The Place of Nursing Theory in the Management of Post-Operative Infections in a Hospital Environment: Case of Cibitoke District Hospital

Introduction: Post-operative infections, such as surgical site infections (SSIs), are a significant concern in healthcare settings. Nurses play a crucial role in the prevention and management of these infections. The use of nursing theory could contribute to the prevention of SSIs. The aim of this study was to evaluate the role of nursing theory in the management of surgical site infections (SSIs) in a hospital environment. Method: A cross-sectional study was conducted using descriptive and analytical methods to assess the role of nursing theory in the management of Post-operative infections (POI) in a hospital setting in October 2023. The study population consisted of nurses working in the Surgery, Emergency, and Maternity units at Cibitoke District Hospital. A sample size of 71 nurses working full or part time in the Surgery were invited to participate in this study. A questionnaire was used to collect the data, and SPSS version 21.0 software was used for analysis. Results: The study found that nursing theory did not have any statistically significant place in the management of POI (p-value = 0.523). However, the results showed that experience was the only significant factor influencing the management of POI (p-value = 0.004). This is explained by the analysis of the net effects of the explanatory variable where we noticed that those who had more experience were more likely to manage post-operative infections. The participants’ knowledge regarding nursing theory in the management was poor as they scored less than 30% in all the variables used to measure their knowledge. Conclusion: The study revealed that nurses’ knowledge of nursing theories and their applications in the management of SSIs was poor. Continuing professional development, curriculum review, and in-service training were highly recommended.

The Evolutionary Profile of Patients Operated for Peptic Ulcer Perforation in Bujumbura

Background: The evolutionary profile of patients operated for peptic ulcer perforation in Bujumbura. Perforated peptic ulcer is a serious complication of peptic ulcer with potential risk of grave complications. Aim: To study the early morbidity and mortality of surgery for peptic ulcer perforation in Bujumbura City Hall hospitals: Kamenge University Hospital Center (CHUK), Kamenge Military Hospital (HMK) and Prince Louis Rwagasore Clinic (CPLR). Patients and methods: This is a retrospective, descriptive and analytical study carried out in the three hospitals of Bujumbura over a period of three years from January 1, 2020 to December 31, 2022. It involved 57 cases (n = 57) of peptic ulcer perforation. Results: The frequency of surgery for peptic ulcer perforation was 2.7% with a mean age of 43.6 years +/- 15.3 years and a male predominance with a sex ratio of 3.7. Eight percent of patients presented with shock, 24.5% were smokers, and 67.9% had taken non steroidal anti-inflammatory drugs. The mean hospital stay was 15.2 days with a standard deviation of 12.1. The morbidity rate was 30.2%, 32% were classified in grade IIIb of the Clavien-Dindo Surgical Complications Scale. There were 9 deaths (17%). Seven patients who underwent surgery and received late consultations died. Conclusion: Surgery for peptic ulcer perforation remains an intervention associated with a high rate of morbidity and mortality in Bujumbura. Surgery for peptic ulcer perforation remains a procedure associated with a high morbidity and mortality rate in Bujumbura. The time before consultation was the only factor associated with early morbidity and mortality of Surgery for peptic ulcer’s perforations.

Nursing Practice in Recovery Room: A Case of Kibuye Hope Hospital and Mutoyi Hospital

Background: Nursing care in the recovery room is oriented to take into account the patient’s condition after surgery intervention with its main purpose of providing direct and continuous patient observation in emergence from general or regional anesthesia. In the absence of professional assistance, patients can develop complications that can lead them into shock or death. This study aims to understand the place of nurses in guiding nursing care in recovery room in two hospitals of Gitega Province by assessing the nurse’s knowledge and attitudes for the promotion of quality nursing care for post-operative patients. Methods: A cross sectional study design was used to assess the practice of nurses in managing nursing care in the recovery room in these two hospitals. A purposive sampling method was used to select the 82 nurses working in the recovery room for these two hospitals and Alain Bouchard’s formula was used to calculate the sample size. Data were collected using a self-report method involving questionnaire completion with five components addressing participants identifications, factors related to the work organization, factors related to the work environment, factors related to healthcare system, and nursing interventions in recovery room. Results: Findings revealed a significant lack of knowledge among the participants and their attitudes were slightly poor as for most of the variables of factors related to healthcare system as their score was less than 50% and their knowledge for nursing interventions was also poor as most of variable scores were less than 25%. Conclusions: The study findings were slightly poor as their scores were less than 50% in most of the variables;therefore, it was recommended that in-service training and workshops should be organized by these healthcare facilities for the purpose of empowering the nurse’s knowledge and practice. Moreover, these institutions should provide and encourage nurses to use nursing guidelines and protocols.

