Author: Rumaisa Hossain – 4th Place in PROMPT!

​​Introduction

In Bangladesh, several studies have confirmed that many bacterial species are becoming resistant to antibiotics. But why should we care? Because antibiotic resistance (AMR) isn’t just a scientific problem, it directly affects how easily we may recover from common illnesses in the future. As former WHO Director-General Dr Margaret Chan once stated,

“A post-antibiotic era means, in effect, an end to modern medicine as we know it.”

According to the Institute of Epidemiology, Disease Control and Research (IEDCR), antibiotic resistance in Bangladesh has increased by about 11% since 2016, showing just how quickly the problem is spreading. 

I’ll admit that I myself have misused antibiotics before, simply because I didn’t know better, like stopping midway through a prescription once I started feeling better. Many of us have probably done the same without realizing the risks. The truth is, every time we misuse antibiotics, we give bacteria a chance to become stronger, and that could make even simple infections much harder to treat later on. This research, therefore, serves as a critical self-assessment and investigation.

Background

Confronting Antimicrobial Resistance (AMR) is a global health challenge, with Bangladesh on the front lines. The World Health Organization (WHO) identifies several foundational failings driving this crisis: high levels of antibiotic use and misuse, widespread lack of clean water, sanitation, and hygiene (WASH), limited access to quality diagnostics, and a general lack of public awareness.

While these are mainly societal issues, they profoundly affect the youth of Bangladesh. The critical question is whether these systemic failures are leading to the next generation becoming victims of societal neglect.

Teenagers face constant exposure to infections due to poor WASH, which accelerates antibiotic resistance within their age group. Furthermore, the lack of quality medical advice often leads to self-medication and misinformation. Teenagers lack the knowledge to distinguish between viral illnesses like colds and bacterial infections, habitually misusing antibiotics—a pattern deeply entrenched in cultural practice. As Nobel Laureate Joshua Lederberg warned, 

“The single greatest threat to man’s continued dominance on the planet is the threat of the microbe.”

A crucial factor is the formal curriculum. If education fails to equip students to be responsible antibiotic stewards, it actively reinforces the culture of misuse within the educated youth.

This research aims to directly investigate the hypothesis that the neglect of proper antibiotic education and practice is fundamentally affecting Bangladeshi teenagers. By analyzing their knowledge and decision-making, I hope to determine if this generation is inheriting and perpetuating the resistance crisis, thereby becoming a victim of broader societal and educational failures.

Data Collection

I conducted research by surveying students across various grades, specifically from 8th grade up to A2 (Year 13). This range includes students preparing for their O-Level (IGCSE) and A-Level examinations, which follow the Cambridge Assessment International Education (CAIE) system or similar standardized curriculums. I have also taken into account Bangladesh’s national board curriculum to ensure a diverse range of perspectives, and to avoid any possible bias, I included participants from my neighborhood and performed interviews using a set of prepared survey questions.

To expand the range of my research to include other schools, I asked two friends who have a strong background in biology and a solid understanding of antibiotics. I provided them with the survey questions, and they carried out the survey in their respective schools.

Additionally, I created an online survey using Google Forms, which I distributed to friends and acquaintances to further enhance the breadth of data collected.

Curriculum	Count
English Medium (Have Bio)	86 people
English Medium (don’t have biology as a subject)	22 people
National Board	29 people
Total	137 people

With a total of 51 students who did not get antibiotic knowledge in school and 86 who did.

What did I find from this data

This is an analysis of the data that I collected from my previously stated methods and what I concluded from the results after comparing all the students from the different curriculums

Question (1) Do you know what antibiotics are used for?

group (A) consists of people who do not study antibiotics in their main curriculum. 

group(B) consists of people who do study antibiotics in their main curriculum. 

Response	Group A(National + EM No Bio)	Group B(EM)
Yes	45 people	76 people
No	6 people	1 person
Not Sure (N/S)	0 people	9 people
Total	51 people	86 people

Key Comparison Findings

“Yes” Responses are Nearly Identical: Both groups showed an overwhelmingly positive response, with roughly 88% of people in both groups answering. The vast majority of people, regardless of their curriculum group, provided a positive answer to the question in this question

Difference in “No” Responses: Group A (Non-Antibiotics Study) had a significantly higher rate of negative responses, with 11.8% of people answering “No” compared to only 1.2% in Group B.

