The relation between self-directed use of antibiotics and children's health condition among preschool children in Huangshan City
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摘要:
目的 了解黄山市学龄前儿童抗生素自主使用现状及其主要影响因素，并探讨与儿童健康状况的关系。 方法 采用分层随机整群抽样方法，对2 395位学龄前儿童，采用自填式问卷，调查家长对儿童自主使用抗生素情况及其相关因素。同时对儿童进行健康体检，评定儿童营养状况。 结果 本次研究共调查2 395名学龄前儿童，其中男童1 177人，女童1 218人。37.4%(896/2 395)的家长在过去12个月自主给子女使用过抗生素，其中81.8%(733/896)的家长给子女自主使用头孢菌素类。母亲的文化程度及怀孕时父亲的年龄是家长给儿童自主使用抗生素的重要影响因素(均有P < 0.05)。学龄前儿童抗生素的自主使用是儿童哮喘(OR=1.870，95% CI：1.187~2.948，P=0.007)、生病1~2次/年(OR=3.048，95% CI：2.264~4.103，P < 0.001)和生病≥3次/年(OR=4.863，95% CI：3.606~6.558，P < 0.001)、输液1~2次/年(OR=1.324，95% CI：1.091~1.607，P=0.005)及住院1~2次/年(OR=1.339，95% CI：1.071~1.676，P=0.011)的影响因素。 结论 黄山市区学龄前儿童自主使用抗生素的现象较为严重，需要开展合理有效使用抗生素的宣传教育。 Abstract:Objective To investigate the current status and determinants of parents' self-directed practices towards the use of antibiotics, and its possible association with the health conditions of the preschool children in Huangshan City. Methods Self-designed questionnaires were used to collect information regarding self-directed practice towards use of antibiotics among parents of 2 395 preschool children, who were selected through stratified random clustering sampling method. Nutritional status was assessed through physical examination. Results A total of 2 395 preschoolers and their parents were included in the present study, including 1 177 boys and 1 218 girls. About 37.4% (896/2 395) of parents reported self-directed practice towards use of antibiotics in the past 12 months, among whom 81.8% (733/896) had used cephalosporin. Maternal education and paternal age were associated with parents' self-directed use of antibiotics (all P < 0.05). Parents' self-directed practice towards use of antibiotics was associated with increased odds of asthma [OR (95% CI): 1.870 (1.187-2.948)], frequent episodes of illness of 1-2 times per year [3.048 (2.264-4.103)], frequent episodes of illness of ≥3 times per year [4.863 (3.606-6.558)], illness≥3 per year, intravenous medication of 1-2 times per year [1.324 (1.091-1.607)] and hospitalization of 1-2 times per year [1.339 (1.071-1.676), respectively (all P < 0.05)]. Conclusions Majority of parents reported self-directed practice towards use of antibiotics among preschool children in Huangshan, which suggests that more educational activities to parents are needed regarding appropriate antibiotics use among young children on physician's advice. -
Key words:
- Preschool children /
- Self-directed use of antibiotics /
- Health condition
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表 1 不同人口特征学龄前儿童抗生素自主使用的影响因素
Table 1. The influencing factors of self-directed use of antibiotics among preschool children with different characteristics
特征 抗生素使用 β值 Wald值 OR(95% CI)值 P值 性别 男 436(37.0) 1.000 女 460(37.8) 0.038 0.202 1.039(0.879~1.228) 0.653 年龄(岁) ≤3 201(37.2) 1.000 4 272(37.4) 0.027 0.051 1.027(0.814~1.296) 0.821 5 280(38.6) 0.089 0.570 1.094(0.867~1.379) 0.450 6 143(35.6) -0.057 0.169 0.945(0.720~1.239) 0.681 分娩方式 自然分娩 306(38.2) 1.000 剖宫产 590(37.0) -0.075 0.685 0.928(0.776~1.108) 0.408 怀孕时母亲年龄(岁) ≤25 295(35.3) 1.000 25~ 454(38.2) -0.058 0.276 0.943(0.759~1.172) 0.599 ＞30 147(39.4) -0.052 0.106 0.949(0.695~1.297) 0.745 怀孕时父亲年龄(岁) ≤25 121(33.5) 1.000 25~ 429(36.2) 0.056 0.156 1.057(0.802~1.393) 0.693 ＞30 346(40.8) 0.314 3.838 1.369(1.000~1.875) 0.050 母亲文化程度 初中及以下 111(28.5) 1.000 高中或中专 220(37.0) 0.371 5.570 1.450(1.065~1.973) 0.018 大专 276(40.1) 0.506 8.821 1.659(1.188~2.316) 0.003 本科及以上 289(40.0) 0.491 7.178 1.634(1.141~2.340) 0.007 父亲文化程度 初中及以下 106(30.2) 1.000 高中或中专 206(36.9) 0.130 0.645 1.139(0.829~1.564) 0.422 大专 242(38.4) 0.079 0.205 1.083(0.768~1.526) 0.651 本科及以上 342(40.0) 0.140 0.578 1.150(0.802~1.648) 0.447 家庭经济状况 中等偏上 106(42.4) 1.000 中等 730(37.0) -0.262 3.572 0.769(0.586~1.010) 0.059 中等偏下 60(35.3) -0.366 3.066 0.694(0.461~1.045) 0.080 6个月内喂养方式 纯母乳喂养 457(36.6) 1.000 人工喂养 123(34.1) -0.099 0.602 0.906(0.706~1.163) 0.438 混合喂养 316(40.3) 0.124 1.708 1.132(0.940~1.364) 0.191 合计 896(37.4) 
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表 2 学龄前儿童抗生素自主使用与儿童哮喘、营养状况的关系[n(%)]