Prevalence and Associated Factors of Viral Hepatitis C among Burundian Population during a Screening Campaign: A Cross-Sectional Study Carried out in Burundi

Approximately 180 million people worldwide are affected by Viral hepatitis C, with 350,000 to 500,000 deaths yearly. The present study sought to investigate the prevalence and associated factors of viral hepatitis C (VHC) among the Burundian population during a screening campaign. A total of 629 participants took part in the study, and the prevalence of viral hepatitis C was (8.11%). The associated factors identified as statistically associated were medical and surgical history (P = 0.02) and ear and nose piercing (P = 0.01). 51% of the infected persons were females. The mean age for viral hepatitis C carriage was 46.13 ± 14.3 years and 10.40% of viral hepatitis C carriers were over 50 years old. We found a high viral hepatitis C prevalence in married (9.55%) and divorced (9.38%) participants. The majority of our participants were farmers (60.25%) with a prevalence of viral hepatitis C (7.92%) while 11.54% of the infected participants were not educated. In conclusion, the current study shows a high prevalence of Viral Hepatitis C infection in Burundi. Infection was more likely to occur in older, married, farmer, and illiterates. Unsafe medical and surgical interventions with traditional practitioners were significant risk factors for contracting VHC infection.

Assessment of Nurses’ Knowledge of the Management of Pre-Eclampsia in a Hospital Setting: The Case of the Van Norman Clinic. Bujumbura-Burundi

Background: Pre-eclampsia is one of the pathologies of pregnancy that causes serious maternal and fetal complications. Good nursing management of pre-eclampsia could stabilize and limit possible maternal and fetal complication. Aim: This study aims to assess nurses’ knowledge of the management of pre-eclampsia. This is a descriptive prospective study conducted at the Van Norman Clinic over three-month period from November 1st, 2020 to January 31st, 2021 to assess the knowledge of nurses assigned to the Patient reception service, Emergency service, Gynecological-Obstetrics service and Community Medicine department on the management of pre-eclampsia. Data were treated using Microsoft Word and analyzed by Statistical Package for Social Scientists version 16 (SPSS). During the period of our study, we collected 40 nurses out of 44 nurses, which represents 90.9% (n = 40) of the nurses assigned to the Patient reception service, Emergency service, Gynecological-Obstetrics service and Community Medicine department. Among the 40 cases collected, 30% respondents did not give the true definition of pre-eclampsia. Our study also showed that 70% of nurses had not been trained on the management of pre-eclampsia and 90% had not used nursing theories in their practice while the Inquiry-Based Practice (IBP) and Evidence-Based Practice (EBP) applications were known in 7.5% of cases. With regard to the nursing management of pre-eclampsia, 62.5% of cases knew the first gestures of management while 90% of cases did not know the overall nursing management of pre-eclampsia. Last of continuing education, use of nursing theories and lack of resuscitation were the main obstacles observed in the nursing management of pre-eclampsia. For better nursing management of pre-eclampsia, emphasis should be placed on building staff capacity and executing the care plan by applying nursing theories.

Morbidity and Mortality of Emergency Hernia Surgery in Children in Bujumbura: Analysis of Favourable Factors

Background: Management of emergency hernias surgery should include certain complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days of emergency hernia surgery in children in the surgical departments of 8 Bujumbura hospitals. Patients and Methods: This is a prospective study over a period of one year which included all hernias operated on in emergency from January 1, 2022 to February 29, 2023. Results: During the period, 282 patients (children) were admitted to the operating theatre for abdominal parietal hernias, of which 46 were admitted for emergency hernia surgery. Males accounted for 86.96% (40), sex ratio 6.6. The average age was 3.4 years. The persistence of the peritoneo-vaginal canal represented 52.17% of cases. Inguino-scrotal hernia was prevalent (43.48%). The main complication was strangulation (80.43%). Morbidity accounted for 1.3% of complications (infection, residual pain, testicular atrophy, hernia recurrence). No deaths were found. Altemeier stage and gender were statistically related to morbi-mortality of emergency hernia surgery in adults at 30 days post-op (p = 0.0260 and p = 0.0212 respectively). Conclusion: Abdominal parietal hernias are common in children, dominated by groin hernias. The high frequency of strangulation calls for awareness of cold hernia repairs.

