Assessment of knowledge, attitude and practices on antibiotic resistance among undergraduate medical students in the school of medicine at the University of Zambia


  • Annie Zulu Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
  • Scott K. Matafwali Department of Basic Sciences, School of Medicine, Copperbelt University, Ndola, Zambia
  • Michelo Banda Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
  • Steward Mudenda Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia



Antibiotic resistance, Attitude, Knowledge, Medical students, Practices, Zambia


Background: The issue of antibiotic resistance has become a global public health concern, with an extensive clinical and economic burden. The study aimed to assess the knowledge, attitude, and practices of antibiotic resistance among undergraduate medical students at the University of Zambia.

Methods: This cross-sectional study was conducted at the University of Zambia Ridgeway Campus. A structured questionnaire was administered to 260 randomly selected undergraduate medical students. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0. Associations between dependent and independent variables were done using a Chi-square test. The statistical significance was done at 95% confidence level (p<0.05). Ethical approval was done by the University of Zambia Health Sciences Research Ethics Committee.

Results: The study found that 227 of 260 (87.3%) of the medical students had good knowledge on antibiotic use and resistance. The majority of the medical students 252 of 260 (96.9%) had positive attitudes and 195 of 260 (75%) had good practices towards antibiotic resistance. There was a significant difference between the year of study and the level of knowledge (χ2=16.333, p=0.003). There was no significant difference between the year of study and the attitude of the participants (χ2=4.061, p=0.398). A significant difference was found between the year of study and the practices of the respondents (χ2=10.926, p=0.027).

Conclusions: The medical students had good knowledge, a positive attitude, and good practices towards antibiotic resistance. Final year students had higher levels of knowledge and attitude but lower levels of practice compared to other years of study.

Author Biography

Annie Zulu, Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia

Department of Pharmacy, Lecturer II


World Health Organisation (WHO). Antimicrobial Resistance Global Report on Surveillance. 2014. Geneva: World Health Organisation. Available at: Accessed on 5 September 2019.

Thriemer K, Katuala Y, Batoko B, Alworonga J-P, Devlieger H, Van Geet C, et al. Antibiotic Prescribing in DR Congo: A Knowledge, Attitude and Practice Survey among Medical Doctors and Students. PLoS ONE. 2013;8(2):e55495.

Sharma S, Jayakumar D, Palappallil DS, Kesavan KP. Knowledge, attitude and practices of antibiotic usage and resistance among the second year MBBS Students. Int J Basic Clin Pharmacol. 2016;5(3):899-903.

Khan AK, Banu G, Reshma K. Antibiotic resistance and usage - A survey on the knowledge, attitude, perceptions, and practices among the medical students of a Southern Indian teaching hospital. J Clin Diagn Res. 2013;7:1613-6.

Byarugaba DK. A view on antimicrobial resistance in developing countries and responsible risk factors. Int J Antimicrob Agents 2004;24:105-10.

Vlieghe E, Phoba M, Tamfun J, Jacobs J. Antibiotic resistance among bacterial pathogens in Central Africa: a review of the published literature between 1955 and 2008. Int J Antimicrob. Ag 2009;34:295-303.

Scaioli G, Gualano MR, Gili R, Masucci S, Bert F, Siliquini R. Antibiotic use: A cross-sectional survey assessing the knowledge, attitudes, and Practices amongst Students of a School of Medicine in Italy. PLoS One. 2015;10:e0122476.

Jamshed SQ, Elkalmi R, Rajiah K, Al-Shami AK, Shamsudin SH, Siddiqui MJ, et al. Understanding of antibiotic use and resistance among final-year pharmacy and medical students: A pilot study. J Infect Dev Ctries. 2014;8:780-5.

Om C, Daily F, Vlieghe E, McLaughlin JC, McLaws ML. If it's a broad spectrum, it can shoot better”: Inappropriate antibiotic prescribing in Cambodia. Antimicrob Resist Infect Control. 2016;5:58.

Ganesh M, Sridevi S, Paul C. Antibiotic use among medical and Paramedical students: knowledge, attitude and it's practice in a tertiary health care Centre in Chennai - a scientific insight. Int J Sci Res. 2014;3:332-5.

Desai AJ, Gayathri GV, Mehta DS. Public's Perception, Knowledge, Attitude, and Behaviour on Antibiotic Resistance - A survey in Davangere City, India. J Prevent Med Holistic Health. 2016;2(1):17-23.

Masaiti GC, Malambo C, Hikaambo C, et al. Antibacterial Properties of Ficus sycomorus Bark Extract Against Staphylococcus aureus and Escherichia coli. Int J Biomed Investig. 2019;2:121.

Fischbach MA, Walsh CT. Antibiotics for emerging pathogens. Science. 2009;325:1089-93.

Tenover FC. Mechanisms of antimicrobial resistance in bacteria. Am J Med. 2006;119:3-10.

Blair JM, Webber MA, Baylay AJ, Ogbolu DO & Piddock LJ. Molecular mechanisms of antibiotic resistance. Nat. Rev. Microbiol. 2015;13:42-51.

Sefton AM. Mechanism sofanti microbial resistance. Drugs 2002;62:557-66.

Mudenda S, Bangara FF, Sitali J, Banda M. Knowledge, Attitude, and Practices on Antibiotic Resistance among Pharmacists at the University Teaching Hospitals in Lusaka, Zambia. J Harmonized Res. 2019;8(2):12-24.

Tegagn GT, Yadesa TM and Ahmed Y, Knowledge, Attitudes and Practices of Healthcare Professionals towards Antimicrobial Stewardship and Their Predictors in Fitche Hospital. J Bioanal Biomed. 2017;9:91-7.

