Introduction: The Challenge of URTIs and Antibiotic Use in Sudan
Upper respiratory tract infections (URTIs) are among the most common reasons for antibiotic prescriptions in children. In Sudan, where antimicrobial resistance (AMR) is rising, understanding parental knowledge, attitudes, and practices (KAP) is essential. This study, conducted in two major Khartoum teaching hospitals, sheds light on how parents perceive URTIs, antibiotic necessity, and the influence of expectations on prescribing patterns.
Methods: How the Study Was Conducted
Researchers recruited 211 parents from Ibrahim Malik and Jaafar Ibn Auf Children’s Teaching Hospitals in Khartoum using simple random sampling. A questionnaire adapted from a prior study collected data on knowledge, attitudes, and practices related to antibiotic use for childhood URTIs. The study received ethical clearance from the University of Khartoum and participating health authorities. Data were analyzed with SPSS.
Key Findings: Knowledge Gaps, Attitudes, and Real-World Practices
Knowledge gaps: About 39.3% of parents knew URTIs are often viral and do not require antibiotics. While 63.5% opposed giving antibiotics for every fever, many held misconceptions, with 60% believing antibiotics speed symptom relief and 70.6% unaware that inappropriate use drives resistance. By contrast, about three in ten had good overall knowledge (29.9%).
Detection and recognition of antibiotics: Most parents could correctly identify several antibiotics (e.g., amoxicillin/clavulanic acid and azithromycin). Yet a notable minority misidentified non-antibiotics as antibiotics, signaling confusion about drug categories. Overall, 8.1% could not recognize any antibiotic among common drugs.
Attitudes: Expectations and Confidence in the Doctor-Patient Relationship
Parental attitudes revealed strong expectations for antibiotic prescriptions: 73.3% would expect antibiotics when visiting the doctor for URTIs, and 65% favored antibiotics for a cold or nasal drainage. About 71.7% believed antibiotics are overused in general. However, 58.3% recognized potential antibiotic side effects, and 59.3% doubted whether scientists can always outpace resistance with new drugs. Only 31.8% demonstrated a good attitude toward antibiotic use for URTIs, with female parents more likely to have poorer attitudes (p = .042).
Practices: Over-the-Counter Use and Doctor-Patient Communication
The most common driver of unsupervised antibiotic use was pharmacist recommendations (56.9%), followed by prior prescriptions for similar symptoms (43.1%). About 54.5% of parents had good practice scores, while 23% admitted doctors explain antibiotic use less than often. A striking 85.3% claimed they usually follow their pediatrician’s guidance, but 22.7% believed doctors prescribed antibiotics based on parental requests, and 23% said they administer antibiotics without consulting a doctor at times. The tendency to reuse leftover antibiotics and obtain antibiotics over the counter without prescription remains notable.
Implications for Policy and Practice
The findings underscore the need for targeted educational interventions for Sudanese parents. Key goals include clarifying that most URTIs are viral, detailing appropriate antibiotic use, and emphasizing the dangers of self-medication and leftover-antibiotic reuse. Strengthening physician-patient communication about treatment options and ensuring adherence to clinical guidelines could reduce unnecessary antibiotic exposure and slow the spread of resistance. The study also highlights the pivotal role of pharmacists and clinicians as trusted information sources in Khartoum.
Conclusion: Toward Safer Antibiotic Practices for Sudan’s Children
Parental knowledge and attitudes significantly shape antibiotic use for childhood URTIs in Khartoum. By improving education on viral URTIs, the risks of antibiotic overuse, and the value of evidence-based management, Sudan can advance AMR stewardship and protect children’s health now and in the future.
