The greatest increase in AMR and related deaths are estimated to occur in sub-Saharan Africa if nothing is done to avert the current trends (28). This study explored the knowledge, confidence level of prescription, perceptions on antimicrobial resistance and training on antimicrobial use of health professions students in Uganda.
Our findings suggest that almost 9 in 10 participants had sufficient knowledge about AMR, especially the male students and those that had received prior additional training on AMR. This finding is in agreement with earlier findings around medical students in, Nigeria (29), Egypt (30), South Africa (31) and China (15,32) which showed that medical students generally were more knowledgeable about antibiotics use. Contrary to this, previous findings among final year medical students in Uganda and Kenya report otherwise; only 36.6% (120/328) of students had good overall total knowledge (Lubwama et al., 2021; Lubwama et al., 2020). The variations in the findings of these studies could be attributed to the fact that our study had a larger sample size i.e. 681 participants from 9 medical schools versus 328 participants in a study by Lubwama et al., 2021 from 3 medical Schools (24). Furthermore our study included students pursuing other medical courses i.e. Bachelor of Dental Surgery (BDS), Bachelor of Science in Nursing (BNS), and Bachelors of Anesthesia (BNA) which is not the case with the other study. Our findings are also contrary to previous studies in other parts of the world that reported limited knowledge amongst final year medical students; in Thailand (34) and Australian (35). Such discrepancies could probably be due to the geographical reasons where diseases targeted by antibiotics may not be equally prevalent in the respectively settings. Also, the differences in medical curricula used, could also have an impact on the overall students’ knowledge regarding antibiotic use and antimicrobial resistance.
The knowledge scores of students on AMR increased up the years peaking at fifth year and a significant knowledge difference was observed among third years against fourth and fifth years. Also, the medicine students scored significantly higher than nursing students on AMR knowledge. Similar findings are drawn from other studies in Malaysia and China (2,15). As students’ progress in their respective academic programs, they get more encounters with antimicrobials, start prescribing and administering them under supervision thus garner more knowledge. Despite our study not showing a strong evidence on the effect of sex on AMR, males have been found to have poorer levels of knowledge compared to females (30).
Students in our study mainly used Medscape (47.7%), guidelines from professional bodies (31.0%), and UpToDate (30%) and as their sources of information on AMR. This is however in disagreement, with an earlier study among Chinese medical students which found textbooks or study guides, peers, and Wikipedia to be the topmost used resources of information (32). There is need to ensure that medical students use the right information sources to help them acquire quality and updated good AMR knowledge. Over the past decades, there has been a significant increase in the number of educational websites and smartphone applications with information on drug prescriptions. Some of these include in addition to UpToDate, drugs.com, Medline, WebMD, Mayo Clinic, rxlist.com, goodrx.com, etc. Health professional students can utilize these readily available sources to improve their prescription practices.
It is encouraging to realize that most students in our study (over 80%) were aware about the essential medicines, and rational use of medicine, and could name prescription parts. This is a good indicator on their pharmacological training that could translate into better practices towards use of antimicrobials. The majority also appreciated the fact that antibiotics don’t speed up recovery of common cold because this is a great contributor to misuse of antibiotics. Over half of the students (54.5%) reported that antimicrobials were overused at their university teaching hospitals. This is consistent with several other Global Point Prevalence surveys done in hospitals in Uganda, Tanzania, Ghana, and other international reviews (36–38). This shines a light on the pressing drivers of resistance that should be addressed within our hospitals by establishment of medicines and therapeutic committees, and/or infection prevention committees in which students’ representatives can be invited to become members.
About two-thirds of participants in our study believed that strong knowledge of antimicrobials is important in for their medical career. This result has also been previously documented among Chinese medical student by Yang et al.,2016(16). The role of having strong antimicrobial knowledge can’t be overemphasized in antimicrobial stewardship, because it’s what drives antibiotics prescribing behaviors of health care workers (32). There is need for more efforts to be directed towards improvement of medical students’ knowledge of antibiotics and their rational use of medicines, among especially those medical students with poor knowledge, attitudes and perception regarding AMR for example among Japanese medical students, of whom only 43 (6.5%) had ever heard about the AMR (39).
Unlike several systematic reviews that have consistently reported unpreparedness and low self-reported confidence of medical students to prescribe antimicrobials (23,40,41), majority of our respondents were confident on choosing the correct antimicrobial to use (71.1%) and using a combination therapy if appropriate (65.1%). This could be due to for instance having 430 (89.4%) of students in our sample having had prior AMR training. Furthermore, the level of confidence was significantly highest among fifth year students possibly because they are the most senior and have encountered patients and prescriptions often. But this is also an encouraging finding as these confident students are soon entering into the health system. Thus, the confidence exhibited should be built on to create strong stewardship towards AMR.
Although students exhibited high confidence and good knowledge, almost all of them (97.5%) believed they need more training on antimicrobial selection and a separate course unit on AMR and rational use of medicine. This is in consonance with various other KAP studies on AMR among students (15,21,42) which underscores the need to rethink the medical curriculum in line with delivery of pharmacology course to put emphasis on antimicrobial prescription and resistance. The largest proportion of students knew about their teaching hospital antimicrobial guidelines and had consulted them
Limitations and Strengths
This is a cross-sectional study that only provides a snippet of the prevailing situation at the time. The convenience sampling method used could have created bias in the different categories with few numbers represented in some however we tried to control for this by consistently sharing the tool across all groups. However, our study involved many health professions students across different universities and courses therefore the findings can be generalized with much confidence.