Involving Students in the Reduction of Unnecessary Antibiotic Use for Colds and Flu in Moldova

2. Involving Students in the Reduction of Unnecessary Antibiotic Use for Colds and Flu in Moldova Cebotarenco N, Bush PJ, Tchebotarenco S, Veltman K

3. Project Purpose • Develop, implement, and evaluate a school-based program to decrease antibiotic use for colds and flu in Moldova

4. Intervention: The formative Phase I: focus group discussions with groups of students, parents, teachers and physicians to assist with the development of the intervention and the baseline questionnaires in the winter of 2002-03 The formative Phase II: Six sessions of peer education in school with outreach to parents, two meetings with parents, video vignettes, a pamphlet, newsletters, a poster contest, and parent meetings. 2003- 2004 The post-intervention Phase III: follow-up survey (is done in march, 2004), a conference to disseminate results and determine whether this intervention method should be extended to other schools or used for other health problems

5. Result • Baseline surveys were completed by 3,586 sixth-level students and 2,716 of their parents • The post-intervention surveys were completed in March 2004 • during the winter of 2002–2003, 72.5% of students and 56.8% of adults had 1+ colds and/or cases of flu

6. Result • Rates of antibiotic use were high: • of those with 1+ colds and/or cases of flu, 50.6% of students and 71.3% of adults treated with antibiotics; • however, 32.3% of students indicated that they didn’t know if they had an antibiotic.

7. Result • 87.5% of adults believed that students should be taught about antibiotics in school; • 78.7% of students indicated that they wanted to learn about antibiotics in school.

8. Key Lessons: • School-based educational programs may be a practical effective method to reduce the unnecessary use of antibiotics for colds and flu in a community. • Trained peers of 7th grade students have the desire, capacity, and ability to teach their classmates and parents.

9. Key Lessons: • Students say they like to be taught by peer trainers and often, during the program, ask to be included in the peer team. • Students can be taught about the appropriate use of antibiotics as early as 5th grade.

10. Key Lessons: • Trained student peers use simple language and many attractive teaching methods that create a positive friendly atmosphere and active participation of all students during the program’s sessions.

11. Trained students use simple language and many attractive methods teaching classmates that create good friendly atmosphere and active participation of all students during the sessions of the program.

12. Key Lessons: • It is very important for trained peer students to have support and appreciation from the school administration. • Teachers also enjoy being taught by the students and like to participate in the sessions, but often are reluctant to ask to be included.

13. Key Lessons: • Parents listen to their children and believe in school-based health education for them. • Parents of the trained student peers are very proud of them and of their role as teachers disseminating the information and knowledge of the program among other parents.

14. Project Implications • The educational program shows that students want to know more about medicines and want to continue to teach other students after completing the program in their schools.

15. Project Implications • Trained students can be catalysts for students in other Moldavian schools. • The trained team can help teach new groups of peer trainers in other schools. • Even 5th grade students’ parents want their children be trained and be trainers on appropriate use of antibiotics in colds and flu.

16. Project Implications • The success of the educational program depends on the school administration’s cooperation and the presence of an active group of teenagers in the school.

17. Project Implications • The implications are that the trained students and the majority of their classmates and families will not use antibiotics for colds and flu in either the short- or long-term. • In order to evaluate the long-term implications of the educational program, it would be useful to repeat the survey in five years – when the students are in 12th grade, and again later if possible.

18. Future research • A follow-up survey to determine if the educational benefits last over a period of time. • Determine if it is possible to extend the school-based peer education method to reduce inappropriate antibiotic use for colds and flu to other school districts via training manuals and other education materials. • Extension of the school-based peer trainer program to include other health problems.

19. Future research • Comparison of the school-based peer trainer program with a community-based education program on rational antibiotic use. • Implementation and evaluation of a educational program to teach the parents of pre-school and kindergarten children about rational antibiotic use using trained student teachers.

20. Acknowledgement To the World Health Organization, Management Science for Health RP Plus and Center for International Health and Development, Boston University School of Public Health for the support of this research