Knowledge, Attitude and Practices of the Public and Healthcare-Professionals Towards Sustainable Use of Antimicrobials: The Intersection of Pharmacology and Social Medicine

Introduction: Self-medication with antibiotics (SMA) is a widespread problem in developing nations, including Tanzania.

Methods: This study compared knowledge, attitudes, practices, and factors influencing antibiotic SMA among medical and non-medical students.

Results: The prevalence of SMA among medical students was 49.1% and 59.2% among non-medical students, respectively. The mean knowledge score of medical students (6.4) was significantly higher (p-value <0.001) than that of non-medical students (5.6). The main factors influencing SMA practices were the availability of antibiotics without a prescription, easy access to pharmacies, and a lack of knowledge about the risks of SMA. This experience was pivotal in influencing medical students to take antibiotics, with a substantial proportion of 67.5% as opposed to 59.4% of non-medical students. Medical students were 1.6 times more likely to self-medicate with antibiotics than non-medical students (Adjusted Odds Ratio (AOR): 1.6; 95% Confidence Interval (CI): 1.2–2.3, p-value = 0.004). Age was also associated with self-medication, with an AOR of 1.1 (95% CI: 1.04–1.2, p-value = 0.006) per year increase in age. Additionally, attitude was associated with self-medication, with an AOR of 1.05 (95% CI: 1.04–1.1, p-value = 0.001) per unit increase in attitude score.

Discussion: No significant associations were found between sex, marital status, having children, year of study, knowledge score, and self-medication with antibiotics. This study emphasizes the importance of educational interventions and public awareness campaigns to promote antimicrobial stewardship, appropriate antibiotic use, and preventing pharmacies from dispensing antibiotics without a prescription.

Antimicrobial resistance (AMR) is a major threat to global health and a key One Health challenge linking humans, animals, and the environment. Livestock are a key target for moderation of antimicrobial use (AMU), which is a major driver of AMR in these species. While some studies have assessed AMU and AMR in individual production systems, the evidence regarding predictors of AMU and AMR in livestock is fragmented, with significant research gaps in identifying the predictors of AMU and AMR common across farming systems. This review summarizes existing knowledge to identify key practices and critical control points determining on-farm AMU/AMR determinants for pigs, layer and broiler hens, beef and dairy cattle, sheep, turkeys, and farmed salmon in Europe. The quality and quantity of evidence differed between livestock types, with sheep, beef cattle, laying hens, turkeys and salmon underrepresented. Interventions to mitigate both AMU and/or AMR highlighted in these studies included biosecurity and herd health plans. Organic production typically showed significantly lower AMU across species, but even in antibiotic-free systems, varying AMR levels were identified in livestock microflora. Although vaccination is frequently implemented as part of herd health plans, its effects on AMU/AMR remain unclear at farm level. Social and behavioral factors were identified as important influences on AMU. The study fills a conspicuous gap in the existing AMR and One Health literatures examining links between farm management practices and AMU and AMR in European livestock production.