Prevalence of knowledge, attitudes, and practices regarding antimicrobial resistance in Africa: a systematic review and meta-analysis
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SUBMITTER: Atalay Y
PROVIDER: S-EPMC10996921 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:The misuse of antimicrobials in livestock may lead to the emergence and spread of resistant pathogens harmful to human, animal, and environmental health. Therefore, determining the behavior and practices of farmers regarding antimicrobial use (AMU) and antimicrobial resistance (AMR) is crucial for addressing the growing threat of AMR. This cross-sectional study was conducted in the Eastern Province of Rwanda on 441 participants using a structured questionnaire to determine the knowledge, attitudes, and practices (KAP) towards AMU and AMR. Frequency distributions, chi-square test of association and logistic regression model were used to analyze the data. This study showed poor biosecurity measures at the farm level with various antimicrobials used here; 83.9% of participants obtained them from friends and neighbors and 61.9% used them for growth promotion. Our assessment revealed a low level of KAP towards AMR among cattle farmers from the study districts. Our data showed that at a 69% cutoff, only 52.6% of farmers had correct knowledge, whereas 56% had good attitudes (47% cutoff). Finally, 52.8% had correct practices toward AMR based on a calculated cutoff of 50%. Positive attitudes, correct knowledge, and practices regarding AMU and AMR were associated with higher educational levels. Sex was correlated with knowledge and attitudes, whereas farm location was associated with attitudes and practices. Farmers expressed a need for more access to veterinary services and AMR-related training for themselves, the community animal health workers, and veterinarians. This study highlighted the low levels of KAP associated with using antimicrobials, which may lead to the misuse of antimicrobials and the spread of AMR. It is imperative to develop and implement cross-cutting measures to minimize antibiotic usage and reduce the risk of antibiotic resistance.
| S-EPMC11008905 | biostudies-literature
Project description:The use of antibiotics in livestock production is considered a major driver of antibiotic resistance on a global scale. In Vietnam, small- and medium-scale livestock producers dominate the domestic market and regulatory pushes have done little to decrease antibiotic use. In order to inform future policy directions, this study aims to explore knowledge, attitudes, and practices amongst livestock producers to identify their perspectives on antibiotic use and resistance. A total of 392 small- and medium-scale producers specialized in pig, poultry and aquaculture production participated in the study. The results showed that the primary reason for antibiotic use reported by producers was for the treatment of infections (69%). However, prophylactic use was also evident, with farmers reporting other reasons for antibiotic use such as "animals display abnormal symptoms or behaviour" (55%), the "weather is about to change" (25%), or "animals on neighboring farms fall ill" (27%). Only one-fifth of producers demonstrated favorable attitudes towards antibiotic use and preventing antibiotic resistance. Moreover, administering antibiotics remained the preferred countermeasure directly applied by farmers at the first indication of disease (17%), compared to enacting hygiene (10%) or quarantine (5%) measures. The results showed divergent trends amongst producers, with pig producers demonstrating higher levels of knowledge, more favorable attitudes, and higher self-reported utilization of good practice. Better knowledge, attitudes, and practices were also associated with producers who engaged in efforts to explore information on antibiotic use and resistance, which improved incrementally with the number of sources consulted and hours invested. However, there were some areas where increased knowledge or more favorable attitude scores did not translate into better practices. For instance, producers with higher levels of formal education performed significantly better than those with lower education in terms of knowledge and attitude, though both groups reported similar practices. The findings of this study may support future interventions to prevent both antibiotic misuse and the development of antimicrobial resistance.