Difference in “Not Sure (N/S)” Responses: Group B (EM) accounted for all of the “Not Sure” responses, with 9 people choosing this option, while Group A had zero “Not Sure” responses.

Inference

This tells us that basic awareness about the intended purpose of antibiotics is uniformly high across the teenage demographic, regardless of whether they encounter the topic formally in their studies. The consistently high “Yes” rate across both groups strongly suggests that this foundational knowledge is absorbed from pervasive external sources like familial instruction or media, effectively ruling out a widespread knowledge vacuum.

However, Group B exhibited a massive disparity between its “No” rate (1.2%) and its “Not Sure” rate (10.5%). This dramatic divergence implies that while curriculum exposure may not significantly boost fundamental knowledge, it introduces a sense of intellectual caution. Students who study antibiotics are exposed to the nuances and caveats of the subject, making them less willing to hazard a definitive, yet potentially inaccurate, “No.” They are trained to acknowledge and report uncertainty. Conversely, Group A’s high “No” rate (11.8%) and zero “Not Sure” responses indicate a higher tendency to make a definitive assertion when unsure. This pattern is often characteristic of knowledge gained from less rigorous, non-academic sources, where ambiguity is dismissed in favor of a quick, assumed answer.

Question (2) Have you ever taken antibiotics without a doctor’s prescription?

group (A) consists of people who do not study antibiotics in their main curriculum. 

group(B) consists of people who do study antibiotics in their main curriculum. 

Response	Group A (National + EM No Bio)	Group B (EM)
Yes	38 people	77 people
No	11 people	3 people
Not Sure (N/S)	2 people	6 people
Total	51 people	86 people

Key Comparison Findings

“Yes” Responses in group B had a significantly higher proportion of positive answers at 89.5%, compared to 74.5% in Group A. 

“No” Responses in group A had a much higher rate of negative answers at 21.6%, compared to only 3.5% in Group B.

“Not Sure” Responses: Group B had a slightly higher proportion of “Not Sure” responses than Group A.

Inference

This data powerfully confirms that self-medication with antibiotics is a massive and prevalent issue among Bangladeshi teenagers, regardless of their academic background.

The key inference is the counterintuitive finding from the Curriculum Paradox: Students who formally study antibiotics (Group B) report a significantly higher rate of misuse (89.5% “Yes”) than those without curriculum exposure (Group A, 74.5% “Yes”). This suggests that Group A’s lack of formal knowledge may instill a greater sense of caution or fear regarding the drug, making them more hesitant to use it without a prescription. Conversely, Group B’s formal, yet likely incomplete, knowledge may breed false confidence and overestimation of their own competence leading to reckless self-prescription. This highlights a fundamental failure in the educational system to translate scientific facts into responsible behavior.

Question (3) Do you think it’ s okay to stop taking antibiotics once you feel better even though your course is unfinished?

group (A) consists of people who do not study antibiotics in their main curriculum. 

group(B) consists of people who do study antibiotics in their main curriculum. 

Response	Group A (National + EM No Bio)	Group B (EM)
Yes	1 person	1 person
No	47 people	82 people
Not Sure (N/S)	3 people	3 people
Total	51 people	86 people

Key Comparison Findings

Both groups responded “No” at a very high rate, with Group B (EM) slightly higher at 95.3% and Group A at 92.2%.

The “Yes” rate is almost non-existent for both groups, just for Group B.

The “Not Sure” rate is low and the same for both.

Inference

This data demonstrates that awareness regarding the necessity of completing the full antibiotic course is highly consolidated among teenagers, irrespective of formal schooling. The minuscule difference in correct responses suggests that the knowledge required for this specific rule is effectively disseminated by external sources (doctors, pharmacists, or parental instruction) rather than being reliant on the school curriculum.

Observing a slightly higher accuracy and fewer “Not Sure” responses simply confirms that formal study provides a marginal degree of certainty, reinforcing a rule that the students have already learned from the public domain. Critically, this widely known rule (completing the course) stands in sharp contradiction to the behavioral data, highlighting a critical failure to connect the known consequences of misuse with responsible action.

