53(6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Do you know the difference between prescription and over-the-counter drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e129(16.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttitudes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Combinations of antibiotics are generally more effective than a single antibiotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e226(28.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Expensive antibiotics are definitely more effective than cheap ones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e280(35.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. More antibiotics you use, the shorter time the disease lasts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e347(44.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. The longer the course of medication, the shorter the disease lasts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e451(57.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Medication is better than no medication for minor physical discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e533(67.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cb\u003eNote\u003c/b\u003e: for knowledge item 1, the correct response is \u0026ldquo;true\u0026rdquo;; for knowledge item 2\u0026ndash;4, the correct response is \u0026ldquo;false\u0026rdquo;; for knowledge item 5\u0026ndash;6, the correct response is \u0026ldquo;yes\u0026rdquo;. For attitudes items 1\u0026ndash;5, the desired response is \u0026ldquo;disagree\u0026rdquo;. Using a score of 1 for a correct/desired response and 0 for an incorrect/not desired or uncertain response.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003ePractices regarding self-medication with antibiotics among the older adults\u003c/h3\u003e\n\u003cp\u003eOf the 788 respondents interviewed, 643(81.6%) participants reported they had at least one minor discomfort in the past year. Among the 643 older adults, 400(62.2%) reported that they had taken at least one kind of antibiotic to cure the discomfort, and 234(36.4%) of participants reported self-medication with antibiotics. Which also means more than half (58.5%) of the total antibiotics use decisions were not made by prescriptions in the past year. Among older adults who medicated themselves with antibiotics, 142(60.7%) used left-over antibiotics without consulting a doctor while 196(83.8%) bought antibiotics from drugstores without a prescription. One-third of the respondents reported that they had gotten antibiotics from both two ways in the past year.\u003c/p\u003e \u003cp\u003eAmong the older adults who had SMA behaviors for the past year, respondents reported a range of symptoms that they believed can be categorized as minor discomfort and treated with antibiotics. The top 3 most frequently reported minor discomforts were common cold (49.3%), toothache (28.2%), and cough (18.3%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the past year 19.0% of older adults reported\u0026thinsp;\u0026ge;\u0026thinsp;3 minor discomforts and self-medicated with antibiotics.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with self-medication with antibiotics among the older adults\u003c/h2\u003e \u003cp\u003eSix potential factors which showed a \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were included into multivariate regression (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The results showed that age\u0026thinsp;\u0026ge;\u0026thinsp;80 [OR\u0026thinsp;=\u0026thinsp;0.450(95%CI 0.242\u0026ndash;0.837)], knowledge score\u0026thinsp;\u0026ge;\u0026thinsp;3 [OR\u0026thinsp;=\u0026thinsp;0.461(95%CI 0.282\u0026ndash;0.752)] were negatively associated with SMA, while 0\u0026ndash;6 years of education [OR\u0026thinsp;=\u0026thinsp;1.558(95%CI 1.061\u0026ndash;2.289)], family per capita monthly income\u0026gt;1000RMB [OR\u0026thinsp;=\u0026thinsp;1.742(95%CI 1.127\u0026ndash;2.693)], distance to the nearest hospital\u0026thinsp;\u0026ge;\u0026thinsp;1km [OR\u0026thinsp;=\u0026thinsp;1.720(95%CI 1.151\u0026ndash;2.571)], and stored antibiotics at home [OR\u0026thinsp;=\u0026thinsp;2.216(95%CI 1.555\u0026ndash;3.159)] were apt to SMA behaviors.\u003c/p\u003e \u003cp\u003eUsing the same method, factors related to using leftover antibiotics without consulting doctors and buying antibiotics in a drugstore without a prescription were also analyzed. The results showed that age\u0026thinsp;\u0026ge;\u0026thinsp;80 [OR\u0026thinsp;=\u0026thinsp;0.354(95%CI 0.148\u0026ndash;0.847)] was negatively associated with using left-over antibiotics without consulting doctors, while family per capita monthly income\u0026gt;1000RMB [OR\u0026thinsp;=\u0026thinsp;1.820(95%CI 1.163\u0026ndash;2.850)], had commercial health insurance [OR\u0026thinsp;=\u0026thinsp;2.793(95%CI 1.360\u0026ndash;5.739)] and stored antibiotics at home [OR\u0026thinsp;=\u0026thinsp;2.783(95%CI 1.861\u0026ndash;4.160)] were positively associated with such behavior.\u003c/p\u003e \u003cp\u003eRegarding buying antibiotics in a drugstore without a prescription, the results showed that age\u0026thinsp;\u0026ge;\u0026thinsp;80 [OR\u0026thinsp;=\u0026thinsp;0.518(95%CI 0.274\u0026ndash;0.977)] and knowledge score\u0026thinsp;\u0026ge;\u0026thinsp;3 [OR\u0026thinsp;=\u0026thinsp;0.441(95%CI 0.264\u0026ndash;0.739)] were negatively associated with buying antibiotics in a drugstore without prescription, while family per capita monthly income\u0026gt;1000RMB [OR\u0026thinsp;=\u0026thinsp;1.618(95%CI 1.063\u0026ndash;2.463)] and stored antibiotics at home [OR\u0026thinsp;=\u0026thinsp;2.092(95%CI 1.471\u0026ndash;2.975)] were positively associated with such behavior.