Discrepancy between Knowledge and Practice Regarding Antimicrobial Resistance among Retail Pharmacists in Sana’a City, Yemen

Abstract

Background: Antimicrobial resistance (AMR) is a growing global health threat. While improving knowledge is a key part of antimicrobial stewardship (AMS), a significant gap often exists between what healthcare providers know and what they actually practice. assess retail pharmacists’ knowledge, awareness, and dispensing practices regarding AMR and its contrib­uting factors in Sana’a City, Yemen.

Methods: A cross-sectional survey was conducted among 300 conveniently sampled retail pharmacists from nine districts in Sana’a City, Yemen, between October 2023 and January 2024. Data were collected using a structured, self-administered questionnaire assessing pharmacists’ demographic and professional characteristics, knowledge of AMR, awareness of its factors contributing, and antibiotic-dispensing practices. Knowledge and awareness items were scored on a 3-point Likert scale, while dispensing practices were assessed using a 5-point Likert scale. Scores were converted to percentage values and categorized as good or poor using a 75% cutoff. Associations of pharmacists’ characteristics with their knowledge, awareness, and practices were examined using chi-square or Fisher’s exact tests, with statistical significance set at P <0.05.

Results: Most pharmacists demonstrated good knowledge of AMR, where 83.7% correctly defined AMR, 88% recognized it as a major global health problem, and 88.7% identified it as a direct threat to human health. Microbial mutations were recognized as a key driver of AMR by 84.3%, while only 51% acknowledged genetic transmission, and fewer recognized healthcare-associated spread (42.3%) or hospital-acquired resistant infections (45.7%). Awareness of contributing factors was high, including inappropriate antibiotic use (85.7%), treatment interruption (93.3%), suboptimal dosing (77.7%), use of broad-spectrum antibiotics (61.3%), antibiotic use in livestock (86.3%), and environmental contamination (83.3%). Despite high levels of good knowledge (86%) and awareness (86.7%), poor antibiotic-dispensing practices were common (86.0%), with 35.7% reporting dispensing antibiotics without prescription. Pharmacists with a bachelor’s degree had higher odds of good knowledge and awareness than those holding a diploma degree (OR = 2.1, 95% CI: 1.06–4.03; P = 0.034 and OR = 2.0, 95% CI: 1.03–4.05; P = 0.040, respectively).

Conclusion: Retail pharmacists in Sana’a exhibit a notable level of knowledge and awareness of AMR and its contributing factors, but this level does not translate into good antibiotic-dispensing practices. This discrepancy underscores the pressing necessity for a comprehensive strategy that goes beyond existing AMS by implementing mandatory training, educational work­shops, and strict enforcement of dispensing regulations. Further research into the social and professional drivers of these practices is essential to develop more effective, targeted interventions.