Question (4) Do you believe the misuse of antibiotics can make bacteria harder to kill?

group (A) consists of people who do not study antibiotics in their main curriculum. 

group(B) consists of people who do study antibiotics in their main curriculum. 

Response	Group A (National + EM No Bio)	Group B (EM)
Yes	45 people	77 people
No	5 people	3 people
Not Sure (N/S)	1 person	6 people
Total	51 people	86 people

Key Comparison Findings

“Yes” Responses are Nearly Identical as both groups showed a high rate of positive responses, with 89.5% for Group B and 88.2% for Group A.

Group A had a significantly higher rate of negative answers at 9.8%, compared to 3.5% in Group B.

Not Sure Responses in group B had a higher proportion of “Not Sure” responses compared to Group A 

Inference

This finding confirms that awareness about the core concept of Antibiotic Resistance (AMR) that misuse makes bacteria harder to kill, is extremely strong and uniform among teenagers (Group B: 89.5% vs Group A: 88.2% “Yes”). This foundational knowledge is clearly well disseminated across all curricula, suggesting the information is part of the general academic environment or public health messaging.

The slight increase in “Not Sure” responses in Group B suggests that the curriculum, while confirming the knowledge, also teaches the complexity of AMR, leading students to acknowledge nuance rather than offering a simple “Yes.” Critically, the overwhelming theoretical recognition of AMR’s danger (Q4) stands in direct contradiction to the high rates of misuse (Q2) and inappropriate recommendation (Q5), indicating a severe breakdown between scientific knowledge and responsible health action.

Question (5) if a friend of yours has fever or cold, would you recommend antibiotics to them?

group (A) consists of people who do not study antibiotics in their main curriculum. 

group(B) consists of people who do study antibiotics in their main curriculum. 

Response	Group A (National + EM No Bio)	Group B (EM)
Yes	38 people	76 people
No	10 people	6 people
Not Sure (N/S)	3 people	4 people
Total	51 people	86 people

Key Comparison Findings

Group B (EM) had a significantly higher proportion of positive answers at 88.4%, compared to 74.5% in Group A.

Group A had a much higher rate of negative answers at 19.6%, compared to 7.0% in Group B.

The proportion of “Not Sure” responses was low and similar between the groups, with Group A slightly higher compared to Group B 

So, what does this mean?

majority of participants in both groups would inappropriately recommend antibiotics (Group B: 88.4%; Group A: 74.5%). This would suggest a fundamental lack of awareness that these common ailments are typically viral, not bacterial.

Group B is significantly more likely to recommend them (88.4%) than Group A (does not study antibiotics) (74.5%). This suggests the current formal curriculum may be reinforcing, rather than correcting, the culture of antibiotic misuse.

Low “No” Response: The extremely low “No” rate in group B (7.0%) is particularly concerning, indicating that simply possessing formal knowledge about antibiotics may not translate into responsible decision-making also

What conclusion can we draw from all this?

In conclusion, the findings of this study suggest that the majority of participants, regardless of whether they had formally studied antibiotics or not, possessed a general understanding of their intended use. However, a significant proportion of respondents admitted to having taken antibiotics without a doctor’s prescription.

Interestingly, while many of these same individuals acknowledged that it is inappropriate to discontinue an antibiotic course before completion, they nonetheless engaged in the practice of self-medicating. This contradiction highlights a concerning gap between knowledge and behavior. As Dr. Tom Frieden, former Director of the CDC, noted about health issues

“Awareness without action is useless.”

If students recognize the importance of completing a prescribed course, then it raises the question of why they do not seek proper medical consultation in the first place to ensure they are taking the right medication at the correct dosage.

Furthermore, although the majority were able to correctly identify that the misuse of antibiotics contributes to the development of stronger, resistant bacteria, they still indicated a willingness to recommend antibiotics inappropriately to friends suffering from common illnesses such as fever or cough. These findings bring up a critical issue: while awareness of the dangers of antibiotic misuse exists, it does not consistently translate into responsible action.