\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\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate logistic regression of self-medication with antibiotics among the older adults (n\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"16\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" 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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSelf-medicated with antibiotics, (n\u0026thinsp;=\u0026thinsp;234)\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUse left-over antibiotics, (n\u0026thinsp;=\u0026thinsp;142)\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBuy antibiotics in a drugstore\u003c/p\u003e \u003cp\u003e, (n\u0026thinsp;=\u0026thinsp;196)\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecrude OR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eadjusted OR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ecrude OR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eadjusted OR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003ecrude OR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eadjusted OR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65(45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e91(46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\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=\"left\" colname=\"c2\"\u003e \u003cp\u003e126(53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.063(0.770\u0026ndash;1.467)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e77(54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.072(0.738\u0026ndash;1.558)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e105(53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.041(0.743\u0026ndash;1.457)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220(94.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e136(95.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e183(93.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.337(0.185\u0026ndash;0.615)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.450(0.242\u0026ndash;0.837)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.259(0.110\u0026ndash;0.608)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.354(0.148\u0026ndash;0.847)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e13(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.410(0.221\u0026ndash;0.763)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.518(0.274\u0026ndash;0.977)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEducation (year)\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92(39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53(37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e79(40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98(41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.691(1.181\u0026ndash;2.421)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.558(1.061\u0026ndash;2.289)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e59(41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.617(1.064\u0026ndash;2.460)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e79(40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.473(1.0013\u0026ndash;2.143)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44(18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.421(0.906\u0026ndash;2.229)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.975(0.579\u0026ndash;1.644)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.664(0.998\u0026ndash;2.776)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e28(19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.399(0.877\u0026ndash;2.230)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"16\" nameend=\"c16\" namest=\"c1\"\u003e \u003cp\u003eOne of the family members employed in medical occupations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e211(90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e127(89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e176(89.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.749(0.963\u0026ndash;3.174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15(11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.731(0.909\u0026ndash;3.296)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e20(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.768(0.966\u0026ndash;3.235)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"16\" nameend=\"c16\" namest=\"c1\"\u003e \u003cp\u003eFamily per capita monthly income (RNB)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174(74.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e99(69.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e145(74.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.859(1.250\u0026ndash;2.764)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.742(1.127\u0026ndash;2.693)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43(30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.252(1.465\u0026ndash;3.461)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.820(1.163\u0026ndash;2.850)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e51(26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.802(1.201\u0026ndash;2.704)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e1.618(1.063\u0026ndash;2.463)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"16\" nameend=\"c16\" namest=\"c1\"\u003e \u003cp\u003eHad commercial health insurance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e217(92.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e127(89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e181(92.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.378(0.716\u0026ndash;2.651)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.347(1.196\u0026ndash;4.606)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.793(1.360\u0026ndash;5.739)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e15(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.461(0.749\u0026ndash;2.849)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"16\" nameend=\"c16\" namest=\"c1\"\u003e \u003cp\u003eHad at least one kind of chronic disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31(21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e36(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e191(81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.917(0.603\u0026ndash;1.395)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e111(78.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.701(0.441\u0026ndash;1.114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e150(81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.925(0.597\u0026ndash;1.432)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"16\" nameend=\"c16\" namest=\"c1\"\u003e \u003cp\u003eDistance to the nearest hospital\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;1km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171(73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e107(75.