Background: Antibiotic resistance is one of the biggest global threat in modern medicine. The situation is even more consequential in lower-and middle-income countries (LMIC) as financial limitations and political instability may become barriers to an impactful health policy. Therefore, The World Health organization has urge all nations to increase public awareness on antibiotic through effective educational interventions. In order for interventions to be successful, it is important to acknowledge that each country is unique in its problems as the demographic in LMIC are diverse. This study aims to identify the community’s attitude appropriateness towards antibiotic usage and their knowledge gaps, the relationship between antibiotic knowledge and their attitude as well as factors associated with inappropriate attitude towards antibiotic among outpatients attending an established primary care specialist center in Malaysia.Methodology : This cross-sectional study was conducted among 256 respondents attending a public primary care specialist clinic center. Those who fulfilled the inclusion and exclusion criteria from June to August 2017 were given a self-administered, validated and translated questionnaire. Pearson correlation was used to deduce the relationship between knowledge and attitude. Chi square test, independent t-test and multiple logistic regression were used to determine factors associated with inappropriate attitude towards antibiotic.Results: It was found that the respondents’ mean attitude and knowledge score were 29.5 ± 4.19 and 5.94 ± 2.4 respectively. The highest inappropriate attitude response was expecting antibiotic from the doctor for common colds and the most frequent incorrect knowledge response was on the domain of role of antibiotics. There is a weak positive relationship between antibiotic knowledge and attitude (r=0.315, n=256, p=0.0001). Respondents with low education level and poor antibiotic knowledge were at least 2.5 times more likely to have inappropriate attitude when handling antibiotics.Conclusion: Our study demonstrated the common inappropriate attitude towards antibiotic and areas of knowledge gap among the population. Antibiotic education should be incorporated in non-pharmacological measures of viral illnesses that is targeted among those with low education and poor antibiotic knowledge. The weak relationship between antibiotic knowledge and attitude suggest that health campaign should focus on behavioral change rather than a theoretical approach.

Background: Reports of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child delivery facilities. We aimed to explore the reasons for women to make such decision. Methods: Twelve mothers participated in-depth interviews. They were identified using snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literature. The interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Results: Women in this study described a range of birthing experiences and personal beliefs to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) a natural process, iii) expressing autonomy and iv) faith, as reasons for choosing unassisted homebirth. Such decision was firm and strong despite the possible risks and complications that can occur during home birthing. Giving birth is perceived to occur naturally regardless of assistance and home birthing provide the preferred environment which health facilities may lack. Women believed that they were much in control of the birth processes apart from fulfilling the spiritual beliefs. Conclusions: Women may choose unassisted home birth to express their personal beliefs and values, at the expense of the health risks. Apart from increasing mothers’ awareness of the possible complications arising from unassisted home births, urgent efforts is needed to providing a better birth experiences in healthcare facilities that resonate with the mothers’ beliefs and values. Keywords: Home birth; free birth; unassisted home birth; Malaysia; healthcare delivery system; qualitative.