Evidence mapPaperPMID 40134815Full record

ReviewJAC-antimicrobial resistance2025

Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance and stewardship among low- and middle-income countries.

Zikria Saleem, Catrin E Moore, Aubrey C Kalungia, Natalie Schellack, Olayinka Ogunleye, Audrey Chigome, Kona Chowdhury, Freddy Eric Kitutu, Amos Massele, Nishana Ramdas and 16 more

Abstract readReview
In one paragraph

Review in JAC-antimicrobial resistance, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

26 authors.

Zikria SaleemDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan.ORCID https://orcid.org/0000-0003-3202-6347
Catrin E MooreCentre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George's, University of London, London SW17 0RE, UK.ORCID https://orcid.org/0000-0002-8639-9846
Aubrey C KalungiaDepartment of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia.ORCID https://orcid.org/0000-0003-2554-1236
Natalie SchellackDepartment of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa.ORCID https://orcid.org/0000-0001-9690-6285
Olayinka OgunleyeDepartment of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria.ORCID https://orcid.org/0000-0002-8921-1909
Audrey ChigomeDepartment of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa.
Kona ChowdhuryDepartment of Pediatrics, Gonoshasthaya Somaj Vittik Medical College, Dhaka 1344, Bangladesh.ORCID https://orcid.org/0000-0002-3836-1691
Freddy Eric KitutuSustainable Pharmaceutical Systems (SPS) Unit, School of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.ORCID https://orcid.org/0000-0003-2277-9572
Amos MasseleDepartment of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania.ORCID https://orcid.org/0000-0003-3816-2040
Nishana RamdasDepartment of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa.
E Sam OrubuDepartment of Biomedical Engineering, Boston University College of Engineering, Boston, MA, USA.
Aislinn CookCentre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George's, University of London, London SW17 0RE, UK.ORCID https://orcid.org/0000-0002-9189-7815
Felix KhuluzaPharmacy Department, Formerly College of Medicine, Kamuzu University of Health Sciences (KUHeS), Blantyre P.O. Box 278, Malawi.
Trust ZaranyikaFaculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP167, Zimbabwe.
Elisa FunicielloCentre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George's, University of London, London SW17 0RE, UK.ORCID https://orcid.org/0000-0001-7042-881X
Giulia LorenzettiCentre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George's, University of London, London SW17 0RE, UK.
Miriam NantamuCentre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George's, University of London, London SW17 0RE, UK.
Ayuska ParajuliHERD International, Lalitpur, Nepal.ORCID https://orcid.org/0000-0002-3631-2335
Amanj KurdiDepartment of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa.ORCID https://orcid.org/0000-0001-5036-1988
Hellen NabayigaManagement Science Department, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow G4 0QU, UK.
Ammar Abdulrahman JairounHealth and Safety Department, Dubai Municipality, Dubai, United Arab Emirates.ORCID https://orcid.org/0000-0002-4471-0878
Mainul HaqueUnit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai, Besi, 57000 Kuala Lumpur, Malaysia.ORCID https://orcid.org/0000-0002-6124-7993
Stephen M CampbellDepartment of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa.ORCID https://orcid.org/0000-0002-2328-4136
Dena Van Der BerghDivision of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.ORCID https://orcid.org/0000-0003-4057-4925
Brian GodmanCentre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George's, University of London, London SW17 0RE, UK.ORCID https://orcid.org/0000-0001-6539-6972
Mike SharlandCentre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, City St George's, University of London, London SW17 0RE, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: There are concerns globally with rising rates of antimicrobial resistance (AMR), particularly in low- and middle-income countries (LMICs). AMR is driven by high rates of inappropriate prescribing and dispensing of antibiotics, particularly Watch antibiotics. To develop future interventions, it is important to document current knowledge, attitudes and practices (KAP) among key stakeholder groups in LMICs. Methods: We undertook a narrative review of published papers among four WHO Regions including African and Asian countries. Relevant papers were sourced from 2018 to 2024 and synthesized by key stakeholder group, country, WHO Region, income level and year. The findings were summarized to identify pertinent future activities for all key stakeholder groups. Results: We sourced 459 papers, with a large number coming from Africa (42.7%). An appreciable number dealt with patients' KAP (33.1%), reflecting their influence on the prescribing and dispensing of antibiotics. There was marked consistency of findings among key stakeholder groups across the four WHO Regions, all showing concerns with high rates of prescribing of antibiotics for viral infections despite professed knowledge of antibiotics and AMR. There were similar issues among dispensers. Patients' beliefs regarding the effectiveness of antibiotics for self-limiting infectious diseases were a major challenge, although educational programmes did improve knowledge. The development of the AWaRe (Access, Watch and Reserve) system, including practical prescribing guidance, provides a future opportunity for the standardization of educational inputs. Conclusions: Similar KAP regarding the prescribing and dispensing of antibiotics across LMICs and stakeholder groups presents clear opportunities for standardization of educational input and practical training programmes based on the AWaRe system.

Identifiers

PMID40134815
PMCPMC11934068

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.