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e143(73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.515(1.038\u0026ndash;2.212)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.720(1.151\u0026ndash;2.571)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26(24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.190(0.769\u0026ndash;1.843)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e37(27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.470(0.995\u0026ndash;2.173)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"16\" nameend=\"c16\" namest=\"c1\"\u003e \u003cp\u003eStored antibiotics at home\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e203(86.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e118(83.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e172(87.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.295(1.653\u0026ndash;3.187)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.216(1.555\u0026ndash;3.159)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24(16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.881(1.961\u0026ndash;4.233)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.783(1.861\u0026ndash;4.160)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2.180(1.550\u0026ndash;3.067)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e2.092(1.471\u0026ndash;2.975)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eKnowledge score\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206(88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e119(83.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e174(88.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.518(0.327\u0026ndash;0.822)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.461(0.282\u0026ndash;0.752)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.883(0.535\u0026ndash;1.457)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e22(11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.495(0.300-0.815)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.441(0.264\u0026ndash;0.739)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAttitudes score\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171(73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101(71.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e141(71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.080(0.750\u0026ndash;1.556)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41(28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.208(0.798\u0026ndash;1.830)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e55(18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.167(0.800\u0026ndash;1.730)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"16\"\u003e\u003cb\u003eNote\u003c/b\u003e: OR, odds ratio; CI, confidence interval. \u0026ldquo;-\u0026rdquo; represents this variable was not included in the multivariate logistic regression. For all of the dependent variables, no response to the behavior was recorded as 0, yes response to the behavior was recorded as 1.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study confirmed that self-medication was an important way in which the older adult population in rural areas use antibiotics. In addition, other inappropriate practices regarding antibiotic use, such as keeping leftover antibiotics for future use and buying antibiotics without a prescription were also identified among older adult.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study to investigate the self-medication of antibiotics among rural older adults in Anhui, China. The results showed that the prevalence of SMA among rural older adults was relatively high, compared with older adults of Malaysia (3.5%)\u003csup\u003e14\u003c/sup\u003e and general population of France (18.0%)\u003csup\u003e35\u003c/sup\u003e. Considering more than half (58.8%) of the antibiotics use decisions in the past year were made by self-decision, SMA behaviors needs to be addressed in this population.\u003c/p\u003e \u003cp\u003eTo be specifically, SMA mainly came from left-over antibiotics and bought from pharmacies. Left-over antibiotics from previous illness episodes are likely to indicate over-prescription by physicians or poor compliance by patients\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. It can be solved by limiting the number of antibiotics dispensed at a single time, selling an accurate number of antibiotic tablets, and increasing the coverage and accessibility of pharmaceutical services. To tackle the issue of purchasing over-the‐counter antibiotics, China Food and Drug Administration have released Provisions for Supervision of Drug Distribution Regulation, in which forbidding the sale of antibiotics without prescription\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. However, the findings suggested that buying antibiotics from pharmacies was still an access of antibiotics for citizens. Future strategies should put more effort on strengthening regulation of selling antibiotics.\u003c/p\u003e \u003cp\u003eThe top three reasons cited for taking antibiotics during the past year were common cold, cough and toothache. SMA regarding upper respiratory tract infections was consistent with results of other review\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. However, using antibiotics to relieve toothache was the first time reported by the current study. Toothache was usually presented as \u0026ldquo;red, swollen and pain\u0026rdquo;, which older adults believe were signs of inflammation. Therefore they need to be treated with anti-inflammatory drugs, which were the common name for antibiotics among rural older adults. To address such concept confusion, anti-inflammatory drugs and antibiotics are different types of medicine need to be included as an essential knowledge item regarding knowledge improvement. The result also indicated that enhanced oral health care in the older adults can also reduce SMA behaviors.