| S-EPMC6760827 | biostudies-literature
Project description:The diagnosis, etiology, and optimal management of fibromyalgia remains contentious. This uncertainty may result in variability in clinical management. We conducted a systematic review and meta-analysis of cross-sectional studies examining physicians' knowledge, attitudes, and practices regarding fibromyalgia. We searched MEDLINE, Embase, and PubMed from inception to February 2023 for cross-sectional surveys evaluating physicians' attitudes toward, and management of, fibromyalgia. Pairs of independent reviewers conducted article screening, data extraction, and risk of bias assessment in duplicate. We used random-effects meta-analysis to pool proportions for items reported by more than one study and the Grading of Recommendations Assessment, Development, and Evaluation approach to summarize the certainty of evidence. Of 864 citations, 21 studies (8904 participants) were eligible for review. Most physicians endorsed fibromyalgia as a distinct clinical entity (84%; 95% confidence interval [CI], 74-92), and half (51%; 95% CI, 40-62) considered fibromyalgia a psychosocial condition. Knowledge of formal diagnostic criteria for fibromyalgia was more likely among rheumatologists (69%, 95% CI, 45-89) versus general practitioners (38%, 95% CI, 24-54) (P = .04). Symptom relief was endorsed as the primary management goal by most physicians (73%, 95% CI, 52-90). Exercise, physiotherapy, antidepressants, nonsteroidal anti-inflammatory drugs, and non-opioid analgesics were most endorsed for management of fibromyalgia, but with wide variability between surveys. Opioids and most complementary and alternative interventions (e.g., homeopathy, chiropractic, and massage) received limited endorsement. There is moderate certainty evidence to suggest that physicians are divided regarding whether fibromyalgia is a biomedical or psychosocial disorder. Physicians typically prioritize symptom relief as the primary goal of management, and often endorse management with exercise, non-opioid analgesics, nonsteroidal anti-inflammatory drugs, antidepressants, and physiotherapy (moderate to high certainty evidence); however, important practice variation exists.
| S-EPMC11296454 | biostudies-literature
Project description:Antimicrobial resistance (AMR) is a silent pandemic that has claimed millions of lives, and resulted in long-term disabilities, limited treatment options, and high economic costs associated with the healthcare burden. Given the rising prevalence of AMR, which is expected to pose a challenge to current empirical antibiotic treatment strategies, we sought to summarize the available data on knowledge, attitudes, and practices regarding AMR in Ethiopia. Articles were searched in international electronic databases. Microsoft Excel spreadsheet and STATA software version 16 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 checklist was followed. The methodological quality of the studies included was assessed by the Joana Briggs Institute critical appraisal checklists. The random-effect meta-analysis model was used to estimate Der Simonian-Laird's pooled effect. Statistical heterogeneity of the meta-analysis was checked through Higgins and Thompson's I2 statistics and Cochran's Q test. Publication bias was investigated by funnel plots, and the regression-based test of Egger for small study effects with a P value < 0.05 was considered to indicate potential reporting bias. In addition, sensitivity and subgroup meta-analyses were performed. Fourteen studies with a total of 4476 participants met the inclusion criteria. Overall, the pooled prevalence of good AMR knowledge was 51.53% [(95% confidence interval (CI): 37.85, 65.21), I2 = 99.0%, P <0.001]. The pooled prevalence of favorable attitudes and good practices were 63.43% [(95% CI: 42.66, 84.20), I2 = 99.6, P <0.001], and 48.85% [(95% CI: 38.68, 59.01), I2 = 93.1, P <0.001] respectively. In conclusion, there is a significant knowledge and practice gap on AMR among the general public, patients, and livestock producers. As a result, we call for greater educational interventions to raise awareness and build a strong national AMR narrative.
| S-EPMC10256206 | biostudies-literature
Project description:BackgroundInappropriate and injudicious use of antimicrobials in broiler and layer farms has become a common practice in lower and middle-income countries including Bangladesh. This study aimed to assess poultry farmers' knowledge, attitude, and practices regarding antimicrobial usage (AMU), and their beliefs in factors that affect antimicrobial resistance (AMR) spread and emergence in humans through commercial poultry farms in Bangladesh.MethodsA cross-sectional study was conducted among 204 farmers (95.6% male; meanage = 35.14 ± 10.25 years) in the Rajshahi district of Bangladesh who were recruited from three upazilas (sub-districts) through a multistage sampling technique. Data were collected from June to November 2021 via face-to-face interviews using a semi-structured questionnaire.ResultsThe proportion of farmers who reported having received information regarding AMU from veterinarians was higher in layer compared to broiler farms (65.9% vs. 44.9%, p < 0.001). A higher proportion of layer compared to broiler farmers believed that antimicrobial residues and pathogens in poultry can pass to humans through the consumption of contaminated eggs (28.1% vs. 5.8%, p < 0.05). The mean score of the farmers' attitude towards addressing AMU was 4.49 (SD = 1.37) out of 7, with the higher score indicating a better attitude. The mean score of better attitudes towards addressing AMU was significantly higher among educated participants (bachelor's or higher levels of education (p = 0.006). A higher proportion of layer (56.3%) farmers did not keep a record of AMU when compared to broiler farmers (37.7%) (p = 0.012). More broiler (50.7%) compared to layer (38.5%) farmers continued using the full dose of antimicrobials (p = 0.042). The most frequently used antimicrobials in broiler and layer poultry farms were Colistin (broiler vs layer: 73.9% vs. 86.75%; p = 0.024), and Ciprofloxacin (broiler vs. layer: 95.7% vs. 84.4%; p = 0.021). Farmers' beliefs were significantly associated with the spread of AMR pathogens from contaminated eggs to humans (p < 0.001).ConclusionsThe findings reflected that majority of farmers had inadequate knowledge of AMU, less knowledgeable beliefs aboutAMU, and inappropriate AMU (e.g., poor record keeping, incomplete doses) in chicken production systems. The government should ensure education or advisory services for poultry farmers on proper AMU, enforce current veterinary laws and regulations on antimicrobials, and implement AMU surveillance systems.