Morbidity and Mortality of Emergency Hernia Surgery in Adults in Bujumbura: Analysis of Favourable Factors

Background: Abdominal parietal hernia, a temporary or permanent exit of viscera through an anatomically pre-existing zone of weakness, is a frequent pathology in surgery. So, the management of emergency hernias surgery should include some complications most often up after 30 days of the operation. Aim: To analyze the factors contributing to morbidity and mortality after 30 days of emergency hernia surgery in adults in the surgical departments of Bujumbura hospitals. Methodology: This is a prospective study over a period of one year that included all hernias operated on in emergency from January 2022 to February 2023. Results: During the period, 251 patients were admitted to the operating room for abdominal parietal hernias, including 49 for emergency hernia surgery. There were 43 men (87.76%) and 6 women (12.24%), i.e. a sex ratio of 7.1. The average age was 49.6 years, with extremes of 18 and 84 years. The occupation of strength (farmer, labourer, mechanic, mason, mason’s helper) represented 75.51% of the cases. Inguino-scrotal hernia was preponderant (65.31%) followed by inguinal hernia (25.58%), umbilical hernia (4.08%);femoral hernia represented 4.08%. Hernial strangulation represented 89.80% and engorged hernia 10.20%. Morbidity was minor, 2.04% of complications (suppuration, hematoma, urinary retention). No deaths were found. Altemeir stage and occupation were statistically related to morbi-mortality of emergency hernia surgery in adults at 30 days postoperative (p = 0.0028 and p = 0.0284 respectively). Conclusion: Abdominal parietal hernias are frequent, dominated by groin hernias. The high frequency of strangulation calls for awareness of cold hernia cures.

Nurses’ Knowledge, Attitudes and Practice regarding Pressure Ulcers Prevention and Treatment

Pressure ulcers (PU) are one of the most common hospital-acquired problems that occur in patients with mobility limitations. Such wounds can produce pain and deterioration of the underlying condition. Sometimes, they can be life-threatening, and their treatment can impose a financial burden on both the patient’s family and society. Nurses’ knowledge, attitude, and practice are the most important weapons to fight this preventable burden of PU among patients with impaired mobility. The purpose of this study was to assess nurses’ knowledge, attitude, and practice regarding PU prevention and treatment at Clinique Prince Louis Rwagasore (CPLR) in Bujumbura, Burundi. A cross-sectional study design was used. Convenience sampling was used to invite all 28 qualified nurses and nurses’ aids who work in the services where critically ill patients are admitted to participate. A questionnaire was created, and underwent evaluation of face validity before using it to collect data which was analysed using SPSS 21.0. Results revealed that nurses’ knowledge and practice scores were low as participants scored less than 50% on the six knowledge items and the six practice items. However, the attitude scores were greater than 65% on the five items used to evaluate attitude. A strong negative correlation was found between nurses’ knowledge and their attitude scores (r = ?0.479, p = 0.015). Education level was negatively associated with nurses’ knowledge and practice scores of PU prevention and treatment. A high attitude score did not correlate with a higher practice score which might be explained by low knowledge scores (less than 50% on knowledge items). Continuous professional development (CPD) was recommended to improve nurses’ knowledge scores and implementation of PU preventive practices at CPLR.

Inquiry Based on Evidence and its Practices in Two Healthcare Facilities of Bujumbura