Table 2. The relationship between the self-directed use of antibiotics, children's nutritional status and asthma [n(%)]
自主使用抗生素 哮喘 营养状况 无 有 正常 低体重 超重 肥胖 是 855(95.4) 41(4.6) 688(81.9) 66(7.9) 52(6.2) 34(4.0) 否 1 462(97.5) 37(2.5) 1 156(82.0) 81(5.7) 90(6.4) 82(5.8) 合计 2 317(96.7) 78(3.3) 1 844(82.0) 147(6.5) 142(6.3) 116(5.2) x2值 7.906 6.817 P值 0.005 0.078
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表 3 学龄前儿童抗生素自主使用与儿童发病状况的关系
Table 3. The relationship between the self-directed use of antibiotics and disease among preschool children
自主使用抗生素 生病频率 输液频率 住院频率 无 1~次 ≥3次 无 1~次 ≥3次 无 1~次 ≥3次 是 65(7.3) 360(40.2) 471(52.6) 605(67.5) 247(27.6) 44(4.9) 714(79.7) 166(18.5) 16(1.8) 否 357(23.8) 634(42.3) 508(33.9) 1 093(72.9) 342(22.8) 64(4.3) 1 256(83.8) 219(14.6) 24(1.6) 合计 422(17.6) 994(41.5) 979(40.9) 1 698(70.9) 589(24.6) 108(4.5) 1 970(82.3) 385(16.1) 40(1.7) x2值 135.761 7.961 6.614 P值 < 0.001 0.019 0.037
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表 4 学龄前儿童抗生素自主使用与儿童疾病关系的多因素Logistic回归分析模型分析
Table 4. Multivariate Logistic regression analysis on the self-directed use of antibiotics and disease among preschool children
疾病 β值 标准误 Wald值 OR(95% CI)值 P值 哮喘 0.626 0.232 7.282 1.870(1.187~2.948) 0.007 生病频率 1~次 1.114 0.152 53.939 3.048(2.264~4.103) < 0.001 ≥3次 1.582 0.153 107.511 4.863(3.606~6.558) < 0.001 输液 1~次 0.280 0.099 8.056 1.324(1.091~1.607) 0.005 ≥3次 0.235 0.204 1.331 1.265(0.848~1.887) 0.249 住院 1~次 0.292 0.114 6.546 1.339(1.071~1.676) 0.011 ≥3次 0.115 0.328 0.123 1.122(0.590~2.132) 0.725
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[1] Sihavong A, Lundborg CS, Syhakhang L, et al. Antimicrobial self-medication for reproductive tract infection in two provinces in Lao People' s Democratic Republic[J]. Sex Transm Infect, 2009, 82(2):182-186. DOI: 10.1136/sti.2005.016352. [2] 谢新鑫, 杨青廷, 旷满华, 等. 2004~2015年中国儿童抗生素使用情况分析[J].中南医学科学杂志, 2016, 44(2):130-134. DOI: 10.15972/j.cnki.43-1509/r.2016.02.003.Xie XX, Yang QT, Kuang MH. Analysis of the status of antibiotics use of children in China from 2004 to 2015[J]. Medical Science Journal of Central South China, 2016, 44(2):130-134. DOI: 10.15972/j.cnki.43-1509/r.2016.02.003. [3] 杨波.安徽省宿州市儿童家长自主使用抗生素的知信行调查及影响因素分析[D].合肥: 安徽医科大学, 2016.Yang B. Investigation of knowledge attitude and practice and analysis of influencing factors of children's parents' self use of antibiotics in Suzhou City, Anhui Province[D]. Hefei: Anhui Medical University, 2016. [4] Domoff SE, Miller AL, Kaciroti N, et al. Validation of the children's eating behaviour questionnaire in a low-income preschool-aged sample in the United States[J]. Appetite, 2015, 95:415-420. DOI: 10.1016/j.appet.2015.08.002. [5] 姚振江, 周俊立, 李颖, 等.广州市幼儿园儿童抗生素自主使用情况分析[J].中国公共卫生, 2013, 29(10):1485-1487. DOI: 10.11847/zgggws2013-29-10-26.Yao ZJ, Zhou JL, Li Y, et al. Prevalence of self-medication with antibiotics in kindergarten children of Guangzhou City[J]. Chin J Public Health, 2013, 29(10):1485-1487. DOI: 10.11847/zgggws2013-29-10-26. [6] Yeh KW, Ou LS, Yao TC, et al. Prevalence and risk factors for early presentation of asthma among preschool children in Taiwan[J]. Asian Pac J Allergy Immunol, 2011, 29(2):120-126. [7] Eldeirawi KM, Kunzweiler C, Atek A, et al. Antibiotic use in infancy and the risk of asthma in Mexican American children[J]. J Asthma, 2015, 52(7):707-714.DOI: 10.3109/02770903.2015.1004338. [8] Donovan BM, Abreo A, Ding T, et al. Dose, timing, and type of infant antibiotic use and the risk of childhood asthma[J]. Clin Infect Dis, 2020, 70(8):1658-1665. DOI: 10.1093/cid/ciz448. [9] Jedrychowski W, Perera F, Maugeri U, et al. Wheezing and asthma may be enhanced by broad spectrum antibiotics used in early childhood. Concept and results of a pharma-coepidemiology study[J]. J Physiol Pharmacol, 2011, 62(2):189-195. http://pubmedcentralcanada.ca/pmcc/articles/PMC3684948/ [10] Kusel M M, de Klerk N, Holt P G, et al. Antibiotic use in the first year of life and risk of atopic disease in early childhood[J]. Clin Exp Allergy, 2008, 38(12):1921-1928. DOI: 10.1111/j.1365-2222.2008.03138.x. -
