Almost half of all medicines globally are used irrationally. This can have severe consequences: adverse drug reactions, drug resistance, protracted illness and even death . In addition, the financial cost incurred by individuals and governments due to irrational use is unnecessary and often extremely high, particularly in developing countries where patients often pay for medicines out of their own pockets . Irrational use of medicines includes over-treatment of a mild illness, inadequate treatment of a serious illness, misuse of anti-infective drugs, over-use of injections, self-medication of prescription drugs and premature interruption of treatment. Data from many countries shows that such practices are frequent, and not exclusive to developing countries [1–3].
According to figures gathered by surveys presented to the World Health Organization (WHO) in 2000, about 60% of antibiotics in Nigeria were prescribed unnecessarily. In Nepal, over 50% of antibiotics prescribed in 1996 were not needed and 40% of medicines expenditure in the same year was wasted due to inappropriate prescriptions. Globally, the figure for unwarranted antibiotic prescriptions stands at roughly 50% [1, 2].
Schools are considered a second home in Nepal, where students spend a large percentage of their time during childhood and adolescence. These days, students spend about seven to nine hours five or six days a week at school. The first place of learning is considered to be the home, where one is born and grows up with ones parents. School is the second place where the child learns how to interact, behave with others and to give and accept respect; therefore it is called the second home. Schools are organizations designed to influence and promote cognitive development and behavioral change. Health education provided by teachers may have an immediate effect on students and continue to influence students’ health behaviors into adulthood.
Strong beliefs among children and adolescents in the curative power of medicines , their limited knowledge about prevention and the easy accessibility to household medicines raises serious concerns. Since students spend most of their time in school with their teachers, proper education to the school teachers on the use of medicines will lead students toward a more rational and safer use of medicines. Self-medication among adolescents has become a serious problem that plays an important role in irrational use of medication and tends to increase with the age of adolescents [5, 6]. A study done in Kuwait among school teachers, found that teachers considered teaching their students about the proper use of medicines so important that they felt it should be included in the national curriculum of health education .
Authors have consulted various reports and studies done within Nepal and outside [7–10] for identifying the problem areas in medicine use. A study done in Greece indicated irrational use of antibiotics and a need of exploring issues related to their use. This study explored parents' attitudes which often contribute to inappropriate prescription of antibiotics . Similarly, another study done in Poland indicated that useful educational tools implemented in primary and secondary schools could play an important role in reducing the burden of community-acquired infections. The resource improves knowledge about microorganisms, hygiene and antimicrobial agents, and can be targeted at pupils, teachers and parents . A pre-post comparison of a community intervention in Nepal has also shown the importance and benefits of educating school teachers and their impact on students .
Students at schools are taught various subjects including health and environmental health and science from class eight till class ten. Various topics taught are the human body, health and nutrition, physical education, health and physical fitness, community health and personal sanitation. Students are also given an orientation about common diseases. The topics of disease causing ‘germs’ and medicines which can be used to treat these diseases are also introduced. The information level about these topics gradually increases as the students progress through high school. About four to six hours are devoted to these topics every week. Teachers who teach these subjects have at least a Bachelor degree in biology.
Providing knowledge regarding use of medicine to school teachers is an important component of the overall health care delivery system of any country . In developing countries such as Nepal where infant and early childhood mortality is high its importance cannot be overemphasized. For this reason the knowledge, attitude and practice among school teachers regarding use of medicines in Nepal needs to be evaluated. School teachers can help in rational use of medicines if they have the relevant information which can be transferred to students and through them to parents and the community.
The authors planned to study the knowledge, attitude and practice (KAP) regarding medicines among school teachers which is lacking in the Nepalese context. The association of KAP scores with demographic factors would help to identify subsections of teachers who may have deficiencies in knowledge and may need extra educational programs. In Nepal, there are various ethnic groups whose members have a common heritage, often consisting of a common language, a common culture often including a shared religion. The caste group is a system of social stratification in which communities are defined by thousands of endogamous hereditary groups called jatis. The jatis are formally grouped by the Brahminical texts under four well known categories, Brahmans (priests), Kshatriyas (kings, warriors, law enforcers, administrators), Vaishyas (agriculturists, cattle-herders and traders), and Shudras (lower caste menials, artisans, labourers, craftsmen, service providers) . People belonging to the lower castes are disadvantaged and may have lesser knowledge and teachers from these disadvantaged groups have lesser opportunities for education compared to their counterparts. These people come from rural areas and face more hurdles. Lalitpur is one of the seventy-five districts of Nepal. The district, with Patan as its district headquarters, covers an area of 385 km2 and has a population (2001) of 337,785. It is one of the three districts in the Kathmandu Valley, along with Kathmandu and Bhaktapur. Its population was 466,784 in the initial 2011 census tabulation. Lalitpur District has many famous schools, colleges and hotels .
In Nepal classes from 1–5 are considered as primary school. The main objective is to reach children to read, write and do arithmetic. Secondary education (classes 6–8), stresses personality development and trains the students for higher learning. Classes 9 and 10, upper secondary, serve as the stepping stone for the higher secondary level. Classes 8 to 10 are termed as high school. Classes 11 and 12 are regarded as higher secondary where students take up different streams of study. Science, humanities, and commerce are the main courses for higher secondary study. The private schools in general have better facilities, are better managed and show better performance in the school leaving certificate (SLC) examinations as compared to Government schools. Government schools get financial aid for running the educational programs and hence the school fees are lesser compared to the private ones .
Rationale of the study: Studies have revealed major misconceptions about and irrational use of medicines in different countries. Studies regarding the knowledge, attitude and practice (KAP) of medicines among school teachers are lacking in the Nepalese context. As teachers could play an important role in educating their students and are regarded as learned and respected persons in local communities it is important that they have proper knowledge about medicines. This knowledge can be transferred to their students, their parents and members of the community. Authors thought that it is important to obtain their baseline KAP so that strengths and deficiencies can be noted and appropriate educational interventions planned.
This study was carried out with the following objectives.
To obtain knowledge, attitude and practice about medicines among school teachers of selected schools in Lalitpur district.
To note the association of knowledge, attitude and practice with demographic and other characteristics of school teachers and
To compare KAP scores before and after an educational intervention.