Knowledge, attitudes and practices on antimicrobial resistance among practising veterinary and para-veterinary professionals in Zambia

Abstract Background : Antimicrobial resistance (AMR) is a growing global threat affecting both animal and human health, largely driven by the misuse and overuse of antimicrobial agents. Veterinary and para-veterinary professionals play important roles through their involvement in animal health care, antimicrobial use and advice provided to animal owners. However, evidence on AMR knowledge, attitudes, and practices (KAP) among these professionals in Zambia remains limited. This study assessed the KAP related to AMR among practising veterinary and para-veterinary professionals in Zambia. Methods : A national cross-sectional survey was conducted among veterinary and para-veterinary professionals between August and December 2024. Data was collected using a 39-item structured questionnaire which comprised sections on demographics, KAP related to antibiotic use and AMR. The questionnaire was self-administered through the ZOHO survey platform, yielding 144 responses. Data were analysed using descriptive statistics and logistic regression in IBM SPSS Statistics version 25. Knowledge and attitudes were scored using Bloom’s cut-off points while practices descriptively analysed and categorized as risky or non-risky according to recommended antimicrobial use practices. Results : Of the 144 respondents, 54.2% demonstrated good knowledge of AMR, while 40.2% had moderate knowledge and 5.6% had poor knowledge, with a mean knowledge score of 77.0%. Regarding attitudes, 90.9% of participants exhibited positive attitudes towards antimicrobial stewardship, whereas 5.5% had moderate attitudes and 3.5% had negative attitudes, with a mean attitude score of 88.8%. Despite this strong knowledge and generally positive attitudes, several risky antimicrobial use practices were reported. Empirical treatment without diagnostic testing was common (62.5%), and only 20.8% of respondents routinely performed antimicrobial susceptibility testing (AST). In addition, 75% reported that animal owners frequently initiate antibiotic treatment without veterinary supervision. The most commonly reported barriers to performing AST included a lack of laboratory services (57.6%), cost constraints (24.3%), urgent treatment needs (11.1%), and long waiting times for results (16.7%). Logistic regression analysis showed no significant associations between socio-demographic characteristics and levels of knowledge or attitudes (p > 0.05). Conclusion : While veterinary and para-veterinary professionals in Zambia demonstrate strong knowledge and generally positive attitudes towards antimicrobial resistance, gaps persist in antimicrobial stewardship practices, largely driven by systemic and structural constraints. Strengthening diagnostic capacity, improving regulatory enforcement, and expanding continuing professional development on antimicrobial stewardship are critical to promoting responsible antimicrobial use in the veterinary sector. One Health impact statement AMR represents a critical One Health challenge because resistant pathogens can spread between animals, humans, and the environment. In many low- and middle-income countries, livestock production systems rely heavily on antimicrobial use for disease management and productivity. Veterinary and para-veterinary professionals therefore play an essential role in safeguarding both animal and public health through responsible antimicrobial stewardship. This study provides important baseline evidence on knowledge, attitudes, and practices related to AMR among veterinary professionals in Zambia. While awareness of AMR was generally high, several risky practices were identified, including empirical antimicrobial use and limited access to diagnostic testing. These findings highlight structural and systemic barriers affecting antimicrobial stewardship in the livestock sector. Addressing these challenges through improved veterinary diagnostic infrastructure, strengthened regulatory oversight, and enhanced professional training could significantly reduce inappropriate antimicrobial use. Such interventions would not only improve animal health and productivity but also contribute to reducing the emergence and spread of antimicrobial resistance across human, animal, and environmental health systems.