\u003c/p\u003e \u003cp\u003eThe study suggested a poor knowledge level and not optimistic attitudes among rural older adults. A very small part (9.3%) of older adults believed that antibiotics cannot kill viruses. This percentage is far more lower than that in European populations (40%)\u003csup\u003e38\u003c/sup\u003e and that from Chinese university students (68.2%)\u003csup\u003e39\u003c/sup\u003e. Our results also showed that only 6.7% of participants had heard of antibiotic resistance. This percentage accounted only half of the data from a study conducted in Nepal\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Regarding attitudes toward antibiotics, our findings were consistent with previous studies. Nearly 70% of participants believed combinations of antibiotics are more effective than a single antibiotic, similar with the study conducted among adult residents in Anhui Province\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, although the relationship between attitudes and SMA was not identified, our findings confirmed that higher knowledge scores were linked with less SMA behaviors. This indicated that it is beneficial to reinforce antibiotics education among the older adult population. And some essential information such as differentiation between anti-inflammatory drugs and antibiotics need to be included combined with the above findings.\u003c/p\u003e \u003cp\u003ePrevious studies had indicated that the older adults have a high prevalence of storing drugs at home\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e, while the present study found approximately 40% of participants stored antibiotics at home. Older adults can store some kinds of medicine at home such as drugs for controlling chronic diseases, but inappropriate storage is more likely occurring in the population\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. It\u0026rsquo;s worth noting that the current study found that stored antibiotics at home increased the possibility of SMA behaviors. Antibiotics should not be included in the home storage medicine list. Therefore, pharmacy service including what and how medicine can home reserved should be provided to the older adults to reduce home storage of antibiotics thus reduce SMA behaviors eventually.\u003c/p\u003e \u003cp\u003eInterpretation of the findings of this study should consider certain potential limitations. Firstly, recall bias regarding self-medication behaviors for the last year is possible. Secondly, the generalizability of this study might be prudent since the study was conducted in one province of China. Thirdly, this was a cross-sectional study and had limited ability to confirm the causality of different variables. Despite these limitations, the results provide important information for understanding the SMA behaviors among the aged population and indicate strategies to promote rational use of antibiotics among them.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study has revealed that the prevalence of self-medication with antibiotics was relatively high among the rural older adults in Anhui, China. Common cold, cough and toothache were the top three reasons cited by the older adults for self-medication with antibiotics. The research findings indicated the importance of both prudent prescriptions by physicians and strengthened antibiotics sale rules implemented by pharmacies. A low level of knowledge about antibiotics and incorrect beliefs were observed among the rural older adults. A higher knowledge score was associated with less SMA behaviors among the rural older adults. Our findings suggest that it\u0026rsquo;s beneficial to educate the rural older adult population and some key messages should be included when designing educational projects. In addition, pharmacy services including proper home storage guidance should be promoted for older adults\u0026rsquo; convenience. Although several limitations exist, we believe that the current study helps understand rural older adults\u0026rsquo; knowledge and beliefs regarding antibiotic and their relationships with SMA among rural older adults. The findings may help to develop intervention strategies to reduce SMA behaviors in the community.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the all study participants who have contributed to the procedure of data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the National Natural Science Foundation of China (grant number: 71704003).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: ZPL and CYX. Methodology: ZPL and WJD. Software: CYX Xu and ZPL. Formal analysis: ZPL, JC and CYX. Writing-original draft preparation:ZPL and CYX. Writing-review and editing: all authors. Supervision:JC. Project administration:JC. Funding acquisition: JC.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed upon the final version of the manuscript.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eCorrespondence to Jing Cheng.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was conducted according to the guideline laid down in the Declaration of Helsinki. The study was approved by the Ethical Committee of Anhui Medical University (reference number: 20170260) and the informed consent from the respondents was obtained before the survey started.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors have indicated they have no potential conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData Availability Statement: Data can be made available upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupporting information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAppendix S1.docx\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbera B, Kibret M, Mulu W. 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Feb. 2013;47(1):94\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStatistics CNBo. Bulletin of the seventh National Census. 2021. Accessed 2022.05.06.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamay BM, Lambour P, Cer\u0026oacute;n A. Comparing antibiotic self-medication in two socio-economic groups in Guatemala City: a descriptive cross-sectional study. BMC Pharmacol Toxicol Apr. 2015;27:16:11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdulraheem I, Adegboye A, Fatiregun A. Self-medication with Antibiotics: Empirical Evidence from a Nigerian Rural Population. Br J Pharm Res. 2016;11(5):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBogale AA, Amhare AF, Chang J, et al. Knowledge, attitude, and practice of self-medication with antibiotics among community residents in Addis Ababa, Ethiopia. \u003cem\u003eExpert review of anti-infective therapy\u003c/em\u003e. Jun. 2019;17(6):459\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbawani SM, Bin Hassan Y, Abd-Aziz N, Gnanasan S. Self-medication with antibiotics in Sana'a City, Yemen. Trop J Pharm Res May. 2017;16(5):1195\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBulabula ANH, Dramowski A, Mehtar S. Antibiotic use in pregnancy: knowledge, attitudes and practices among pregnant women in Cape Town, South Africa. J Antimicrob Chemother Feb. 2019;75(2):473\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZawahir S, Lekamwasam S, Halvorsen KH, Rose G, Aslani P. Self-medication Behavior with antibiotics: a national cross-sectional survey in Sri Lanka. \u003cem\u003eExpert review of anti-infective therapy\u003c/em\u003e. Apr. 2021;14:1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcNulty CA, Boyle P, Nichols T, Clappison P, Davey P. Don't wear me out\u0026ndash;the public's knowledge of and attitudes to antibiotic use. J Antimicrob Chemother Apr. 2007;59(4):727\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGillani AH, Chang J, Aslam F, et al. Public knowledge, attitude, and practice regarding antibiotics use in Punjab, Pakistan: a cross-sectional study. Expert Rev anti-infective therapy Mar. 2021;19(3):399\u0026ndash;411.