All healthcare professionals (HCPs) are at high risk of influenza infection. Therefore, immunization is recommended for all HCPs. Due to safety and effectiveness concerns, HCPs have a low vaccination rate. This study was designed to explore the attitude, awareness and knowledge of HCPs toward vaccination for influenza. A cross-sectional study was performed during October–November 2016. A total of 405 questionnaires were distributed in 8 major hospitals in Saudi Arabia. A validated questionnaire consisting of 31 questions and 5 sections was administered. Statistical Analysis Software (SAS®) version 9.2 was used to analyze the data. A total of 364 HCPs responded to the study survey, which is a response rate of 90%. A large proportion (61.8%) of participants were female. The majority of the participants were nurses (60.4%). More than half of the respondents (57.7%) were working in government-run hospitals. Among all the participants, approximately 67.6% of HCPs were vaccinated. The majority (84.1%) of HCPs believed that influenza vaccine prevents the flu. Furthermore, approximately 75% of participants believed that HCPs can be more susceptible to influenza infections than other people. The majority of participants (89.6%) knew the proper signs and symptoms of influenza. HCPs’ belief that vaccination prevents influenza infection (OR = 3.93, 95% CI = 1.97–7.82), their awareness of the Scientific Committee for Influenza and Pneumococcal Vaccination (SCIPV)‘s guidelines (OR = 2. 13, 95% CI = 1.16–3.90) and the presence of the standing orders regarding influenza vaccine (OR = 1.57, 95% CI = 1.01–3.21), were the predictors for receipt of influenza vaccine by HCPs. Many (58.0%) respondents believed that vaccine safety concerns is a major barrier to the vaccination of HCPs. Some misconceptions, such as influenza infection due to vaccination (42.3%) and incorrect perceptions about the symptoms of influenza in adults (50.5%), were found. The acceptance of and participation in influenza vaccination by HCPs in Saudi Arabia appears to have markedly increased in the 2016 season. Continuing evaluation of vaccination practices is necessary, and more training programs are needed in the future.

Background: Antimicrobial resistance (AMR) is a global threat and the antimicrobial stewardship program (ASP) is a globally used tool to combat AMR. There is little information on the views among Pakistani physicians regarding AMR and the benefits of hospital antimicrobial stewardship implementation. This study was designed to explore the physicians’ views about ASP. Methods: Qualitative face-to-face and telephonic interviews were conducted by using purposive sampling method with 22 physicians working in seven tertiary care public hospitals of Punjab, Pakistan. All interviews were audio recorded and transcribed verbatim. Qualitative software was used, and a thematic analysis was conducted. Results: Three broad themes were identified: (1) the growing concern of antimicrobial resistance in Pakistan, (2) the role(s) of healthcare professionals in antibiotic prescribing, and (3) managing antibiotic resistance in hospitals. Inadequate resources, poor healthcare facilities, and insufficiently trained medical staff were the major hurdles in ASP implementation in Pakistan. Conclusions: Our study found a poor familiarity of hospital ASP among physicians working in public sector tertiary care teaching hospitals, and a number of distinct themes emerged during this study that could be helpful in establishing the concept of hospital ASP in Pakistan. Overall, physicians showed a positive attitude towards the enforcement of ASP in all healthcare settings, including teaching hospitals.

Purpose: Patient satisfaction can identify specific areas of improvement in community pharmacy services. Currently in Pakistan, no evidence exists in this regard. This study was conducted to determine the needs of patients and the current standards of pharmacies. Methods: A cross-sectional study was conducted between October 2016 and June 2017. A pilot tested questionnaire was used to collected the data from 1088 patients of 544 community pharmacies. Likert scale and one way ANOVA was used to analyze the data. Results: The response rate of community pharmacies was 80% and that of purchasers was 68.1%. The mean age of participants was 35.2 years. The mean overall satisfaction score of participants was 2.78/5.00. Many patients were dissatisfied (1.65/5.00) with parking facilities provided by pharmacies. Pharmacy service time fulfilled the requirements of most patients (4.16/5.00). The counseling person’s good attitude (3.99/5.00) was credited by purchasers. Level of patient satisfaction with the availability of medicines (3.19/5.00), safe storage of medicines in pharmacy stores (3.66/5.00), and quality of medicines (3.41/5.00) were almost moderate. Many patients were very satisfied (4.35/5.00) with readable instructions for their medications. Approximately half of the patients were dissatisfied with the waiting time. Many patients were also dissatisfied (2.28/5.00) with the knowledge of the counseling person. Patients perceived that staff interest in patient recovery (2.24/5.00) was low. No significant difference in level of satisfaction with regard to participant’s characteristics was found. Conclusions: The current study demonstrated a low level of patient satisfaction with regard to community pharmacy services in Pakistan. These services need improvement.

