Rational use of antimicrobials is the main strategy to prevent AMR, which is achieved by changing the prescribers’ behavior and knowledge [3, 7, 8]. In this work, it was depicted that 55 % of the participants experienced a poor knowledge about antimicrobial resistance, which was comparatively low as compared to other studies done in India, Malaysia, Portugal, Trinidad and Tobago, which reported a better understanding of antimicrobial resistance among the study participants [8, 24,25,26].
More than 50 % of the study participants were well informed about the effect of the frequent use of antibiotics on drug efficacy, the cause of antimicrobial resistance and the consequences of inappropriate utilization of antibiotics. Nevertheless, the bulk of the participants had a misconception about the strategies to control antimicrobial resistance, the importance of antibiotics for common cold /flu, and the essence of poor hygiene practices on the spread of bacteria in healthcare contexts. For instance, 98.8% of the participants understood that inappropriate use of antibiotics puts their patients at risk but only 35% of the participants correctly answered whether antibiotics can speed up the recovery of common cold/flu or not. This outcome was very inadequate as compared to other studies, in which 62% of students at Ahmad et al. and 95% of students at Jamshed et al. correctly answered this question [24, 26]. The target populations in Jamshed et al. and Ahmad et al. studies were only pharmacy and medical students. This might be the possible reason for the disagreement. This suggests that participants had an encouraging score on knowledge questions embedded in basic science even if they underperformed on the queries that need practical exposure.
Furthermore, misunderstanding of antibiotic indication and effectiveness was clearly noticed. Around 28% of the participants conceived that antibiotics could kill both viruses and bacteria. This result was encouraging as compared to a study conducted in Portugal, in which more than 60% of their participants stated that antibiotics should be prescribed for viral illness . Such misconception may lead to high rate of inappropriate use of antibiotics, which in turn fuels the expanding antimicrobial resistance. Sadasivam et al. suggested that creating clear understanding about the therapeutic and non-therapeutic effect of antibiotic at an earlier stage of the medical education for paramedical students as well as the staff members is highly imperative .
A variety of resources were reported by the participants to learn about antimicrobial resistance. Since all fields included in this study have pharmacology course in their curriculum, three-fourths of the respondents reported that academic courses were their main source of information. Therefore, this implicates that giving additional emphasis regarding antimicrobial resistance, during delivering the course, might be a good opportunity to prosper the students’ knowledge and attitude.
In regard to participants’ attitude, a substantial percentage of the participants (96%) had a favorable attitude towards antimicrobial resistance (they viewed antimicrobial resistance as a public problem and preventable if appropriate strategies are devised). This result was more eminent than the studies performed in India, Trinidad, and Tobago [8, 11, 26]. Nearly three-fourths (70%) of the participants believed that antimicrobial resistance is a major problem in the universe as comfortably as in Ethiopia. This finding was lower as compared to Patel H et al. study, in which 92% of the respondents conceived that antimicrobial resistance is a local as well as a global problem . Besides, the majority of the participants (82.4%) agreed that dispensing antibiotics without prescription should be more closely controlled. It was advancing as compared to another similar study, in which 65% of the participants thought that antibiotics should never be purchased as over the counter drugs .
Interestingly, the vast majority of the participants (96%) considered that special training on the rational use of antimicrobials and antimicrobial resistance should be given to paramedical students. This result was comparable to other studies, in which 90% of students in Abbo et al., 78% in Minen et al. and 74% in Dyar et al. pursued more education on the appropriate use of antimicrobials and proper antibiotic selection [27,28,29]. The potential reason for the difference might be variation target population.
In Kruskal-Wallis test, a statistically significant knowledge and attitude score difference in between the field of studies was found. Health officer and pharmacy students achieved better knowledge and attitude scores as compared to other paramedical students, respectively. There are a number of factors behind it. The main source of difference is variation in the scope of practice. Health officer and pharmacy students have frequent practical exposure to infectious disease management as compared to other health students. Some other factor is variation in their course of study. Health officer and pharmacy students took the course with higher credit per hours as compared to paramedical students. Hence, it argues that substantial efforts need to be invested in paramedical students, particularly Optometry, Midwifery, Nursing students. Furthermore, a statistically significant attitude difference towards antimicrobial resistance across the level of knowledge was noticed. Participants with a proficient level of knowledge had greater attitude rank as compared to those who possessed a moderate and poor level of cognition. This result was supported by a study done in Putrajaya, Malaysia, in which a positive correlation between mean knowledge and attitude score was found . This result implicates that improving the students’ level of knowledge about antimicrobial resistance might be an approach to flourish their attitude.
Even if this work concentrated on potential target populations who play important roles in the prevention of antimicrobial resistance, the sufficiency of the sample size would not be fully addressed. It was due to the fact that the total population during the data collection period was less than the computed sample size. So generalization might be fairly limited. Another limitation was related to the design of the questionnaires. Even if the questions regarding knowledge and attitude allow the respondents to state their true thoughts without any suggestion, there is a possibility that respondents gave socially acceptable answers.