Knowledge, attitudes, and practices regarding antimicrobial use and resistance among smallholder dairy farmers in Zambia: a cross-sectional study

Abstract

Introduction The irrational use of antibiotics in livestock encourages the development of antimicrobial resistance (AMR), which poses a risk for human and animal health. This study assessed knowledge, attitude and practices (KAP) regarding antimicrobial use (AMU) and AMR among smallholder dairy farmers in Zambia. Methods A cross-sectional survey was conducted among 617 farmers selected using a cluster-randomized proportionate sampling strategy across six districts between August and October 2024. KAP scores were computed based on 16 knowledge, 12 attitudes, and 14 practice items. Correct or appropriate responses were scored as “1” and incorrect or inappropriate responses as “0”. For knowledge, “not sure” responses were coded as incorrect, and for attitudes and practices, “sometimes” responses were coded as inappropriate to prioritize adherence to stewardship standards. Domain scores were summed and converted to percentages. For comparability to previous studies in similar regional contexts, cut-offs of 60% for knowledge, 58% for attitude and 65% for practice were adopted to classify levels as appropriate or positive rather than as validated standards. Statistical associations were identified using multivariate logistic regression adjusted with cluster-robust standard errors. Results Of the 617 participants, the majority displayed inappropriate knowledge (70.99%) and inappropriate practices (59.97%), though 64.34% held positive attitudes. Key factors associated with higher odds of appropriate knowledge included milking dairy cattle only (AOR = 4.34, 95% CI: 1.956–9.651, p < 0.001) and membership in a cattle cooperative (AOR = 3.35). Farmers with tertiary education (AOR = 15.04, 95% CI: 3.39–66.77, p < 0.001) and those who listened to cattle management radio programs (AOR = 2.02, 95% CI: 1.24–3.38, p < 0.001) also demonstrated significantly better knowledge. However, longer farming experience (over 11 years) was associated with lower odds of appropriate practices compared to those with less than 5 years of experience (AOR = 0.49, 95% CI: 0.31–0.79, p = 0.003). Conclusion These KAP levels among smallholder dairy farmers are consistent with conditions that facilitate antimicrobial misuse and the potential spread of AMR. While cooperatives and radio programs are associated with knowledge awareness, coupling them with interventions addressing structural barriers and enforcing prescription-only regulations may bridge the gap between knowledge and practice.