Knowledge, Attitudes, and Practices Regarding Antimicrobial Resistance among Healthcare Professionals (HCPs) in Anambra State, Nigeria

Abstract

Chinelo K. Ezejiegu, Benjamin O. Anyigor, Anieto C. Ezinne, Ikeotuonye B. Chimdalu and Ebenebe Ijeoma

Background: Antimicrobial resistance (AMR) is a major global health threat. In Anambra State, underfunding, poor infrastructure, and underutilization of public healthcare facilities contribute to suboptimal antimicrobial use, increasing the risk of healthcare-associated infections and resistant organisms. As the behavioral and systemic drivers of prescribing remain understudied in resource-limited settings, assessing healthcare providers’ knowledge, attitudes, and practices (KAP) is essential.

Purpose: The survey was carried out to assess HCPs’ knowledge, attitudes, and practices regarding antimicrobial resistance, stewardship principles, and antibiotic policy awareness.

Method: The study employed a descriptive cross-sectional design using physical and online questionnaires to survey 150 healthcare professionals, including physicians, pharmacists, and nurses, practising in Awka metropolis, Anambra State. The study assessed awareness and knowledge of AMR, stewardship principles, antibiotic policy familiarity, attitudes, confidence, and antimicrobial practices.

Results: Overall awareness of antimicrobial resistance (AMR) was high, with 83.3% recognizing AMR as a problem in Anambra State and 90% rejecting antibiotic sharing. Physicians and pharmacists demonstrated significantly better knowledge of AMR causes and WHO AWaRe antibiotic classifications than nurses (p < 0.001). Only 22.1% were aware of institutional or national antibiotic guidelines. Lower scores were observed for narrow-spectrum antibiotic use, avoidance of unnecessary prophylaxis, and limiting treatment duration. Active prescribers demonstrated higher stewardship practice scores than non-prescribers. Respondents reported positive attitudes toward AMR prevention and strong patient counselling practices, particularly pharmacists. Educational campaigns, stewardship guidelines, infection control, and antimicrobial sales regulation were the most commonly identified AMR control strategies.

Conclusion: Low awareness of antimicrobial policies highlights a major challenge to stewardship implementation. The findings suggest the need for multidisciplinary stewardship education, better guideline dissemination, stronger institutional stewardship programs, and greater integration of pharmacists and nurses into stewardship initiatives.

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