Knowledge, attitude and practice (KAP) survey regarding antibiotic use among pilgrims attending the 2015 Hajj mass gathering

Background: Overuse and misuse of antibiotics have been reported in Hajj. However, little is known about Knowledge, Attitude and Practice (KAP) of pilgrims themselves in relation to these agents. Methods: Adult pilgrims from seven countries attending the 2015 Hajj were interviewed using a structured KAP questionnaire. Results: KAP information was collected from 1476 pilgrims. Misconceptions regarding antibiotics included that they: cure all diseases (24.6%); cure common cold and flu (63.0%); are used to stop fever (47.3%); have no side effects (43.2%). Negative attitudes included prophylactic use (50%), self-medication (43.2%), non-compliance with therapy (63.5%) and storage of left-overs for future use (54.1%). In practice, 87.3% of pilgrims admitted to using non-prescribed antibiotics, only 19.3% use antibiotic as directed by their doctor and 54% do not usually check the expiry date of antibiotics before use. Over 60% brought antibiotics from their home country to KSA and 39.2% acquired non-prescribed antibiotics in Saudi Arabia. KAP scores were higher among the younger age group (<= 43 years old) and among those with healthcare-related work or education and increased with increasing levels of education. Conclusions: Multifaceted and multidisciplinary approaches, both in KSA and in pilgrims' countries of origin, are needed to address antibiotic misuse during Hajj.