Introduction
Upper respiratory tract infections (URTIs) are among the most common reasons for antibiotic prescriptions in children. In Khartoum, Sudan, understanding how parents perceive, decide, and act on antibiotic use for their children’s URTIs is essential for antimicrobial stewardship and reducing resistance. This cross-sectional hospital-based study explored parental knowledge, attitudes, and practices (KAP) at two major children’s teaching hospitals, highlighting areas where education and policy interventions could curb irrational antibiotic use.
Methods
Researchers conducted a hospital-based survey at Ibrahim Malik and Jaafar Ibn Auf in Khartoum. Using simple random sampling, a questionnaire adapted from prior work captured demographics and KAP related to antibiotic use for pediatric URTIs. Data were analyzed with SPSS. Ethical approvals were secured from the University of Khartoum, the Ministry of Health, and the participating hospitals.
Key Findings
Of 239 eligible parents, 211 participated (response rate 88.3%), with mothers comprising the majority of respondents (about 77%). Several insights emerged:
- Knowledge gaps: 39.3% understood that URTIs are often viral and do not require antibiotics. About 60% believed antibiotics hasten URTI symptom relief, and 70.6% were unaware that inappropriate use can drive bacterial resistance.
- Recognition of antibiotics: Most parents correctly identified amoxicillin/clavulanic acid and azithromycin as antibiotics (78.2%), but 32.7% misidentified cephalexin as non-antibiotic, and a notable minority confused cough syrups and analgesics with antibiotics.
- Attitudes toward antibiotic use: A substantial majority (63.5%) opposed using antibiotics for every fever, yet only 25.1% agreed that antibiotics have no side effects. About 58.3% acknowledged potential adverse effects, while 59.3% believed scientists can always develop new antibiotics against resistance.
- Care-seeking behavior: Earache was the prompt for medical consultation for 80.6% of children, followed by fever and sore throat. Notably, 73.3% expected antibiotics when visiting a physician, and over 65% favored antibiotics for a child with a cold or nasal drainage.
- Practices: Around 40% always ask whether antibiotics are essential; 33.6% rarely do. About 54.5% demonstrated good antibiotic-use practices, with younger parents (<35 years) more likely to show good practice (p=0.000).
Beyond individual knowledge, the study documented a broader trend: parents depend heavily on physicians and pharmacists for information, yet many still equate URTIs with a need for antibiotic therapy. Almost 85% reported following pediatricians’ instructions, while 22.7% believed doctors prescribed antibiotics based on parental requests.
Implications for Public Health
The findings underscore the need for targeted education to align parental expectations with clinical guidelines. Key strategies include:
- Enhancing public awareness about the viral nature of most URTIs, expected illness duration, and self-limiting courses in children.
- Strengthening antibiotic stewardship programs in pediatric care, including patient and caregiver counseling during consultations.
- Training healthcare providers to communicate clearly about when antibiotics are indicated and the risks of unnecessary antibiotic use.
- Addressing cultural and socioeconomic factors that influence antibiotic misuse, stigma, and pressures on clinicians.
Given Sudan’s high burden of antimicrobial resistance, reinforcing parent education and clinician-patient communication is critical. Such measures can reduce unnecessary antibiotic exposure in children, decrease adverse drug events, and slow the spread of resistant bacteria.
Conclusion
Parental knowledge, attitudes, and practices toward antibiotic use for URTIs in Khartoum reveal meaningful gaps that sustain overuse. By elevating education on URTI natural history, and by empowering healthcare workers to guide appropriate antibiotic use, Sudan can advance toward more rational prescribing and healthier outcomes for children.
