Knowledge, attitudes and practices of veterinary drug shop attendants regarding antibiotic use and antimicrobial resistance in Wakiso District, Uganda

Abstract

Antimicrobial resistance is a major global health threat that hits low- and middle-income countries hardest, and in Uganda the veterinary drug-shop attendants who control antimicrobial dispensing remain an understudied yet influential group in the AMR problem. Objective: This study assessed the knowledge, attitudes, and practices (KAP) of veterinary drug-shop attendants regarding antibiotic use and antimicrobial resistance in selected areas of Wakiso District, Uganda, in order to identify gaps and inform targeted stewardship interventions. Methods: A descriptive cross-sectional study of 30 attendants from licensed veterinary drug shops across three peri-urban areas of Wakiso District used a WHO-adapted structured questionnaire to assess knowledge, attitudes, and practices on AMR, with three key informant interviews and thematic analysis triangulating the descriptively analyzed quantitative findings. Results: Regarding knowledge, attendants demonstrated only moderate understanding of antimicrobial use and resistance (mean 9.77/15), with just 33.3% reaching a high level. Regarding attitudes, responses were contradictory: 90.0% accepted a responsibility to educate clients about AMR, yet only 30.0% rejected the use of antibiotics for growth promotion. Regarding practices, a pronounced knowledge–practice gap emerged, with 43.3% of attendants always dispensing antibiotics without a veterinarian’s prescription and none dispensing only after a confirmed diagnosis; notably, a demand-side driver of inappropriate use was farmer peer-discussion forums fueling self-formed diagnoses and dose modification. Conclusions: Veterinary drug-shop attendants in Wakiso District showed moderate knowledge but consistently inappropriate dispensing practices, a gap structurally explained by pharmaceutical-company-dominated training and a novel demand-side driver in farmer peer-discussion forums, providing the first baseline data for this stakeholder group and an evidence platform for targeted AMR interventions spanning independent training, strengthened NDA enforcement, levy consolidation, and stewardship engagement of farmer networks.