Background: Inquiry evidence-based practice (IBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs. IBP and its practice in health care promote also many advantages, such as improvements of practices based on the attitudes and cognitive ideas. This study aims to assess the inquiry based on evidence (IBP) and its practices in two Health Care Facilities (HCFs) of Bujumbura to help the practitioners to understand its importance. Methods: A cross-sectional study design was used to analyze the importance of IBP and its practice in these two hospitals. The probability-sampling technique was used also to select 104 nurses from the Military Hospital of Kamenge and 55 nurses from the Van Norman Clinic. A questionnaire was used to collect data with two mains components, demographic data and knowledge and attitudes addressing the following parameters: evidence practice during inquiry, nursing theory, current analysis in nursing care oriented the evidence, prioritization of care, rational diagnostic, monitoring and assessment. Results: The findings from this study revealed a poor knowledge and attitude among participants towards Inquiry Based Practice. In all variables, participants were scoring less than 10%. However, majority of participants (76.5%) know the indicators of patients’ satisfaction with nursing interventions through survey-based practice and 74.1% argued to analyze their information collected. Conclusion: This study revealed a weak awareness on IBP and its importance during nursing practice among participants as for almost all variables, participants were scoring less than 10%, except for the indicators of patients’ satisfaction with nursing interventions through survey-based practice (76.5%). Therefore, in-service training and curriculum revision had been highlighted and recommended another to provide the best rational diagnosis and achieve the patient’s outcomes.

Women’s Attitudes and Knowledge towards the Use of Contraceptive Methods

Background: Contraceptive use reduces the need for abortion by preventing unwanted pregnancies, and the causes of maternal death worldwide. Contraceptive use helps women to plan their pregnancies and contributes for population growth. This study aims to analyze the attitudes and knowledge of the women attending Van Norma Clinic for the use of contraceptive methods. Methods: A cross-sectional study was used to analyze the information. A convenience sampling method has been used to select the 100 women who attended Van Norman Clinic in Family planning service in the period of the study of four months (April to July, 2020). A self-administered questionnaire with four parameters addressing importance of using contraceptive methods, the factors affecting the women’s attitudes for not using contraceptive methods, types of contraceptive methods currently used, advantages and disadvantages of using contraceptive methods was used to collect data. Results: Research findings show that the majority of respondents knew the importance of using contraceptive methods like preventing unwanted pregnancies (97%), spacing pregnancies (96%), planning pregnancies (92%), and getting well (70%). Two factors affecting women for not using contraceptive methods had been identified such as religion (73%) and fear (70%). In addition, the women attending Van Norman Clinic prefer using implants (99%) and injectable (99%). It is clear that women do not know the consequences related to the nonuse of contraceptive methods. Some recommendations have been made to the health care facilities, parents, women themselves, churches’ leaders and government in general. Conclusion: Factors which influence women’s attitudes for not using contraceptive methods were notified in our study such as religion (73.0%) and fear (70.0%) which was explained by the fact that in Burundi most people are catholic which is the most religion prohibiting the use of contraceptive methods. However, the participants’ knowledge was significantly good as their score was more than 50% for all variables.

Infection Control Measures among Healthcare Workers: Knowledge, Attitude and Practice

Background: Nosocomial infections are some of public health problems globally and continue to be increased regardless of the hospital’s efforts on infection control measures and are contributing significantly to morbidity, mortality and cost. The absence of infection control policies, guidelines and trained professionals also contributes to the magnitude of the problem. The aim of this study was to assess the Knowledge, attitude and practices towards infection control measures among healthcare workers at Old Mutare Hospital. Methods: A cross-sectional survey design was used to acquire information. A purposive sampling method was used to select 22 nurses, 15 nurse Aids and 2 laboratory technicians (Lab Tech). A self-administered questionnaire with four components addressing demographic data, knowledge, attitudes and practices was used to collect data that was completed by a checklist. Results: The study findings revealed a poor knowledge of infection control measures among the nurse’s aide. The attitude and practices among participants were impartially good in all variables. The participants had scored over 50% towards their attitude and their practices on infection control. A significant statistical difference was found between the professional status of the participants and the ability to explain how one can get Hospital Acquired Infections (HAIs) and awareness of infection control programs in their hospital (rs = 0.640, 0.645) with P < 0.05 (0.01, 0.01) respectively. Conclusion: Despite of having a fair attitude and practice towards infection control, the participants had presented poor knowledge;therefore, it had been recommended that in service training and workshop should be planned by the administration to update their knowledge and attain full compliance towards their practice.

