Exploring factors for antibiotic over-prescription in children with acute upper respiratory tract infections in Assiut, Egypt: a qualitative study.

BACKGROUND: Over-prescription of antibiotics contributes to antibiotic resistance, which is a global health threat. Egypt has alarmingly high rates of antibiotic over-prescription for acute upper respiratory tract infections (URIs) in children. To effectively address this issue, it is important to understand the various factors that influence prescription behaviors. The Teixeira antibiotic prescription behavioral model (TAPBM) offers a comprehensive framework through which these factors can be explored. This qualitative study sought to investigate the perspectives of key stakeholders involved in pediatric healthcare in Egypt, with the primary goal of identifying the underlying determinants that contributed to this problem. METHODS: This qualitative study was conducted in Assiut City, Egypt, between January and March 2023. Purposive sampling was used to select participants, including consultant pediatricians, supervisors of pediatric training programs, and specialists in infection prevention and control. Thirteen semi-structured in-depth interviews (IDIs) were conducted, audio-recorded, and transcribed. Thematic analysis was performed using MAXQDA 2020 software. RESULTS: Two main themes emerged from the analysis: intrinsic factors related to physicians, extrinsic factors related to patients, and nonphysician factors. Intrinsic factors encompass personal characteristics and attitudes. Prescribing decisions were influenced by factors such as fear of complications, limited follow-up visits, and competition. Knowledge and education also played a significant role. Moreover, diagnostic uncertainty in distinguishing between bacterial and viral infections posed a challenge. Extrinsic factors included patient and caregiver factors, such as parental expectations and demands for antibiotics, driven by the belief that they produced rapid results. Moreover, patients' demographic factors, including socioeconomic status and living conditions, affected their prescribing behavior. Health system-related factors, such as the type of healthcare institution and the absence of formal national guidelines, were identified as influential factors. Additionally, this study highlighted the influence of the pharmaceutical industry. The potential impact of the COVID-19 pandemic on antibiotic prescriptions was addressed. CONCLUSIONS: The study highlights the intricate interplay between intrinsic and extrinsic factors that shape antibiotic prescription decisions, underscoring the significance of addressing these factors in mitigating overprescribing.

Prevalence of skin diseases in rural areas of Assiut Governorate, Upper Egypt.

BACKGROUND: Few epidemiological surveys have been carried out to determine the prevalence of skin diseases in the population of Egypt, particularly "Upper Egypt". So it is a pressing necessity to conduct such a study in rural Assiut. OBJECTIVES: To determine the prevalence of various skin diseases in rural Assiut. SUBJECTS AND METHODS: A cross-sectional community-based survey was followed. The survey included 8008 rural inhabitants of all ages and both sexes from a representative of three villages of Assiut Governorate, Upper Egypt. The data were collected through personal interview and examination at homes from December 1994 to December 1996. RESULTS: They showed that 6961 (86.93%) of the studied population had one or more skin diseases. The group with parasitic skin infestations had the highest prevalence rate (27.40%) of the total sample, of which pediculosis capitis (19.37%) was the commonest. Eczema/dermatitis group had a rate of 19.82%, with pityriasis alba forming the majority (13.49%). Pigmentary disorders were 17.68%, followed by fungal skin infections (16.17%), then naevoid disorders (16.10%), hair and scalp disorders (12.07%), bacterial skin infections (10.10%), sweat gland disorders (6.16%), acne vulgaris (5.37%). Leprosy constituted 1.6/10,000. Other various skin disorders were recorded. CONCLUSIONS: Infective-parasitic diseases were a major problem particularly among the younger age-group and those of low socio-economic status.