The Hidden Influence

Beyond the broad societal factors identified by the WHO, a more intimate form of neglect may be fueling this crisis among the youth, the transfer of poor medication habits from parent to child.

Through personal observation, it is clear that many young participants in this survey simply take medication at the direction of a parent, often “without any proper explanation” of the drug’s purpose or risks. This system—where the child is taught to comply rather than understand is a form of neglect in learning that may directly contribute to future antibiotic misuse.

This anecdotal evidence is powerfully supported by formal research in Bangladesh:

• Studies show that 75% of young respondents engage in non-prescribed medication use, often for minor ailments like fever and cold.
• The primary drivers of this behavior are not physician advice, but rather recommendation by others and reliance on previous use experience. Categories that perfectly capture the authoritative yet uninformed parental directive.
• Critically, research confirms that there is a significant knowledge gap among parents regarding appropriate antibiotic use, with up to 64% of parents in one Dhaka study exhibiting misuse.

This evidence suggests a vicious cycle: when parents lack the knowledge to administer drugs responsibly, their children are denied the opportunity to learn correct usage, thus guaranteeing that the next generation remains a victim of inherited medicinal neglect. 

Recommendations and proposed solutions

Awareness campaigns

The Viqarunnisa Noon School & College (VNSC) art competition provides a powerful model for effective, youth-focused educational campaigns. By distributing comic books to 481 students and engaging 404 in a competition, VNSC demonstrated a method that uses art to help students internalize and express complex health information

The comic, featuring Tinu, Minu, and the Super Bug, effectively conveys core AMR prevention messages: using prescribed medication only, completing the full course, and avoiding sharing. This reaches a large number of students (404 participants) and equips them as future stewards of responsible antibiotic use.

Such campaigns should be replicated nationally, with local schools serving as hubs for interactive, non-didactic learning about AMR.

Government Initiatives in Bangladesh

The Government of Bangladesh is actively addressing antimicrobial resistance through policy and educational reforms. Efforts to combat AMR include three key policy initiatives, which should be credited to ongoing government studies and action plans:

The government is working to formally incorporate appropriate antibiotic use and AMR awareness into the national school curriculum. This aims to establish foundational health literacy among students.

Efforts are underway to mandate specialized labeling on all antibiotic packaging. This is designed to clearly distinguish antibiotics from other drugs and reinforce the critical messages about responsible consumption.

The government continues to invest in studies and surveillance systems to track resistance patterns and inform targeted policy actions.

The Crucial Role of Parental Education

While government and school initiatives are essential, the most immediate and profound impact can be made within the home. The observation that many students simply follow parental direction to take medication without any proper explanation points to a critical failure at the family level.

Parents must transition from being unquestioned distributors of medicine to being educators on antibiotics. Instead of merely instructing children to just eat it, parents should

Explain that antibiotics treat bacteria, not viruses (like the common cold).

Emphasize the importance of completing the full course of treatment, even when the child feels better.

Clearly state that leftover antibiotics should never be saved or shared.

This shift in parental behavior from simple directive to informed explanation is vital. It instills in children a sense of responsibility and critical thinking about medication, directly countering the cultural neglect that drives antibiotic misuse.

Final conclusion

This research confirms that while general awareness of antibiotic function is high among Bangladeshi teenagers, this knowledge fails to translate into responsible behavior. The study highlights a critical gap that students are simultaneously aware of AMR’s danger and willing to misuse antibiotics or recommend them inappropriately. This behavioral failure, rooted in inherited poor habits and the curriculum paradox where formal study does not curb misuse, demonstrates that youth are indeed victims of systemic and familial neglect.

Ultimately, combating AMR requires shifting the focus from mere awareness to enforcing responsible action through integrated policy, targeted educational campaigns, and, most crucially, informed parental guidance. As the UN Secretary-General António Guterres stated in reference to AMR,

“We are losing our ability to protect humans and animals from disease.”

This paper argues that despite high general awareness, antibiotic misuse among Bangladeshi teenagers persists due to a critical gap between knowledge and behavior, demonstrating that youth are becoming victims of both systemic and familial neglect which the current formal education system is failing to correct.