Pediatric Nursing Care and Its Practices in Three Health Care Facilities

Introduction: Pediatric nursing cares are among the most important care needed referring to the category of patients. A gap of the best practice in Pediatric Nursing Care (PNC) had been publically a major problem of health and raises the rate of morbidity and mortality. The lack of nursing guidelines, low level of studies, experience at work and low economic status of Health Care Facilities (HCFs) were the main problems assessed in these three HCFs (HUCK, VNC and MHK) in this study. The purpose of this study is to assess the knowledge of nurses during their practices in Pediatric Wards of HCFs and to provide a better contribution. Method: A descriptive study design was used in this study during the period of one month. 43, 25 and 30 nurses were selected among 98 nurses by using Dilman formula. A questionnaire with 5 parameters was distributed. Data were typed using Microsoft ward and analyzed using Statistical Package for Social Scientists version 16 software (SPSS). Results: The current study found that the majority of nurses don’t know to make the best nursing diagnosis neither the factors related to the implementation of EBP in PNC. The nurses have shown different barriers often met during their practices. The all process of nursing diagnosis was not recognized with the average of 97.6% of nurses. Conclusion: Even if the nurses have some experience at work they express their weakness based on low level of study, lack of knowledge and trained professionals on work and the pediatric nursing guidelines.

Clinical Preceptor’s Role in the Development of Nursing Training Based on Professional and Competency Frameworks in Two Health Care Facilities of Bujumbura

Background: The aim of clinical preceptors is to support the development of expertise related to the preceptorship of groups of trainees among nurses in clinical settings by the acquisition and use of theoretical knowledge, know-how and know-that. The support of students remains a major problem in hospitals, because the requirements of the preceptors according to the standards are not considered. The lack of guidelines on nursing preceptorships, theoretical application based on the professional curriculum, and professional expertise were the main problems assessed in the two Health Care (HUCK, VNC) in this study. The purpose of this study is to assess the knowledge of nurses and learners during their preceptorship practices and to contribute to the direction of evidence-based preceptorship. Method: A descriptive cross-sectional study design was used in this study during the 3-month period. A sample of 121 nurses as well as 56 learners were selected from 381 nurses and 80 learners using Alain Bouchard’s formula. A questionnaire developed according to the guidelines of Ernestine Wiedenbach’s theory of care, was distributed. The data were analyzed using the Microsoft Excel and the software program version 16 (SPSS-16). Results: The current study found that the majority of nurses do not know the importance of the clinical tutor. The results state that students experience clinical practice problems, thus clinical preceptorship is required. Nurses showed that there are different barriers often encountered during their practices. The overall nurse preceptorship process is not optimal and the average of 97.6% of nurses does not have expertise in coaching interns in clinical settings. Conclusion: Although that nurses have some experience at work, they express their weakness based on a low level of education, a lack of knowledge and trained professionals on the job, and clinical preceptorship guidelines.

Assessment of Nurses’ Knowledge in the Implementation of the Principles of Asepsis in the Hospital Environment

Introduction: Aseptic procedures are undertaken by nurses in the general ward. The lack of nurse’s aseptic techniques in clinical setting result to patients or healthcare expositions to hospital-acquired infections which are most of the time caused by lack of knowledge or ignorance of implementing the principles of aseptic technique. This study aims to assess nurses’ knowledge and the possible barriers in the implementation of the principles of asepsis in healthcare setting. Methods: A cross-sectional study design was used to assess the nurses’ knowledge and the possible barriers for implementing principles of asepsis in healthcare setting among. The study was carried out at Clinique Van Norm (CVN), a free Methodist Church related institution located in the north District of Bujumbura city in Burundi, from October to November, 2021 among nurses who work within three services of the clinic (Gynecology and Obstetrics, Pediatric and Operating room). A convenience sampling method was used to invite all nurses (44) working in the 3 services of CVN to participate in our study. A self-report method involving questionnaire completion with three components addressing demographic data, participants’ knowledge and barriers to implement the principles of asepsis was used to collect data which were later on analyzed by SPSS version 21. Results: Research findings show a significant participant’s poor knowledge on principles of asepsis in the hospital as for almost variables used to assess their knowledge, they scored less than 50% except for the time of using sterile gloves in which most of the participants (71.4%) said that they do use sterile gloves when indwelling urinary catheters, labor and delivery, newborn care, wound dressing or suturing, or any time handling aseptic equipment, inserting nasogastric feeding tube... In addition, participants argued that they know the principles of asepsis (57.1%), however, only 14.3% of them were able to list at least 5 of the principles of asepsis. Finally, all our participants (100%) confirmed that there are no infection control programs in their hospital, neither an infection control protocol in their service which was evident as none of them wasn’t familiar with the contents of infection control protocol. Financial constraints, workload, lack of materials and ignorance of nurses were the most barriers to implement principles of asepsis in their service. Conclusion: This study shows a poor knowledge among nurses at CVN regarding the implementation of the principles of asepsis. Financial constraints, workload, lack of materials and ignorance of nurses were the most barriers that hinder the implementation of principles of asepsis in their service. Continuing professional development program and curriculum revision were highly recommended to overcome this problem.

