Knowledge, attitudes, and practices of parents toward antibiotic use in children attending public hospitals in Mogadishu, Somalia

Inappropriate antibiotic use in children contributes significantly to antimicrobial resistance (AMR), a major public health concern in low- and middle-income countries (LMICs). In Somalia, fragile health systems, weak regulatory oversight , and widespread non-prescription antibiotic use increase this risk. This cross-sectional study assessed parents’ knowledge, attitudes, and practices (KAP) regarding antibiotic use in children and identified associated sociodemographic factors to inform targeted stewardship strategies. We conducted a hospital-based cross-sectional study using consecutive sampling from May to August 2025 in two public tertiary referral hospitals in Mogadishu. The data set contained 325 records; one record missing the number-of-children field was excluded, giving an analytic sample of 324. The 26 KAP items were dichotomized using the documented answer key. Question 28 had no 'Never' option and consequently had zero variance after scoring. Overall scores were categorized as low (≤ 10), medium (11–17), or high (≥ 18). Descriptive, reliability, factorability, bivariate, and ordinal logistic regression analyses were conducted using Stata 18. The mean KAP score was 10.82 (SD = 3.69; range 4–22). Low KAP was observed in 184 participants (56.79%), medium KAP in 121 (37.35%), and high KAP in 19 (5.86%). Internal consistency was low for knowledge (α = 0.462), attitudes (α = 0.417), and practices (α = 0.484), and moderate overall (α = 0.634). In the adjusted ordinal model, primary paternal education (OR = 0.52; 95% CI 0.28–0.94; p = 0.030), primary maternal education (OR = 0.52; 95% CI 0.28–0.96; p = 0.037), university-level maternal education (OR = 3.54; 95% CI 1.28–9.78; p = 0.015), and regional residence (OR = 0.42; 95% CI 0.20–0.89; p = 0.023) were associated with KAP level. Female sex was borderline (OR = 1.67; 95% CI 1.00–2.79; p = 0.051). More than half of participants were classified as having low KAP according to the prespecified scoring criteria. Maternal education and regional residence remained important correlates, although the observed associations should be interpreted cautiously because ambiguities in the scoring of some questionnaire items may influence KAP classification. These findings should be interpreted cautiously given limitations related to questionnaire scoring and measurement reliability.