Antibiotic resistance is one of the most formidable threats to global health, and its burden falls disproportionately on countries with fragile health systems. Now, a sweeping scoping review has mapped what healthcare providers across Africa actually know, believe, and feel about antibiotic use and the mounting crisis of resistance—and the picture that emerges is one of moderate to good knowledge shadowed by persistent gaps, negative attitudes, and inappropriate practices that persist despite that knowledge.
The review, conducted by a team of researchers led by Tebello Violet Sarele of the University of KwaZulu-Natal in Durban, South Africa, and published in BMC Health Services Research, synthesized 47 studies involving 10,633 healthcare providers drawn from 20 African countries. The work offers the most comprehensive continental snapshot to date of the knowledge, attitudes, and perceptions—often abbreviated as KAPs—that shape how doctors, nurses, pharmacists, and other prescribers and dispensers interact with antibiotics in clinical settings across the continent.
Antimicrobial resistance occurs when bacteria evolve to survive exposure to the drugs designed to kill them, rendering once-reliable treatments ineffective. The World Health Organization has identified resistance as one of the top global public health threats, and sub-Saharan Africa carries a particularly heavy load, driven by high infectious disease burden, limited diagnostic capacity, weak regulatory oversight of drug sales, and constrained pharmaceutical resources. Because healthcare providers sit at the interface between patients and medicines, their understanding of appropriate antibiotic use directly influences prescribing patterns, dispensing behaviors, patient counseling, and ultimately the selective pressures that accelerate resistance.
The research team followed Arksey and O’Malley’s established scoping review framework, complemented by methodological guidance from the Joanna Briggs Institute and reporting standards from the PRISMA-ScR extension, which is the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension specifically designed for scoping reviews. Peer-reviewed studies published between 2000 and July 2025 were retrieved from five major databases: PubMed, MEDLINE, Google Scholar, the Cochrane Library, and Scopus. The search strategy incorporated Medical Subject Headings, or MeSH terms, along with keywords including “antibiotics,” “antibiotic resistance,” “knowledge,” “attitudes,” “perceptions,” “healthcare providers,” and “Africa.”
Rigor was built into the review’s execution at multiple stages. Screening of titles, abstracts, and full texts was carried out systematically, and data extraction relied on a pretested charting tool with double charting—a technique in which two reviewers independently extract data from the same studies to minimize bias and transcription errors. The extracted information was then analyzed descriptively and organized around the review’s thematic areas, allowing the researchers to compare findings across regions, study populations, and time periods.
The geographic distribution of the included studies was itself revealing. West Africa dominated the evidence base, contributing 17 studies, or 36.2 percent of the total. East Africa followed with 15 studies, or 31.9 percent, while Southern Africa accounted for 8 studies, or 17.0 percent. North Africa and Central Africa were markedly underrepresented—a gap the authors flagged as significant, since it means the continental picture is skewed toward regions that may not reflect conditions elsewhere on the continent.
Knowledge emerged as the most frequently assessed domain, appearing in 34 of the 47 studies, with a particular emphasis on knowledge of antibiotic resistance itself, which was examined in 24 studies. When the researchers tallied the reported knowledge levels, 13 studies, or 27.7 percent, characterized healthcare providers’ knowledge as moderate, while 14 studies, or 29.8 percent, rated it as good. Regionally, West African studies most often reported good knowledge, with more than one-third of studies in that region—6 of 17, or 35.3 percent—falling into that category. Studies from East and Central Africa tended to report moderate to good knowledge. On its face, these findings are encouraging, suggesting that the fundamentals of antibiotic pharmacology and resistance mechanisms are reasonably well understood by many providers.
Yet the review’s deeper finding is more sobering: knowledge alone does not translate into appropriate behavior. Several studies included in the analysis reported that despite good knowledge, inappropriate practices were nonetheless observed. This disjunction between knowing and doing is a well-recognized phenomenon in implementation science, and the review underscores that interventions built solely on education—aimed at closing knowledge gaps—are unlikely, on their own, to change prescribing behavior. Structural factors such as diagnostic uncertainty, patient expectations, pharmaceutical marketing pressures, workload, and the absence of laboratory confirmation frequently drive providers to prescribe broadly even when they understand the risks.
Attitudes told a different regional story. Negative attitudes toward antibiotic use and stewardship were reported in a substantial share of West African studies—6 of 17, or 35.3 percent—and in Southern African studies, where 3 of 8, or 37.5 percent, reported negative attitudes. Attitudes in this context encompass providers’ beliefs about the acceptability of practices such as dispensing antibiotics without prescription, self-medication, and the perceived feasibility of stewardship programs in resource-limited settings.