Evaluation of Knowledge and Practice regarding Family Planning among Christians Pregnant Women of Gihanga Attending Antenatal Careat Vyizigiro Health Center, Bubanza, Burundi

Introduction: Family planning is an important service for everyone and contributes to the protection of women from unwanted pregnancies. In Burundi, it remains at a low rate due to different factors such as fear of side effects, low education level, and notably religious guidance. The purpose of this study was to evaluate the knowledge and practice regarding family planning among Christians pregnant women of Gihanga attending antenatal care at vyizigiro Health center. Methods: This cross-sectional study of Christians pregnant women attending antenatal care was conducted at Vyizigiro health center of Gihanga, Burundi in May 2021. The data were collected on a small sheet done in English, and translated into Kirundi’s local language. In this study, were included all women fulfilled all criteria, and were excluded from all impregnated women who were not Christians and refused to participate in the study. Data were analyzed using SPSS. Results: In the current study, among 129 pregnant women who attended antenatal care at Vyizigiro Health center in the period of 1 to 30 October 2020, 118 of them were interviewed. The study found that the participants have low knowledge regarding family planning as participants scored less than 50% in all items assessed for knowledge and its practice was hindered by religious guidance (41.7%), while others refused modern contraceptives for fear of side effects (13%), lack of sufficient information about it (7.4%) and 5.6% were denied by their husband. Conclusion: This study found a low knowledge and practice regarding family planning among the Christians pregnant women of Gihanga attending antenatal care at Vyizigiro health center due to their religious beliefs, fear of side effects, and lack of sufficient information or their husband who don’t want family planning services.

Nursing Theory and Its Practices in Two Health Care Facilities of Bujumbura

Introduction: Nursing theory provides a systematic explanation and description of nursing phenomena. It is very important during nursing practice in healthcare facilities (HCFs) because it guides nurses on how to collect data, which data to collect, decide how to interpret the data through the perspective of the theorist, how to plan and implement care, how to make a change and how to evaluate the patient’s outcomes. This study aims to illustrate how nursing theory can be applied during the implementation of nursing care in HCFs of Burundi by orienting the nurses to understand its application during practice. Methods: A cross-sectional study design was used to assess the use of nursing theories in healthcare facilities. A purposive sampling method was used also to select 81 nurses working full and part by applying Alain Bouchard’s formula and the questionnaire was used as the data collection instrument. Results: The current study had revealed a poor knowledge among the participants on the use of nursing theory in these two HCFs as for all variables, their average scores were almost 24.1% whilst those who had no notion related to nursing theory reach a percentage of 75.9%. Conclusion: The study findings were slightly poor as for all variables, they scored less than 40%. Therefore, the use of theories to guide their practice was highly recommended to enhance the patients’ outcomes based on the use of scientific-based experts which could result from continuous education.

Evaluation of the Regulation of Antibiotics Consumption in Bujumbura, Burundi

Abstract： Background： Antibiotic self-medication is highly prevalent in the developing countries. The objective of the study was to evaluate self-medication with antibiotics and the regulation of antibiotics consumption in the private and public pharmacies of the urban area of Bujumbura. Methods： A cross sectional study using self-administered questionnaire was conducted in private and public pharmacies of Bujumbura. 460 clients were randomly chosen and 32 sellers randomly selected from January to September 2015 and interviewed. Results： Of the 460 participants, 186 （40.43%） practiced self-medication to antibiotics. The average age was 34.89 years. Abdominal pain was the first motivation to practice self-medication （20.8%）. Amoxicillin was the antibiotic most commonly used （47.3%）. Inaccessibility to health care facilities due to the lack of financial resources was cited to be the root of this phenomenon （62%） and these antibiotics were mostly acquired from community pharmacies without prescriptions （84.4%）. Conclusions： The high cost of care and the low level ofstudy of the patients are factors favoring this phenomenon. A national policy for regulation use of antibiotics without a medical prescription and an educational program to general population on the effective use of antibiotics are therefore needed.