| S-EPMC9665401 | biostudies-literature
Project description:BackgroundIn the intensive care unit (ICU), infections due to multidrug-resistant (MDR) bacteria lead to poor clinical outcomes, prolonged ICU and hospital stays, high mortality and morbidity rates, and higher patient care cost. This study investigated knowledge, attitudes and practices (KAP) of ICU head nurses in Iran towards infection prevention and control (IPC) measures and antimicrobial resistance (AMR).MethodsThis study was conducted among 61 ICU head nurses of the 36 hospitals in Isfahan, Iran on 19th July 2023. Data was collected by self-administer questionnaires. Data analysis was performed using SPSS version 25.0 level of significance was considered to be less than 0.05 in all tests.ResultsOf the 61 participants, 56 (91.8%) were female and their ages ranged from 27 to 56 years old with a mean age of 39.3 ± 5.6 years. 75.4% of participants had a bachelor's degree and 24.6% had a master's degree. The mean work experience in the ICU and duration of experience in the hospital was 8.1 and 16.2 years, respectively. The mean scores for KAP were 3.84 ± 1.86 (with a range of 0-9), 55.00 ± 12.50, 35.84 ± 4.19 (with a range of 24-48) and 21.27 ± 3.13 (with a range of 17-29), respectively. There was a significant relationship between knowledge and total years of experience (r = 0.256, P < 0.048).ConclusionThe study showed that most participants had weak knowledge, a positive attitude and weak practices. Consequently, more emphasis is needed to improve the ICU head nurses' KAP toward IPC measures and AMR, especially in areas where gaps were identified. Additionally, there is a need to an educational plan on these topics in the training of nursing programs.
| S-EPMC11905550 | biostudies-literature
Project description:The use of antibiotics in animals for both therapeutic and non-therapeutic purposes is a major driver of the emergence and spread of antimicrobial resistance (AMR). While several studies have investigated prescription and consumption patterns in humans, little attention has been paid to the veterinary sector. A cross-sectional study was conducted in 3002 veterinary students (VS) and non-medical students (NMS) from 12 universities in Bangladesh to explore their knowledge, attitudes and practices (KAP) about antibiotics and AMR using a self-administered questionnaire, and assess the influence of the veterinary curriculum. KAP regarding antibiotic use and AMR was significantly higher in veterinary than non-medical students, and in first-year than final-year students. However, gaps in knowledge and practices were highlighted, suggesting deficiencies in training. Moreover, final-year veterinary students were found to be more likely than first-year students to use antibiotics without instructions, which could indicate deficiencies in their curriculum. Although the study suggested a positive impact of the veterinary curriculum on KAP about antibiotics and AMR in Bangladesh, critical gaps remain that are likely to contribute to inadequate use in their future practice. Therefore, there is scope for improving educational programs on AMR in professional curricula.
