A Cross-Sectional Study of Community Knowledge and Behaviors Regarding Antibiotic Use and Antimicrobial Resistance Among the General Population

Abstract

Background: Antimicrobial resistance (AMR) is a major global public health concern, driven partly by inappropriate antibiotic use, self-medication, and non-prescription access to antibiotics. Understanding community knowledge and behaviors regarding antibiotic use is essential for developing effective antimicrobial stewardship interventions. Objective: To assess knowledge, attitudes, and practices (KAP) regarding antibiotic use and antimicrobial resistance among the general adult population in Diyala Governorate, Iraq, and to examine their associations with selected sociodemographic characteristics. Methods: A community-based cross-sectional study was conducted among 250 participants aged ≥15 years from urban, semi-urban, and rural areas of Diyala Governorate. Participants were recruited using quota-based convenience sampling. Data were collected using a structured questionnaire comprising sociodemographic and background characteristics and 28 KAP items: 10 knowledge, 8 attitude, and 10 practice items. Descriptive statistics, Pearson's chi-square test, Cramér's V, Benjamini–Hochberg false discovery rate correction, and Spearman's rank correlation were used for statistical analysis. Results: The mean knowledge, attitude, and practice scores were 5.88/10 (58.8%), 5.57/8 (69.7%), and 6.08/10 (60.8%), respectively, while the overall KAP score was 17.54/28 (62.6%). Overall KAP was moderate in 61.2% of participants. Although 74.0% recognized that unnecessary antibiotic use contributes to AMR, only 44.0% correctly identified that antibiotics are ineffective against viral infections and 41.2% understood that resistance develops in microorganisms rather than the human body. Inappropriate practices included obtaining antibiotics from pharmacies without a physician's prescription (53.2%), stopping or reducing treatment after symptom improvement (51.6%), and using antibiotics for cold or influenza symptoms (45.2%). Knowledge was significantly associated with educational level, health-related educational background, and residence after false discovery rate adjustment. Significant positive correlations were observed among knowledge, attitude, and practice scores. Conclusion: The findings indicate moderate overall KAP regarding antibiotic use and AMR, with relatively favorable attitudes but important gaps in knowledge and antibiotic-use practices. Misconceptions regarding viral infections and antimicrobial resistance, together with non-prescription antibiotic use and inappropriate treatment behaviors, highlight the need for targeted community education and strengthened antimicrobial stewardship and antibiotic-dispensing practices in Diyala Governorate.