Knowledge, Attitude, and Practice Regarding Antibiotic Use and Resistance for Upper Respiratory Tract Infections among the Population Attending a Mass Gathering in Central India: A Cross-Sectional Study

Background: Good knowledge and appropriate attitude and practice about antibiotic use and resistance among the general population, are significant contributors to minimize the development of antibiotic resistance. We aimed to study the knowledge, attitude, and practice (KAP) regarding antibiotic use, resistance to upper respiratory tract infections (URTI), and associated factors with KAP, among the population attending a mass gathering in India. Methods: A cross-sectional study was conducted in 2016 during a mass gathering held in Ujjain city of Central India. A self-administered, pre-tested questionnaire consisting of 28 questions was used to collect data on demographic characteristics, KAP related to antibiotic use, resistance, and URTI. Descriptive analyses were used to describe participants' responses. Participants were divided into poor or good knowledge and appropriate or inappropriate groups of attitude and practice. Multivariable logistic regression models were used to examine the associations between demographic characteristics, URTI knowledge, and each domain of KAP. All statistical analyses were performed using Stata 16.0. The significance level was set at 5%. Results: A total of 1915 participants consented to participate (response rate 92.7%) with a mean age of 39.3 (+/- 14.7). Complete data on socio-demographics were available for 1619 participants. Of these, 59% were male, and 61% had an education level below high school. Eighty-nine percent of participants had poor knowledge about URTI. A majority of the respondents defined antibiotics incorrectly (93%) and were classified as having poor knowledge (97%). Most of the participants (63%) could not mention any contributors to the irrational use of antibiotics. Appropriate attitudes were observed in 40% of participants, 87% denied to comply with the prescribed course of antibiotics and 88.5% had inappropriate responses for practice. Age of the respondent, sex, education, occupation, and knowledge about URTI, were the main factors associated with the KAP. Conclusions: KAP about antibiotic use and resistance among the general population in India was poor. Knowledge about URTI is strongly associated with KAP. Community interventions, i.e., educational campaigns, should be designed and implemented promptly considering the differences in demographics of the target audience.