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Parental awareness and practices regarding paracetamol use in children: A cross-sectional study from Pakistan

Muhammad Saad Nadeem Butt¹, Sana Shah²

¹Islam Medical College, Sialkot, Pakistan.

PLOS Global Public Health

|October 23, 2025

Insights

Parental awareness of paracetamol (acetaminophen) usage and toxicity is critically low in Pakistan. Most parents lack sufficient knowledge, increasing the risk of paracetamol poisoning in children and necessitating educational interventions.

Area of Science:

Pharmacology
Public Health
Pediatrics

Background:

Paracetamol is a widely used analgesic and antipyretic, available over-the-counter (OTC).
Parental awareness regarding paracetamol usage and toxicity in children is a global concern, particularly understudied in Pakistan.
Medication-associated toxicity in low-resource settings poses significant public health risks.

Purpose of the Study:

To assess parental awareness of paracetamol usage and toxicity in Sialkot city, Pakistan.
To identify critical public health risks associated with improper paracetamol use in children.
To inform policy interventions for reducing medication-associated toxicity.

Main Methods:

A cross-sectional study was conducted using an Urdu-language questionnaire adapted from previous literature.
Data were collected from 418 parents (67% mothers) across six pediatric healthcare facilities.
A knowledge score was used to assess parental awareness, with insufficient knowledge defined as scoring below 66.67%.

Main Results:

Nearly all participants used paracetamol for fever (99%), while fewer used it for pain (18%) or general illness symptoms (81%).
Most parents administered paracetamol as syrup, with healthcare providers being the primary source of dosage information.
Only 32.8% of parents knew that paracetamol overdose could be harmful, and 75.8% demonstrated insufficient knowledge.

Conclusions:

A significant lack of parental knowledge regarding appropriate paracetamol use and its toxicity risks was identified in Pakistan.
The findings highlight a substantial risk of paracetamol poisoning due to widespread insufficient awareness.
Educational initiatives are crucial to improve parental knowledge, reduce toxicity risks, and enhance safe paracetamol administration in children.

Read full analysis

Abstract:

Paracetamol is the one of the most widely administered drug as an analgesic and antipyretic due to its efficacy, safety, and over-the-counter (OTC) nature and is present in various pharmaceutical forms. Paracetamol usage in children is a global concern yet understudied in Pakistan. The present study was conducted to assess parental awareness regarding paracetamol usage and toxicity, highlighting critical public health risks and informing policy interventions aimed at lowering medication-associated toxicity in low-resource settings. This cross-sectional study aimed at assessing parental awareness in Sialkot city of Pakistan via a Urdu-language questionnaire (adapted from previous literature after pilot testing and expert review) was used as a tool to collect data. Questionnaire was distributed in six pediatric healthcare facilities. 450 parents were approached out of which only 420 gave consent and met inclusion and exclusion criteria. 2 responses were removed due to missing data. A total of 418 parents were interviewed, of which 67 % were mothers. Almost 99 % used it as an antipyretic, 18 % used it as an analgesic, and 81 %(n = 340) of the participants employed its use for the symptoms of illness (cough, flu, and vomiting). Most participants used paracetamol as a syrup. Health-care providers were the primary source of knowledge for paracetamol dosage. Only 32.8 % of participants were aware that a paracetamol overdose can cause harm. Approximately 75.8 % of the 418 participants scored below 66.67 % (4/6 questions) on the knowledge score and are considered to have insufficient knowledge. The current study highlights the lack of knowledge in parents regarding proper paracetamol usage which poses a significant risk of paracetamol poisoning. It underscores the importance of implementation of educational initiatives aimed at reducing the risks of toxicity and increasing awareness and knowledge regarding paracetamol among parents.

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