Knowledge, Attitudes, and Practices on Antimicrobial Stewardship among Healthcare Professionals at Juba Teaching Hospital, South Sudan
Bono Bol Ayom Akayding¹, Aquila Hakim¹, Amanya J. Iboyi², Ezbon WApary¹
¹University of Juba School of Public Health
²University of Juba Graduate College
Email: bonobol1994@gmail.com
Abstract: Antimicrobial resistance (AMR) imposes its heaviest burden on sub-Saharan Africa, yet South Sudan lacks baseline evidence on how healthcare professionals understand and enact antimicrobial stewardship (AMS). This study assessed AMS knowledge, attitudes, and practices (KAP) and their correlates at Juba Teaching Hospital, the national referral facility. We administered a COM-B-informed cross-sectional survey to 245 stratified, randomly selected professionals (74 doctors, 26 pharmacists, 145 nurses); we analysed the data using chi-square tests, t-tests, ANOVA, and multivariable logistic regression. We prioritised item-level analysis because composite knowledge and attitude scales showed low internal consistency. The survey response rate was 100%. The mean knowledge score was 67.4% (SD = 16.0), and 33.1% had good knowledge; only 32.7% understood the WHO AWaRe Access category. Knowledge differed significantly by cadre, age, and qualification, and formal AMS training independently predicted good knowledge (AOR = 2.07, 95% CI [1.14, 3.77]). Positive attitudes were held by 45.3%; 80.0% cited inadequate laboratory support, and 44.9% acknowledged patient pressure. Appropriate practice was reported by 23.0% of doctors, compared with 73.1% of pharmacists and nurses, and 55.4% of doctors often prescribed antibiotics for viral infections. Nurses with 1–5 years’ experience had higher odds of appropriate practice (AOR = 7.31, 95% CI [1.68, 31.85]). Moderate knowledge thus coexists with ambivalent attitudes and a pronounced prescriber knowledge–practice gap rooted chiefly in health-system constraints. Training-led capability building must be coupled with diagnostic, governance and AWaRe-based formulary reforms.