| S-EPMC8004205 | biostudies-literature
Project description:BackgroundThis study aims to investigate the knowledge, attitudes, and practices (KAP) regarding keratopathy among diabetic patients.MethodsA web-based cross-sectional study was conducted between May 26, 2023, and September 18, 2023, at Yantai Shan Hospital and Yantai Yuhuangding Hospital. Demographic information and KAP were assessed through the distribution of questionnaires.ResultsAmong the 521 participants, average knowledge, attitude, and practice scores were 6.11 ± 4.53, 27.61 ± 4.41, and 37.25 ± 5.21, respectively. Path analysis revealed a significant association between attitude and knowledge (β = 0.416, P < 0.001), and practice(β = 0.683, P < 0.001). Multivariate logistic regression indicated that attitude score (OR = 1.288, 95%CI: 1.203-1.379, P < 0.001), higher monthly incomes(> 10000 RMB) (OR = 3.494, 95%CI: 1.104-11.055, P = 0.033), higher self-rated control levels(4 and 5 points) (OR = 3.729, 95%CI: 1.687-8.243, P = 0.001 and OR = 3.801, 95%CI: 1.560-9.261, P = 0.003 respectively) and family history of ophthalmic diseases (OR = 0.297, 95%CI: 0.115-0.762, P = 0.012) were independently associated with proactive practice.ConclusionDiabetic patients demonstrated inadequate knowledge, moderately positive attitudes, and reasonably proactive practices concerning keratopathy. The study emphasizes the impact of attitude on practice, influenced by knowledge and other factors such as self-rated blood sugar control and family history of ophthalmic diseases.
| S-EPMC11600788 | biostudies-literature
Project description:ObjectiveTo evaluate knowledge of antimicrobial resistance (AMR), to study how the judgement of health value (HVJ) and economic value (EVJ) affects antibiotic use, and to understand if access to information on AMR implications may influence perceived AMR mitigation strategies.DesignA quasi-experimental study with interviews performed before and after an intervention where hospital staff collected data and provided one group of participants with information about the health and economic implications of antibiotic use and resistance compared with a control group not receiving the intervention.SettingKorle-Bu and Komfo Anokye Teaching Hospitals, Ghana.ParticipantsAdult patients aged 18 years and older seeking outpatient care.Main outcome measuresWe measured three outcomes: (1) level of knowledge of the health and economic implications of AMR; (2) HVJ and EVJ behaviours influencing antibiotic use and (3) differences in perceived AMR mitigation strategy between participants exposed and not exposed to the intervention.ResultsMost participants had a general knowledge of the health and economic implications of antibiotic use and AMR. Nonetheless, a sizeable proportion disagreed or disagreed to some extent that AMR may lead to reduced productivity/indirect costs (71% (95% CI 66% to 76%)), increased provider costs (87% (95% CI 84% to 91%)) and costs for carers of AMR patients/societal costs (59% (95% CI 53% to 64%)). Both HVJ-driven and EVJ-driven behaviours influenced antibiotic use, but the latter was a better predictor (reliability coefficient >0.87). Compared with the unexposed group, participants exposed to the intervention were more likely to recommend restrictive access to antibiotics (p<0.01) and pay slightly more for a health treatment strategy to reduce their risk of AMR (p<0.01).ConclusionThere is a knowledge gap about antibiotic use and the implications of AMR. Access to AMR information at the point of care could be a successful way to mitigate the prevalence and implications of AMR.
| S-EPMC9950892 | biostudies-literature
Project description:Antimicrobial resistance (AMR) is a global health concern and the inappropriate use of antibiotics in animals and humans is considered a contributing factor. A cross-sectional survey to assess the knowledge, attitudes and practices of veterinarians regarding AMR and antimicrobial stewardship was conducted in Nigeria. A total of 241 respondents completed an online survey. Only 21% of respondents correctly defined the term antimicrobial stewardship and 59.8% were unaware of the guidelines provided by the Nigeria AMR National Action Plan. Over half (51%) of the respondents indicated that prophylactic antibiotic use was appropriate when farm biosecurity was poor. Only 20% of the respondents conducted antimicrobial susceptibility testing (AST) frequently, and the unavailability of veterinary laboratory services (82%) and the owner's inability to pay (72%) were reported as key barriers to conducting AST. The study findings suggest strategies focusing on the following areas may be useful in improving appropriate antibiotic use and antimicrobial stewardship among veterinarians in Nigeria: increased awareness of responsible antimicrobial use among practicing and newly graduated veterinarians, increased dissemination of regularly updated antibiotic use guidelines, increased understanding of the role of good biosecurity and vaccination practices in disease prevention, and increased provision of laboratory services and AST at affordable costs.
| S-EPMC7460309 | biostudies-literature