Parents’ Knowledge, Attitudes, and Practices towards Antibiotic Use in Children with Upper Respiratory Tract Infections in Cambodia

Main Article Content

Saveth Kim
Tassanee Prasopkittikun
Sudaporn Payakkaraung


             Purpose: Antibiotic misuse in children with upper respiratory tract infections is a challenge in public health. The study aimed to examine the relationships among knowledge, attitudes and practices of parents regarding antibiotic use in this group of children in Cambodia; and the prediction of parents’ knowledge, attitudes, sex, education, and family income on the parents’ practices.

            Design: A cross-sectional survey with correlational predictive design.

            Methods: A convenience sampling was used to recruit 258 parents who brought their children under 15 years of age to receive health services at eight health centers in Kandal province, Cambodia. Interview and self-administered questionnaires were used. Data were collected from January to March 2020 and analyzed using descriptive statistics, Pearson correlation coefficient, and multiple regression.

            Main findings: Significant relationships between knowledge and attitudes (r = .48, p < .001), and attitudes and practices (r = .23, p < .001) were found, except that between knowledge and practices (r = .11, p = .086). While all study factors accounted for 11% of the variance explained in the parents’ practice (R2 = .11), only three factors could significantly predict the practices; that is, attitudes (β = .24, p < .01), female parent (β = .14, p < .05), and years of education (β = - .17, p < .05).

            Conclusion and recommendations:  Parents’ attitudes towards antibiotic use was related to their knowledge and practices; attitudes, sex and education were the predictors of parents’ practices. Thus, public-directed programs to promote antibiotic awareness is needed. Information about rational drug use should be given in formal education system. Nurses should also pay greater attention on male parents and well-educated parents during giving advice of antibiotic use.

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How to Cite
Kim, S., Prasopkittikun, T., & Payakkaraung, S. (2021). Parents’ Knowledge, Attitudes, and Practices towards Antibiotic Use in Children with Upper Respiratory Tract Infections in Cambodia. Nursing Science Journal of Thailand, 39(4), 83–96. Retrieved from
Research Papers


Ministry of Health. Annually progress report 2018. Phnom Penh, Cambodia: Ministry of Health; 2018. 204 p. (in Khmer).

DeMuri GP, Gern JE, Moyer SC, Lindstrom MJ, Lynch SV, Wald ER. Clinical features, virus identification, and sinusitis as a complication of upper respiratory tract illness in children ages 4-7 years. J Pediatr. 2016;171:133-9.e1. doi: 10.1016/j.jpeds.2015.12.034.

Vandepitte WP, Ponthong R, Srisarang S. Treatment outcomes of the uncomplicated upper respiratory tract infection and acute diarrhea in preschool children comparing those with and without antibiotic prescription. J Med Assoc Thai. 2015;98(10):974-84.

Gelband H, Miller-Petrie M, Pant S, Gandra S, Levinson J, Barter D, White A, et al. The state of the world's antibiotics 2015. Washington, D.C.: Center for Disease Dynamics, Economics & Policy; 2015. 14 p.

Emary KRW, Carter MJ, Pol S, Sona S, Kumar V, Day NPJ, et al. Urinary antibiotic activity in paediatric patients attending an outpatient department in north-western Cambodia. Trop Med Int Health. 2015;20(1):24-8. doi: 10.1111/tmi.12398.

World Health Organization. Antibiotic resistance [Internet]. Geneva, Switzerland: WHO; 2020 [cited on 2020 Aug 31]. Available from:

Al-Shawi MM, Darwish MA, Wahab MMA, Al-Shamlan NA. Misconceptions of parents about antibiotic use in upper respiratory tract infections: a survey in primary schools of the eastern province, KSA. J Family Community Med. 2018;25(1):5-12. doi: 10.4103/jfcm.JFCM_46_17.

Elbur A, Albarraq AA, Abdallah MA. Saudi parents' knowledge, attitudes and practices on antibiotic use for upper respiratory tract infections in children: a population–based survey, Taif, Kingdom of Saudi Arabia. J Med Res. 2016;2(4):99-103.

Salama RA, Bader KN, Rahmen AS, Hashmi F. Parents Knowledge, attitudes and practice of antibiotic use for upper respiratory tract infections in children: a cross-sectional study in Ras Al khaimah, United Arab Emirates. Epidemiol Biostat Public Health. 2018;15(4):e12969. doi: 10.2427/12969.

Teck KC, Ghazi HF, Bin Ahmad MI, Binti Abdul Samad N, Ee Yu KL, Binti Ismail NF, Aizat Bin Esa M. Knowledge, attitude, and practice of parents regarding antibiotic usage in treating children's upper respiratory tract infection at primary health clinic in Kuala Lumpur, Malaysia: pilot study. Health Serv Res Manag Epidemiol. 2016;3:2333392816643720. doi: 10.1177/2333392816643720.

Torres NF, Chibi B, Middleton LE, Solomon VP, Mashamba-Thompson TP. Evidence of factors influencing self-medication with antibiotics in low and middle-icome countriess: a systematic scoping review. Public Health. 2019;168:92-101. doi: 10.1016/j.puhe.2018.11.018.

Kumran E, Doum D, Keo V, Sokha L, Sam B, Vibol C, et al. Dengue knowledge, attitudes and practices and their impact on community-based vector control in rural Cambodia. PLoS Negl Trop Dis. 2018;12(2):e0006268. doi: 10.1371/journal.pntd.0006268.