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol bed bench Winter. 2013;6(1):14\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuras M, Krajewski J, Nocun M, Godycki-Cwirko M. A survey of patient behaviours and beliefs regarding antibiotic self-medication for respiratory tract infections in Poland. Archives Med science: AMS Oct. 2013;31(5):854\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng J, Coope C, Chai J et al. Jun. Knowledge and behaviors in relation to antibiotic use among rural residents in Anhui, China. \u003cem\u003ePharmacoepidemiology and drug safety\u003c/em\u003e. 2018;27(6):652\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemor\u0026eacute; B, Mangin L, Tebano G, Pulcini C, Thilly N. Public knowledge and behaviours concerning antibiotic use and resistance in France: a cross-sectional survey. Infect Aug. 2017;45(4):513\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrigoryan L, Haaijer-Ruskamp FM, Burgerhof JG, et al. Self-medication with antimicrobial drugs in Europe. Emerg Infect Dis Mar. 2006;12(3):452\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdministration NMP. Notice on strengthening supervision of antimicrobial drug sales in retail pharmacies to promote rational drug use.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEurobarometer S. \u003cem\u003eAntimicrobial resistance\u003c/em\u003e. 2013. Accessed 3 Sept 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePan H, Cui B, Zhang D, Farrar J, Law F, Ba-Thein W. Prior knowledge, older age, and higher allowance are risk factors for self-medication with antibiotics among university students in southern China. PLoS ONE. 2012;7(7):e41314.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRijal KR, Banjara MR, Dhungel B, et al. Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey. Sci Rep Jun. 2021;2(1):11554.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmoako EP, Richardson-Campbell L, Kennedy-Malone L. Self-medication with over-the-counter drugs among elderly adults. J gerontological Nurs Aug. 2003;29(8):10\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJafari F, Khatony A, Rahmani E. Prevalence of self-medication among the elderly in Kermanshah-Iran. Global J health Sci Jan. 2015;21(2):360\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartins RR, Farias AD, Oliveira Y, Diniz RDS, Oliveira AG. Prevalence and risk factors of inadequate medicine home storage: a community-based study. Revista de saude publica Nov. 2017;17:51:95.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"antibiotics, self-medication, older adults, knowledge, attitudes, practices","lastPublishedDoi":"10.21203/rs.3.rs-6249071/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6249071/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eAntimicrobial resistance (AMR) is a global public health concern, and self-medication with antibiotics (SMA) can increase AMR. In the older adults, SMA could be more problematic and requires particular concern.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted the study in Anhui, China among 788 rural older adults by using a questionnaire.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe observed poor knowledge, attitudes and relatively high prevalence of SMA behavior among rural older adults. Common cold, cough and toothache were the top three reasons cited by the older adults for SMA. Logistic Regression indicated that age\u0026thinsp;\u0026ge;\u0026thinsp;80, knowledge score\u0026thinsp;\u0026ge;\u0026thinsp;3 were negatively associated with SMA behavior, while 0\u0026ndash;6 years of education, family per capita monthly income\u0026gt;1000RMB, distance to the nearest hospital\u0026thinsp;\u0026ge;\u0026thinsp;1km, and stored antibiotics at home were apt to SMA behavior.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eProper education and guidance, enhanced oral health care, regulated and convenient pharmacy services may support to promote rational antibiotics use among rural older adults.\u003c/p\u003e","manuscriptTitle":"Knowledge, attitudes, and practices of self-medication with antibiotics among rural elders in Anhui, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-29 15:50:55","doi":"10.21203/rs.3.rs-6249071/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-07-29T04:37:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-25T22:06:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127595061938360322771602655697102424377","date":"2025-07-25T15:58:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88652548949565908392140258608469361364","date":"2025-07-24T04:13:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-26T20:56:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334221169809480929216328187167853481032","date":"2025-04-25T20:11:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-25T16:20:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-11T14:19:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-01T10:51:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-31T03:42:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-03-31T03:41:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fc8e40a0-9a5c-43ed-a840-955c84f8939b","owner":[],"postedDate":"April 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-04-29T15:50:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-29 15:50:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6249071","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6249071","identity":"rs-6249071","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}