Predictors of Antibiotic Self-Medication among Residents in the Western Area of Sierra Leone: A cross-sectional Population-based study

Self-medication with antibiotics (SMA) may result in inappropriate use with consequences such as adverse drug reactions, treatment failure, and bacterial antimicrobial resistance (AMR). This study aims to determine the prevalence and predictors of SMA among residents in the Western Area of Sierra Leone. This cross-sectional population-based study was conducted among residents in the Western Area of Sierra Leone. A total of 781 participants were selected using a two-stage stratified sampling method. Data were collected using a pre-tested, structured, interviewer-based questionnaire and analysis was done using descriptive statistics, binary logistic regression and Spearman’s rank correlation, with statistical significance set at p < 0.05. The prevalence of SMA was 87.5%. The most common reasons for SMA were the need for quick relief of symptoms (23.1%), non-serious disease (17.2%), and previous experience (15.8%). The most frequent complaints for SMA were common cold (19.6%), sore throat (15.8%), and cough (14.1%). Although 57.7% of participants had good knowledge about antibiotic and AMR, 79.0% and 92.1 % exhibited negative attitudes and poor practice regarding antibiotic use respectively. Secondary education (AOR=2.77, 95% CI: 1.23–6.23, p=0.014), being employed (AOR=3.19, 95% CI: 1.31–7.78, p=0.011) and overall poor practice (AOR=2.38, 95% CI: 1.22–4.63, p=0.011) were predictors of SMA. The high prevalence of SMA, coupled with negative attitudes and poor practices, highlights the need for targeted interventions to promote rational antibiotic use and combat antimicrobial resistance in Sierra Leone.抗生素自我药疗（Self-medication with antibiotics, SMA）可能引发不合理用药行为，并带来药物不良反应、治疗失败以及细菌抗菌药物耐药性（Antimicrobial Resistance, AMR）等不良后果。本研究旨在探明塞拉利昂西部地区居民的抗生素自我药疗患病率及其影响因素。本研究为基于人群的横断面研究，研究对象为塞拉利昂西部地区居民，采用两阶段分层抽样法共纳入781名参与者。研究采用经预试验验证的结构化访谈问卷收集数据，数据分析采用描述性统计、二元logistic回归及斯皮尔曼等级相关分析，设定统计学显著性阈值为p<0.05。本次研究中抗生素自我药疗的总体患病率为87.5%。最常见的自我药疗原因依次为快速缓解症状需求（23.1%）、罹患非重症疾病（17.2%）以及既往用药经验（15.8%）。自我药疗针对的最常见病症依次为普通感冒（19.6%）、咽喉疼痛（15.8%）及咳嗽（14.1%）。尽管57.7%的参与者对抗生素及抗菌药物耐药性具备良好认知，但分别有79.0%与92.1%的参与者对抗生素使用持负面态度且存在不规范用药行为。中等教育水平（调整优势比（Adjusted Odds Ratio, AOR）=2.77，95%置信区间（Confidence Interval, CI）:1.23–6.23，p=0.014）、就业状态（AOR=3.19，95%CI:1.31–7.78，p=0.011）及整体用药行为不规范（AOR=2.38，95%CI:1.22–4.63，p=0.011）是发生抗生素自我药疗的影响因素。塞拉利昂地区抗生素自我药疗患病率居高不下，叠加负面认知与不规范用药行为的现状，凸显了开展针对性干预措施以推动合理使用抗生素、遏制抗菌药物耐药性的必要性。