Perceptions followed a similar regional patchwork. Most studies conducted in West Africa—4 of 17, or 23.5 percent—East Africa—5 of 15, or 33.3 percent—and Southern Africa—3 of 8, or 37.5 percent—reported negative perceptions regarding antibiotic use and resistance. In contrast, positive perceptions were observed in studies from North Africa and Central Africa, regions where fewer studies were conducted, making these findings harder to generalize but nonetheless noteworthy.
The implications for policy and practice are considerable. The WHO’s Global Action Plan on antimicrobial resistance calls on member states to develop National Action Plans, and healthcare provider education and engagement is a core pillar of those plans. This review suggests that such plans in Africa should look beyond simple knowledge transmission. Because knowledge among providers is already moderate to good in many settings, stewardship interventions will need to target the attitudes and perceptions that mediate behavior, and address the systemic constraints—diagnostics, supply chains, regulation, and workload—that make inappropriate prescribing rational in practice even when it is irrational in principle.
The authors also emphasized the limitations of the existing evidence base and the need for better research. Most of the studies included were cross-sectional surveys, which capture a snapshot of knowledge and attitudes at a single moment but cannot establish causal relationships or track how beliefs and behaviors evolve over time. The review calls for further research, including qualitative and longitudinal study designs, across diverse healthcare cadres and regions. Qualitative work can illuminate why providers hold the attitudes and perceptions they do—surface the lived realities of prescribing under constraint—while longitudinal designs can reveal whether knowledge translates into sustained behavioral change and whether stewardship interventions produce durable effects.
The breadth of the population studied also matters. Healthcare providers in Africa encompass physicians, pharmacists, nurses, community health workers, and drug shop operators across public, private, and informal sectors, and their training, resources, and prescribing authority vary enormously. Mapping KAPs across these diverse cadres is essential for designing targeted interventions: a continuing education module that works for hospital physicians in urban referral centers may be irrelevant to a rural drug dispenser selling antibiotics over the counter without a prescription.
What emerges from this review is a nuanced and regionally varied portrait of the human factors underlying antimicrobial resistance in Africa. Providers are not ignorant of the resistance crisis—indeed, knowledge of resistance mechanisms was the single most studied topic in the literature surveyed. But knowing the science is not the same as practicing it, and attitudes and perceptions in several regions remain misaligned with stewardship goals. Closing the gap between knowledge and practice, the authors argue, will require research that goes deeper into the drivers of antibiotic use, better representation of understudied regions, and interventions that account for the full complexity of the environments in which African healthcare providers work. As antimicrobial resistance continues to erode the effectiveness of the world’s antibiotic arsenal, understanding—and changing—the behaviors of those who prescribe, dispense, and administer these drugs may prove as important as any new molecule in the pipeline.
Subject of Research: Knowledge, attitudes, and perceptions of healthcare providers in Africa regarding antibiotic use and antibiotic resistance
Subject of Research: Medicine
Article Title: Knowledge, attitudes and perceptions regarding antibiotic use and antibiotic resistance among healthcare providers in Africa: a scoping review
Article References: Sarele, T. V., Thamae, P. J., Sekoai, T. E., Makhetha, M. E., & Bolanle Ojewole, E. (2026). Knowledge, attitudes and perceptions regarding antibiotic use and antibiotic resistance among healthcare providers in Africa: a scoping review. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15568-x
Image Credits: AI Generated
DOI: 10.1186/s12913-026-15568-x
Keywords: Antibiotic use, Antibiotic resistance, Knowledge, Attitudes, Perceptions, Healthcare providers, Africa, Scoping review, Antimicrobial stewardship
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Ophelia Keating. (September 10, 2026). African healthcare providers’ knowledge and perceptions of antibiotic resistance reviewed. Scienmag. https://scienmag.com/african-healthcare-providers-knowledge-and-perceptions-of-antibiotic-resistance-reviewed/
Ophelia Keating. “African healthcare providers’ knowledge and perceptions of antibiotic resistance reviewed.” Scienmag, 10 September 2026, https://scienmag.com/african-healthcare-providers-knowledge-and-perceptions-of-antibiotic-resistance-reviewed/. Accessed 10 September 2026.
Ophelia Keating. “African healthcare providers’ knowledge and perceptions of antibiotic resistance reviewed.” Scienmag. September 10, 2026. https://scienmag.com/african-healthcare-providers-knowledge-and-perceptions-of-antibiotic-resistance-reviewed/
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