Knowledge, Attitudes, and Practices (KAP) of Antibiotic Use and Resistance Among Pregnancy Women in Coimbatore

Antibiotics are very important in modern medicine because they help treat bacterial infections and keep people from getting very sick or dying. But their widespread and often wrong use has led to the scary rise of antibiotic resistance (AR), which is a global public health crisis [1,2]. When bacteria change so that they can survive antibiotics, this is called AR. It makes infections harder, or even impossible, to treat. This problem makes many life-saving drugs less effective and is a big threat to global health security [3,4]. In places like India, where there are a lot of people, different ways of getting health care, and the rise of antibiotics is helped by how easy they are to get [5,6].

Importance for Breastfeeding Mothers

Breastfeeding mothers are a very vulnerable and important group when it comes to the use and resistance of antibiotics. After giving birth, mothers may need antibiotics for common infections like mastitis, urinary tract infections, and wound infections [13]. Giving antibiotics to mothers who are breastfeeding brings up some special issues:

• Antibiotics can move from the mother's blood into breast milk, which could put the baby at risk of getting the drug [14,15].
• Even low levels of this exposure can change the baby's gut microbiome, possibly favoring resistant bacteria or causing other problems [16,17].
• The mother's knowledge, attitudes, and actions about how to use antibiotics responsibly have a direct effect on her own health and recovery, as well as the health of the baby and the community's efforts to fight AR [7,8,18,19].
• It is very important to make sure that this group of people uses antibiotics correctly so that the benefits of breastfeeding, which are very important for the baby's immune system and growth, continue [13,15,17].

AIM:

To evaluate how breastfeeding mothers in Coimbatore, Tamil Nadu use antibiotics and what they know about antibiotic resistance.

OBJECTIVES:

1. To find out how often and in what ways breastfeeding mothers use antibiotics.

2. To gauge breastfeeding mothers' understanding of antibiotics and antibiotic resistance.

3. To uncover the habits of breastfeeding mothers regarding antibiotic use and how well they stick to prescriptions.

4. To pinpoint what factors shape breastfeeding mothers' knowledge and behaviors concerning antibiotic resistance.

LITERATURE REVIEW

Global Context of Antibiotic Resistance: Look at studies that show how AR affects the world, what causes it (like using too many antibiotics using them wrong, and poor ways to stop infections from spreading), and how well different places have done in making people aware of it.

Antibiotic Use Patterns: Talk about how antibiotics are used around the world and in different countries. This includes people taking them without a doctor's say-so, not finishing their doses, and getting them from places they shouldn't.

Knowledge and Awareness: What do studies tell us about what regular people know about antibiotics and AR? Are there things many people get wrong?

Focus on Women/Mothers: Check out studies that look at how women pregnant women, or new moms use antibiotics and what they know about them. Try to find any special problems they face or how much they understand about this topic.

Consequences of Antibiotic Use During Lactation: Review literature on the transference of antibiotics to breast milk and their possible impacts on the infant, including gut microbiome alterations and other possible negative drug reactions, as well as the risk of promoting AR in infants.

Global Focus and Regional Focus from Tamil Nadu/India: Cite any available literature from India or Tamil Nadu that addresses the use of antibiotics and AR, or their related KAP, to provide a vital local comparator and pinpoint regional gaps.

Research Gaps: Finish with the specific gap this research addresses: lack of KAP study on breast feeding women from Coimbatore with relation to the use of antibiotics and AR.

Antibiotic Use in Coimbatore

This section sets the stage by discussing the specific environment of antibiotic use in your study region.

● Prevalence and Patterns in Coimbatore/Tamil Nadu:

Considerable data or anecdotal information on antibiotic use in a particular area might be available. Elaborate on frequently occurring bacterial infections in and around Coimbatore that require antibiotics. Focus on the broad categories such as respiratory infections, skin infections, or diarrheal illnesses. Fill in the gaps or use existing studies in the region, if applicable, to show how populations in different areas make use of antibiotics and how consumption was measured and categorized whether high or low.

● Access and Dispensing Practices:

Elaborate on the Rules governing the sale of antibiotics in Tamil Nadu, particularly the enforcement of prescription-only antibiotics, how the rules are applied in practice. Explain how commonplace it is for people to obtain antibiotics from informal, over-the-counter sources, leftover from prior fills, and sharing among family and friends for use. Describe the functions and responsibilities of pharmacies in dispensing and counseling on antibiotics in the city of Coimbatore.

● Prescribing Habits of Healthcare Providers:

Discuss primary care doctors' habits in the area regarding the use of antibiotics (e.g., empirical prescribing, use of broad-spectrum antibiotics, following treatment protocols, when available, treatment protocols). Touch upon the impact of patient requests or expectations within the specific region on decisions to prescribe.

● Local Awareness Initiatives:

Investigate whether any specific public health campaigns or educational programs have been implemented in Coimbatore or Tamil Nadu to promote rational antibiotic use or address AR awareness. Evaluate their perceived impact if information is available.