Community pharmacies are the main channel of antibiotics distribution. We aimed to analyze the dispensing of non-prescribed antibiotics and knowledge of pharmacy staff. We conducted a cross-sectional study in Punjab, Pakistan between December 2017 and March 2018. A self-administered, structured, pretested, and validated bilingual questionnaire was used, and we used chi-square tests in the statistical analysis. A total of 573 (91.7%) pharmacy retailers responded to the survey; 44.0% were aged 31–40 years and all were men. Approximately 81.5% of participants declared that dispensing non-prescribed antibiotics is a common practice in community pharmacies, and 51.1% considered themselves to be authorized to dispense these drugs; 69.3% believed this a contributing factor to antimicrobial resistance. Most (79.1%) respondents believed that this practice promotes irrational antibiotics use, and half (52.2%) considered antimicrobial resistance to be a public health issue. Only 34.5% of respondents reported recommending that patients consult with a doctor prior to using antibiotics, and 61.8% perceived that their dispensing practices reduce patients’ economic burden. Approximately 44.9% of pharmacy retailers stated that they have proper knowledge about antibiotics use. Nitroimidazole was the main class of antibiotic dispensed without a prescription. Dispensing of injectable and broad-spectrum antibiotics can be potential threat for infection cure. Poor knowledge of staff is associated with dispensing of non-prescribed antibiotics. This inappropriate practice must be addressed immediately.

Background: Resistance to antibiotics is one of the major global health challenges. An adequate understanding of the public regarding rational antibiotic use is a prerequisite to limit progression in antibiotic resistance. This study aimed to investigate the knowledge, attitude, and practices (KAP) of antibiotics and antibiotic resistance among customers visiting community pharmacies. Methods: This study was undertaken in three capital cities in China during March 2019 and July 2019 by using a questionnaire of 28 items. The questionnaire had four parts, including sociodemographic characteristics, KAP about antibiotics, and antibiotic resistance. A systematic random sampling approach was used to recruit the participants. Kruskal–Wallis and Mann–Whitney tests were carried out for data analysis. Results: The response rate was 66.7% (1800/2700). Out of the total, only 9.7% of the customers had good knowledge about antibiotics. Nearly half of the participants were unable to differentiate between antibiotics, and anti-inflammatory drugs (n = 820, 45.6%, Median = 2, IQR = 1). Most of the customers were of the view that the use of over the counter antibiotics in pregnant women is unsafe (n = 1307, 72.6%, Median = 2, IQR = 0). Almost half of the participants disagreed that costly antibiotics are more effective and have fewer side effects (n = 897, 49.9%, Median = 3, IQR = 1). Only 22.3% of participants said that they always finish the course of antibiotic treatment (n = 401, 22.3%, Median = 3, IQR = 1). Conclusion: The knowledge of Chinese pharmacy consumers was inadequate, and a lack of good attitudes and practices in certain aspects of antibiotic use was observed. Educational interventions are needed to increase public knowledge of antibiotics.

Background: Community pharmacies are an integrated part of healthcare systems worldwide. In low and middle income countries like Pakistan, the paradigm of pharmacy practice is shifting from dispensing medicines to clinical activities. There are disparities in these practices according to location. Pharmacies in urban localities are better than those in rural areas. This qualitative study was conducted to explore patients’ expectations and current practices in rural pharmacies. Methods: A cohort of adult pharmacy visitors (aged > 18 years) that reside in rural community was selected. Consenting participants were recruited by purposive sampling technique until thematic saturation level was achieved. A total of 34 patients were interviewed. Face-to-face interviews were conducted using a semi structured interview guide. All the data were transcribed and used to originate the themes. Results: On analysis, a total of 20 themes were obtained. Sixteen themes pronounced the current provided services. Four themes provided some suggestions for the development of better pharmacies. On call services to provide medicines, limited free extended pharmacy services, interest in patients’ wellbeing, appropriate referral, vaccination, free medical camp, medical services at home, first aid, and counseling were appreciated by patients. Patients stated that medicines are inappropriately stored in unhygienic conditions, prices of medicines are comparatively high, and medicines are substandard. Unavailability of medicines, inept dispensing, limited staffing with poor knowledge, limited working hours, and quackery promotion are challenges in rural pharmacy practice. Patients say that non marginal pricing, informative services, new legislation, and proper vigilance by officials can improve the pharmacy services in rural communities. Conclusions: Patients alleged that rural pharmacies perform deprived practices. To improve service, new legislation and the proper implementation of existing law is needed.