Inappropriate AMU and the associated risk of AMR is a growing public health issue worldwide. The misuse and abuse of antimicrobials in agriculture, veterinary medicine, and human medicine have been identified as major contributors to the global spread of AMR [15]. The emergence and spread of antimicrobial-resistant pathogens impede the use of antibiotics for both preventative and therapeutic purposes. This issue is becoming more prevalent in low-income African countries [16]. As a result, a questionnaire survey was used in this study to assess knowledge, practices, and attitudes toward AMU and AMR in Gondar City, Ethiopia. Antimicrobial use and resistance knowledge, attitudes, and practices are critical for combating global antimicrobial resistance [17].
According to the findings of the current study, the majority of participants (72.3%) are aware of what antimicrobials are, but only 36.3% are conscious of what they are used for. Amoxicillin was the most commonly used antibiotic among the study participants. The current finding is consistent with the findings of Gebeyehu et al. [10] in Bahir Dar, Ethiopia, Widayati et al. [18] in Indonesia, Sindato et al. [15] in Tanzania, Ocan et al. [19] in Uganda, and Ramay et al. [20] in Guatemala, who reported that Amoxicillin was the most commonly used antibiotic by study participants.
Understanding which conditions can be treated with antibiotics is also important, as using antibiotics for conditions that are not treatable with these medications contributes to misuse and, as a result, resistance development [18]. People in Gondar who participated in the study had sufficient knowledge (54.5%) to answer questions about whether antimicrobials are effective against bacteria, but this is lower than the previous studies in Germany [21] and Malaysia [22], which found that 83.7% and 76.7% of participants correctly identified antibiotics are effective against bacteria, respectively. However, in the current study, some respondents (20%) are unsure whether antimicrobials are effective against bacteria, which is consistent with Kuwait (25.3%) [23]. Thus, some attribute this lack of knowledge to the common use of the term "germ" during counselling or the provision of medical advice to the public/patients rather than the microbiological terms "bacteria" or "virus."
Poverty is also a major driver of AMR development in both developing and developed countries. In developing countries, factors such as insufficient access to effective drugs, unregulated antimicrobial dispensing and manufacture, and insufficient antimicrobial treatments due to cost all contribute to the development of AMR [16]. The use of antimicrobials, according to a large number of participants (48.5%) in this study, can increase bacterial resistance to them. This supports the findings of Tesfaye [24] in Bahir Dar Ethiopia, Pereko et al. [25] in Namibia, Jifar and Ayele [26] in Harar Ethiopia, and Darwish et al. [27] in Jordan, where 69.7%, 72%, 78.3%, and 50% of respondents believed, respectively. As a result, this finding indicates that the majority of those who took part in the study were well-versed in the risks associated with the use of antimicrobials. Antimicrobial agents are widely used in animal production systems in Ethiopia, as in other Sub-Saharan countries; however, evidence on antimicrobial usage is limited and anecdotal [28]. Antimicrobial resistance must be addressed through a variety of actions, including interventions that reduce inappropriate and unnecessary antimicrobial use in humans and animals while ensuring that effective antimicrobial therapy is available when needed [29].
The effectiveness of antimicrobials is jeopardized by antimicrobial resistance, which can arise from discontinuing the entire course of treatment. According to studies, the reasons for the discontinuation of antimicrobials are a lack of knowledge and awareness about antimicrobial use [10]. The participants' attitude toward antimicrobial use and resistance was unavoidable and restrictive in this study. As a result, half of the respondents (50.5%) acknowledged the importance of continuing to take their prescribed medication even after they felt better. While approximately 40% of respondents believed that patients should discontinue treatment as soon as they felt better. This finding is higher than the study done in Bahir Dar Ethiopia by Gebeyehu et al. [10], which reported 27%, and lower than the reports of Dyar et al. [29] in Kuwait, Sakr et al. [30] in Lebanon, and Darwish et al. [27] in Iraq, which reported 45–60% of respondents, respectively, believed that patients should stop their treatment as soon as they felt better. As a result of this misunderstanding in antimicrobial use, the patient is at risk of relapse with resistance to pathogenic bacteria. Inadequate dosing, incomplete courses, and indiscriminate drug use have also contributed to the emergence and spread of antimicrobial resistance, which is a current issue in various countries.
Similarly, we practice self-medication every day in the form of self-care for our health. Self-medication refers to the use of drugs, herbs, or home remedies on one's initiative or the advice of another person, without first consulting a doctor [31]. In this study, 54.25% of study participants had a positive attitude because they never took antimicrobials without first consulting with their doctor. However, 10.5 percent of them did not develop such an attitude and prefer to consult with and obtain antimicrobials from other sources. The current finding was lower than reports from other countries, including the UAE [32], Lebanon [33], Iraq [34], Palestine [35], Jordan [36], and Yemen [37]. Meanwhile, it was higher than reported by You et al. [38] in Hong Kong, McNulty et al. [39] in the United Kingdom, Ling Oh et al. [22] in Malaysia, and Widayati et al. [18] in Indonesia, who reported attitude levels ranging from 4.8 - 9%. The differences observed in the studies were attributed to differences in sample size, education level, and sociodemographic characteristics of the study participants.
Antibiotics that were leftover in many countries around the world reported that medicine at home was one of the major sources of antibiotics that are stocked for emergency or future use issues [40]. In this study, 15% of respondents agreed that they keep leftover antimicrobials at home in case they need them in the future. The findings are comparable to Jifar and Ayele's report in Harar, Ethiopia [26]. The current finding, however, was lower than that of a study conducted in Malaysia [41], Namibia ([25], and Jordan [27]. The disparities observed between the studies could be attributed to differences in the study participants' awareness and education levels.
Furthermore, significant associations (p < 0.05) between various socio-demographic factors and KAP scores were noticed in the current study. Antimicrobial knowledge scores tended to rise as one's level of education increased. Similarly, participants with a college/university education, a secondary education, or a vocational education had higher knowledge scores than those with only primary education or no formal education. It corroborates the findings of Sindato et al. [15] in Tanzania. There was also a statistically significant (p < 0.05) relationship found between respondents' knowledge and practice, knowledge and attitude, and practice and attitudes. As a result, it implied that as participants in the study's knowledge of AMU and AMR increased, so did the proportion of respondents with good practice and behaviour.