Om C, Daily F, Vlieghe E, McLaughlin JC, McLaws M-L. Pervasive antibiotic misuse in the Cambodian community: antibiotic-seeking behaviour with unrestricted access. Antimicrob Resist Infect Control. 2017;6:30. doi: 10.1186/s13756-017-0187-y.

Om C, Daily F, Vlieghe E, McLaughlin JC, McLaws M-L. “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia. Antimicrob Resist Infect Control. 2016;5:58. doi: 10.1186/s13756-016-0159-7.

Hassan WZ, Baiee HA, Altufaily Y. Audit on the knowledge, attitudes and practice about themisuse of antibiotics in upper respiratory tract infections in children among parents in Al-Najaf province. Kufa Journal for Nursing Sciences. 2015;5(2):246-52.

Mohamed SMM. Study of maternal knowledge, attitude and practice on antibiotic use for acute upper respiratory tract infection in children. IOSR Journal of Nursing and Health Science. 2015;4(4):17-23. doi: 10.9790/1959-04461723.

Alkhaldi SM, Al-Mahmoud MF, Kanaan H. Mothers’ knowledge, attitudes, and practices of antibiotic use for children in Jordan. Jordan Med J. 2015;49(4):215-26. doi: 10.12816/0028174.

El Khoury G, Ramia E, Salameh P. Misconceptions and malpractices toward antibiotic use in childhood upper respiratory tract infections among a cohort of Lebanese parents. Eval Health Prof. 2018;41(4):493-511. doi: 10.1177/0163278716686809.

Al-Saleh S, Hammour KA, Hammour WA. Influencing factors of knowledge, attitude, and practice regarding antibiotic use in children with upper respiratory tract infections in Dubai. J Eval Clin Pract. 2020;26(1):197-202. doi: 10.1111/jep.13188.

Shah NM, Rahim MA. Parental knowledge, attitudes and practices (KAP) on the use of antibiotics in children for upper respiratory tract infections (URTIs). Int J Pharm Pharml Sci. 2017;9(3):105-10. doi: 10.22159/ijpps.2017v9i3.15674.

World Health Organization. Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys. Geneva, Switzerland: WHO; 2008. 69 p.

Rav-Marathe K, Wan TTH, Marathe S. A systematic review on the KAP-O framework for diabetes education and research. Med Res Arch. 2016;4(1):1-21.

Docterate of General for Health Sevice. Operational guideline on minimum package of activities (MPA). 3th ed. Phnom Penh, Cambodia: Ministry of Health; 2018. 156 p. (in Khmer).

Hernández-Díaz I, Ayala-Meléndez A, González-González E, Rosario-Calderón I, Figueroa-Ríos D, Melin K, et al. Knowledge and beliefs, behaviors, and adherence among Latino parents or legal guardians related to antibiotic use for upper respiratory tract infections in children under 6 years of age. J Am Pharm Assoc. 2019;59(4):506-13. doi: 10.1016/j.japh.2019.03.004.

Panagakou SG, Spyridis Ν, Papaevangelou V, Theodoridou KM, Goutziana GP, Theodoridou MN, Syrogiannopoulos GA, Hadjichristodoulou CS. Antibiotic use for upper respiratory tract infections in children: a cross-sectional survey of knowledge, attitudes, and practices (KAP) of parents in Greece. BMC Pediatr. 2011;11:60. doi: 10.1186/1471-2431-11-60.

Ajzen I. Attitude structure and behavior. In: Pratkanis AR, Breckler SJ, Greewald AG, editors. Attitude structure and function. Hillsdale, NJ: Lawrence Erlbaum Associates; 1989. p.241-74.

Sirijoti K, Hongsranagon P, Havanond P, Pannoi W. Assessment of knowledge attitudes and practices regarding antibiotic use in Trang province, Thailand. J Health Res. 2014;28(5):299-307.

Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179-211. doi: 10.1016/0749-5978(91)90020-T.

Gežová KC. Father’s and mother’s roles and their particularities in raising children. Acta Technologica Dubnicae. 2015;5(1):45-50. doi: 10.1515/atd-2015-0032.

Investing in Children and their Societies, Royal University of Phnom Penh. Seminar report: parenting in Cambodia [Internet]. Phnom Penh, Cambodia: Investing in Children and their Societies; 2014 [cited 2020 Jul 6]. Available from:

Alsuhaibani MA, AlKheder RS, Alwanin JO, Alharbi MM, Alrasheedi MS, Almousa RF. Parents awareness toward antibiotics use in upper respiratory tract infection in children in Al-Qassim region, Saudi Arabia. J Family Med Prim Care. 2019;8(2):583-9. doi: 10.4103/jfmpc.jfmpc_368_18.

Hahn RA, Truman BI. Education improves public health and promotes health equity. Int J Health Serv. 2015;45(4):657-78. doi: 10.1177/0020731415585986.

Alrafiaah AS, Alqarny MH, Alkubedan HY, AlQueflie S, Omair A. Are the Saudi parents aware of antibiotic role in upper respiratory tract infections in children? J Infect Public Health. 2017;10(5):579-85. doi: 10.1016/j.jiph.2017.01.023.

Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic complican: a review from the patient’s perspective. Ther Clin Risk Manag. 2008;41(1):269-86. doi: 10.2147/tcrm.s1458.

Woolf SH, Aron L, Dubay L, Simon SM, Zimmerman E, Luk KX. How are income and wealth linked to health and longevity? [Internet]. Washington, D.C.: Urban Institute; 2015 [cited 2020 Jul 16]. Available from:

Altman DG, Royston P. The cost of dichotomising continuous variables. BMJ. 2006;332(7549):1080. doi: 10.1136/bmj.332.7549.1080.