Knowledge, attitude, and practice of antifungal resistance and stewardship among pharmacy students in Zambia: a cross-sectional study to inform antifungal stewardship programs
Abstract
Background Antifungal resistance (AFR) is a growing global health threat, particularly in low- and middle-income countries such as Zambia, where antifungals are often accessed without prescription. Antifungal stewardship (AFS) programs aim to optimise antifungal use, yet limited data exist on pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS. This study evaluated pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS in Zambia. Methods A descriptive cross-sectional survey was conducted among 288 randomly selected pharmacy students between August and September 2024 using a structured questionnaire. Descriptive statistics summarised demographics and KAP responses. Associations were analysed using Chi-square and Fisher's Exact Tests, while multivariable logistic regression identified predictors of good KAP ( p < 0.05). Results Among respondents (55.2% female; 76.7% aged 18–25 years), most students (94.1%) knew how to define AFR, and 90.3% recognized antifungal misuse as a factor driving resistance. Nevertheless, only 18.1% showed good knowledge, 67.7% held positive attitudes (especially among fourth-year students, p < 0.001), and merely 2.4% practiced appropriately. Multivariable analysis found that being a fourth-year student increased the likelihood of a good attitude (aOR = 5.10, 95% CI: 2.28–11.43). Married students were more likely to demonstrate good practices (aOR = 2.75, 95% CI: 1.13–6.68) towards AFR and antifungal stewardship (AFS) compared to unmarried ones. Additionally, age above 33 years was not significantly associated with better knowledge (aOR = 1.29, 95% CI: 0.32–5.18). Conclusion Pharmacy students in Zambia demonstrated positive attitudes towards AFR and AFS, but significant gaps in knowledge and practice remain. Strengthening AFR and AFS-related content and experiential training within the pharmacy curriculum is urgently needed to improve preparedness for clinical practice.
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Authors: Steward Mudenda, Bweupe Chibwe, Moses Mukosha, Webrod Mufwambi, Victor Daka, Precious Nkumbu Nachalwe, Maisa Kasanga, Kingsley Kamvuma, M Mwaba, JO Fadare, Adriano Focus Lubanga, N Mugenyi, Moses Gondwe, Adron Mweshi Chimbala, S Mohamed, Jean Mukumbuta, B Mwanza, M Hampango, T Muyenga, Tadious Chimombe, Mubanga Makasa, F Mwaba, R Tembo, Mildred Zulu, Jimmy Hangoma, Amos Yared Massele, Israel Abebrese Sefah, Massimo Sartelli, Rasha Abdelsalam Elshenawy, Shazia Jamshed, John Bwalya Muma, Brian Godman
Institutions: Ministry of Health, Copperbelt University, Mulungushi University, University of Health and Allied Sciences, University of Hertfordshire, CNR de la Résistance aux Antibiotiques, University of Macerata, Ekiti State University, Institute of Infection and Immunity, University of Zambia, National Institute of Public Health, Department of Health, Kamuzu Central Hospital, York Teaching Hospital NHS Foundation Trust, Livingstone Hospital, Sefako Makgatho Health Sciences University, University of Strathclyde, American Association of Colleges of Pharmacy, University of Lusaka, Doctors Hospital, Royal Pharmaceutical Society, University Teaching Hospital, National Public Health Laboratory, National Institute of Public Administration, Mbarara University of Science and Technology, Evelyn Hone College, Lusaka Apex Medical University, Levy Mwanawasa Medical University, Boitekanelo College, Ohlone College, Neoleukin Therapeutics (United States), Ospedale di Macerata