ANTIBIOTIC KNOWLEDGE, PRACTICE, AND ASSOCIATED FACTORS AMONG MOTHERS OF CHILDREN UNDER-FIVE IN RURAL HARAMAYA DISTRICT, EASTERN ETHIOPIA

Abstract

Background: Lack of knowledge among mothers regarding antibiotic use in children under five contributes to inappropriate use, a key driver of antimicrobial resistance (AMR). Despite their critical role, limited data exist on mothers’ antibiotic knowledge and practices in rural Ethiopia. Objective: To assess antibiotic knowledge, practices, and associated factors among mothers of children under five in rural Haramaya District, Eastern Ethiopia. Methods: A community-based cross-sectional study was conducted from May 29 to June 30, 2025, involving 380 randomly selected mothers. Data were collected using a pretested, interviewer-administered questionnaire and analyzed with SPSS version 21. Crude and adjusted prevalence ratios (PRs) with 95% confidence intervals (CIs) were calculated using modified Poisson regression models to identify factors associated with poor antibiotic knowledge and inappropriate practices. Significance was set at p ≤ 0.05. Results: Among participants, 225 (59.2%) had poor antibiotic knowledge. Of 127 mothers reporting antibiotic use for children under five, 51 (40.2%) practiced inappropriate use. Poor knowledge was significantly associated with lack of formal education (APR = 2.06; 95% CI: 1.04 4.09; p = 0.014), experience with suppliers (APR = 2.37; 95% CI: 1.08–4.20; p = 0.004), lack of clinic information (APR = 2.25; 95% CI: 1.12–4.50; p = 0.006), non-working (APR = 2.33; 95% CI: 1.10–4.78; p = 0.008), and longer distance to health facilities (APR = 2.46; 95% CI: 1.17–5.18; p = 0.012). Inappropriate antibiotic use was significantly associated with age of the child (APR = 0.76; 95% CI: 0.67–0.87; p < 0.001), non-prescribed access (APR = 1.87; 95% CI: 1.15–3.04; p = 0.012), obtaining drugs from primary clinics (APR = 5.75; 95% CI: 2.41–13.74; p < 0.001), pharmacies or drug shops (APR = 3.48, 95% CI: 1.19–10.24, p = 0.023) , kiosks (APR = 2.97; 95% CI: 1.13–7.75; p = 0.027), frequency of antibiotic use (≥4 times; (APR = 2.91; 95% CI: 1.35 6.29; p = 0.007), and rare instructions about drugs (APR = 3.18, 95% CI: 1.55–6.53, p = 0.002) . Conclusion: Over half of mothers had poor knowledge of antibiotics, and inappropriate use for children was common. Targeted health education, regulated access, and proper counseling are essential to promote rational antibiotic use and reduce AMR risks.