Unique Challenges in Coimbatore:

Identify specific socio-economic, cultural, or infrastructural challenges within Coimbatore that might exacerbate issues related to antibiotic misuse or contribute to resistance development (e.g., health literacy levels, economic pressures leading to incomplete courses, traditional health beliefs)

Breastfeeding and Antibiotic Resistance

This section elaborates on the critical connection between lactation and the global AR problem, emphasizing the unique aspects for your study population.

● Antibiotic Transfer into Breast Milk and Infant Exposure:

Explain the physiological mechanisms by which various classes of antibiotics can pass from the maternal circulation into breast milk. Discuss factors influencing this transfer, such as the drug's molecular weight, protein binding, lipid solubility, and the mother's dose. Emphasize that the extent of infant exposure varies significantly by drug and individual factors.

● Impact on the Infant's Developing Microbiome:

Highlight the critical role of the gut microbiome in infant immune system development, digestion, and overall health. Explain how even low-level exposure to antibiotics via breast milk can disrupt the delicate balance and composition of the infant's nascent gut flora. Discuss potential consequences of this disruption, including an increased risk of infant candidiasis (thrush), transient diarrhea, or longer-term implications for immune-related disorders (though emphasize that long-term effects are an area of ongoing research).

● Clinical Implications for Infant Health:

Detail potential direct adverse reactions in the infant (e.g., rash, gastrointestinal upset, sedation) if the antibiotic is transferred in significant amounts. Discuss the indirect but significant risk of the infant developing an infection that is harder to treat due to having a population of resistant bacteria in their system, even if the mother's initial infection was not resistant.

METHODOLOGY

● Study Design: Cross-sectional descriptive study.

● Study Setting: Various healthcare facilities (e.g., primary health centers, hospitals, maternal clinics) and/or community settings in Coimbatore, Tamil Nadu.

● Study Population:  Breastfeeding mothers residing in the selected areas of Coimbatore.

● Sample Size:  A total of 265

breastfeeding mothers. (Elaborate on how   this   sample   size   was determined, e.g., convenience sampling due to resource constraints, or a calculation based on expected prevalence with a certain margin of error and confidence level, if applicable).

● Sampling Method: (e.g., convenience sampling, consecutive sampling, or a systematic approach if feasible, explaining any rationale).

● Inclusion Criteria:

○ Mothers currently breastfeeding an infant.

○ Residing in Coimbatore, Tamil Nadu.

○ Aged 18 years and above.

○ Willing and able to provide informed consent.

● Exclusion Criteria:

○ Mothers with severe medical conditions preventing participation.

○ Mothers   not   currently breastfeeding.

○ Healthcare professionals (to avoid bias from professional knowledge).

Data Collection Tool:

Questionnaire: A structured, pre-tested questionnaire administered via face-to-face interviews.

Development: Explain if it was adapted from validated tools or developed specifically for this study. If developed, mention expert review and content validity.

Sections: Sociodemographic Characteristics: Age, marital status, number of children, education, occupation. (As in Table 1)

Antibiotic Use History: Last use of antibiotics, reasons for use, source of antibiotics, and adherence. (Related to Tables 1, 2, 3)

Knowledge Assessment: Questions evaluating understanding of appropriate antibiotic use, definition of antibiotic resistance, causes of AR, and ways to prevent it, and specific questions on antibiotics effect on baby. (As in Table 2 and the supplementary knowledge data)

Practices and Attitudes: Self-medication practices, completion of antibiotic courses, sharing antibiotics, and general attitudes towards antibiotic use. (As in Table 3)

Language: The questionnaire was translated into Tamil and back-translated to English to ensure accuracy and cultural appropriateness.

Pilot Study: A pilot study was conducted on a small sample of breastfeeding mothers (e.g., 20-30) not included in the main study, to refine the questionnaire, assess clarity, and identify any issues in data collection.

Data Collection Procedure: Trained research assistants conducted face-to-face interviews with participants at selected sites. Data was recorded directly onto structured questionnaires. The average interview duration was approximately [X] minutes.

● Ethical Considerations

Ethical approval was obtained from the Institutional Review Board/Ethics Committee of tertiary care hospital. All participants received detailed information about the study's purpose, procedures, confidentiality, and their right to withdraw at any time.

Data Analysis: Data entry was performed using Microsoft Excel and subsequently transferred to Statistical Software.

Descriptive Statistics: Frequencies and percentages were used to summarize categorical variables (e.g., age classes, marital status, knowledge responses, practice patterns). Means and standard deviations were used for continuous variables (e.g., mean age, mean number of children). (Relevant to Tables 1, 2, 3).

RESULT:

Table 1

Summary of characteristics.

Table 1 summarizes 265 breastfeeding mothers' characteristics in Coimbatore. It shows a mean age of 37.2 years, 95.25% married, and 71.43% with more than one child. Nearly half had. Table 2 details breastfeeding mothers' knowledge (N=265). Most (71.69%) knew to complete prescribed courses and 74.58% knew resistance happens in bacteria, not the body. While 56.03% heard of "antibiotic resistance," only 51.28% knew it spreads via contact. These highlight crucial knowledge gaps on AR. secondary education (48.68%) and most were employed (58.44%). A high 61.02% used antibiotics recently, providing key demographic and exposure insights for the study.

Table 2