Ohl CA, Dodds Ashley ES. Antimicrobial stewardship programs in community hospitals: The evidence base and case studies. Clin Infect Dis. 2011;53:23-8.

Paterson DL. The role of antimicrobial management programs in optimizing antibiotic prescribing within hospitals. Clin Infect Dis. 2006;42(2):90-5.

Chuenchom N, Thamlikitkul V, Chaiwarith R, Deoisares R, Rattanaumpawan P. Perception, attitude, and knowledge regarding antimicrobial resistance, appropriate antimicrobial use, and infection control among future medical practitioners: A multicenter study. Infect Control Hosp Epidemiol. 2016;37:603-5.

Huang Y, Gu J, Zhang M, Ren Z, Yang W, Chen Y, et al. Knowledge, attitude and practice of antibiotics: A questionnaire study among 2500 Chinese students. BMC Med Educ. 2013;13:163.

Haque M, Rahman NIA, Zulkifli Z, Ismail S. Antibiotic prescribing and resistance: knowledge level of medical students of clinical years of University Sultan Zainal Abidin, Malaysia. J Therap Clin Risk Management. 2016;12:413.

Shah P, Shrestha R, Mao Z, Chen Y, Chen Y, Koju P, et al. Knowledge, Attitude, and Practice Associated with Antibiotic Use among University Students: A Survey in Nepal. Int J Environ Res Public Health. 2019;16:3996.

Hu Y, Wang X, Tucker DJ, Little P, Moore M, Fukuda K, et al. Knowledge, Attitude, and Practice with Respect to Antibiotic Use among Chinese Medical Students: A Multicenter Cross-Sectional Study. Int J Environ Res Public Health. 2018;15:1165.

Dutt HK, Sarkhil MZ, Hasseb MA, Singh G. A comparative knowledge, attitude, and practice study of antimicrobial use, self-medication and antimicrobial resistance among final year students of MBBS, BDS, and BSc Nursing at a tertiary care hospital at Kannur. Natl J Physiol Pharm Pharmacol. 2018;8(9):1305-11.

Gupta MK, Vohra C, Raghav P. Assessment of knowledge, attitudes, and practices about antibiotic resistance among medical students in India. J Family Med Prim Care. 2019;8:2864-9.

Khajuria K, Kaur S, Sadiq S, Khajuria V. KAP on antibiotic usage and resistance among second professional medical students. Int J Basic Clin Pharmacol. 2019;8:68-73.

Harakeh S, Almatrafi M,Ungapen H, Hammad R, Olayan F, Hakim R, et al. Perceptions of medical students towards antibiotic prescribing for upper respiratory tract infections in Saudi Arabia. BMJ Open Respir Res. 2015;2:e000078.

Nair M, Tripathi S, Mazumdar S, Mahajan R, Harshana A, Pereira A, et al. Knowledge, attitudes, and practices related to antibiotic use in Paschim Bardhaman district: A survey of healthcare providers in West Bengal, India. PLoS One. 2019;14:e0217818.

Ahmad A, Khan MU, Patel I, Maharaj S, Pandey S, Dhingra S. Knowledge, attitude and practice of B. Sc. Pharmacy students about antibiotics in Trinidad and Tobago. J Res Pharm Pract. 2015;4:37-41.

Ajibola O, Omisakin O, Eze A, Omoleke S. Self-medication with antibiotics, attitude, and knowledge of antibiotic resistance among community residents and undergraduate students in Northwest Nigeria. Diseases. 2018;6:32.

Suaifan GA, Shehadeh M, Darwish DA, Al-Ije H, Yousef AM, Darwish RM. A cross-sectional study on knowledge, attitude, and behavior related to antibiotic use and resistance among medical and non-medical university students in Jordan. Afr J Pharmacy Pharmacol. 2012;15:6(10):763-70.

Dyar OJ, Pulcini C, Howard P, Nathwani D, ESGAP (ESCMID Study Group for Antibiotic Policies). European medical students: A first multicentre study of knowledge, attitudes, and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother. 2014;69:842-6.

Wasserman S, Potgieter S, Shoul E, Constant D, Stewart A, Mendelson M, et al. South African medical students' perceptions and knowledge about antibiotic resistance and appropriate prescribing: Are we providing adequate training to future prescribers? S Afr Med J. 2017;107:405-10.

Davenport LA, Davey PG, Ker JS. BSAC Undergraduate Education Working Party. An outcome-based approach for teaching prudent antimicrobial prescribing to undergraduate medical students: Report of a working party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 2005;56:196-203.

Kanneppady SS, Oo AM, Lwin OM, Ahmed Al-Abed AAA, Kanneppady SK. Knowledge, attitude, and awareness of antibiotic resistance among medical students. Arch Med Health Sci. 2019;7:57-60.

Lv B, Zhou Z, Xu G, Yang D, Wu L, Shen Q, et al. Knowledge, attitudes and practices concerning self‐medication with antibiotics among university students in western China. Trop Med Int Health. 2014;19(7):769-79.

Badiger S, Kundapur R, Jain A, Kumar A, Pattanshetty S, Thakolkaran N, et al. Self-medication patterns among medical students in South India. Australas Med J. 2012;5:217-20.

Bharath Kumar VD, Monika N, Kalpana L, Veena RM, Sathish Chandra MR. Assessment of awareness about antibiotic resistance among first-year medical undergraduates in a medical college. Int J Clin Pharmacol Res. 2015;5:239-42.




How to Cite

Zulu, A., Matafwali, S. K., Banda, M., & Mudenda, S. (2020). Assessment of knowledge, attitude and practices on antibiotic resistance among undergraduate medical students in the school of medicine at the University of Zambia. International Journal of Basic & Clinical Pharmacology, 9(2), 263–270.



Original Research Articles