Most people across the Middle East and North Africa have heard of antibiotic resistance, but far fewer understand what antibiotics actually do, when they work, and how misuse fuels the rise of drug-resistant superbugs. That is the central finding of a large new survey spanning seven countries in the region, published in the journal Pharmacia, which suggests that familiarity with the term has not translated into the practical knowledge needed to slow one of the world’s most pressing health threats.
Antimicrobial resistance, or AMR, occurs when bacteria evolve to withstand the drugs designed to kill them. Antibiotics work by disrupting critical bacterial cell functions, inducing cell death, but improper use by one patient can select for resistant strains that then extend harm to others. The World Health Organization has described AMR as an alarming global crisis from both epidemiological and economic perspectives, associated with longer hospital stays, higher mortality and rising healthcare costs. Some projections estimate that around 10 million people could die annually from AMR by 2050 if current trends continue.
To map how well the public understands these risks, researchers conducted a multicenter cross-sectional study across Egypt, Palestine, Algeria, Sudan, Syria, Libya and Jordan, adapting the WHO’s multi-country public awareness questionnaire into validated Arabic versions for each population. A total of 12,729 respondents completed the online survey, recruited through social media platforms using convenience sampling. The sample was predominantly female at 74.6%, largely urban at 76.4%, highly educated with 63% holding bachelor’s degrees, and young, with 47.5% aged between 19 and 24 years.
The headline numbers reveal a striking disconnect. While 82.3% of participants recognized the term antibiotic resistance, only 42.6% achieved a good knowledge score on standardized questions about antibiotic handling and resistance. Less than half correctly identified that antibiotics are ineffective against flu-like viral illnesses, and misconceptions persisted about conditions such as diarrhea, sore throat, gonorrhea and influenza, where correct answers fell well below the 50% mark. In other words, people know the phrase but not the biology behind it.
Behavioral data add to the concern. Around 28% of participants reported taking antibiotics within the last month, and among recent users, nearly one-third, or 29.3%, obtained the medication without a prescription from a doctor or nurse. Pharmacies and medical stores were the primary source of antibiotics for 86.5% of respondents, while 4.7% had saved antibiotics from a previous occasion and 5.3% obtained them from friends or family. Encouragingly, 79.7% knew to stop taking antibiotics only after completing the prescribed course, and 80.7% correctly identified that sharing antibiotics with others is incorrect, even for the same illness.
Demographic patterns in knowledge were clear and statistically significant. Females, urban residents, individuals aged 19 to 24, and those with higher education or medical backgrounds scored significantly higher, with p values below 0.001 across these associations. Participants from medical faculties achieved good knowledge at 60.3%, compared with just 14.5% among humanities and literary faculties. Geographic variation was also pronounced: Egypt recorded the highest average knowledge score at 68.3, with 55.2% of respondents showing good knowledge, while Libya had the lowest at 50.9, with only 31.3% achieving good scores. At the provincial level, Egypt’s Delta and Alexandria regions topped the rankings at 69.1, while Jordan’s Southern District fell to 47.1.
The authors note that Egypt’s strong performance may partly reflect its National Action Plan for AMR, which promotes judicious antibiotic use and public awareness. Countries facing conflict, such as Libya, Syria and Palestine, showed relatively low knowledge levels, possibly linked to disruption of education systems and healthcare facilities. Yet the pattern is not straightforward: Gaza showed relatively high knowledge despite conflict, while Jordan, at peace, scored relatively low. This complexity suggests that factors beyond security and finances, including healthcare infrastructure, local beliefs and educational programs, interact in ways that demand further research.
Attitudes toward responsibility and prevention were mixed. A majority, 60.4%, acknowledged their own responsibility to use antibiotics appropriately, and 42.4% believed they could personally influence the spread of resistance. However, 43.7% incorrectly believed that taking antibiotics correctly completely eliminates personal risk, and only 24% recognized that anyone, regardless of antibiotic use, could be affected by resistant infections. Trust in medical experts to solve the problem before it becomes critical was far from universal, with 55.2% disagreeing or remaining uncertain. On prevention measures, support was strong: 83.6% strongly agreed on regular handwashing, 81.2% on up-to-date childhood vaccinations, and 79.6% on government support for developing new antibiotics.
Comparisons with earlier data offer both reassurance and warning. Antibiotic use within the last month fell to 28%, considerably lower than the 54% reported for Egypt and 49% for Sudan in the original WHO survey conducted nine years earlier. Self-medication at 29% was lower than previously reported regional rates but still higher than the WHO estimate of 19% and dramatically above the 4% reported among Italian university students. Public awareness campaigns reached only 7.6% of the population, while media sources informed 16%, well below the WHO estimate of 41%, suggesting that current communication strategies remain ineffective despite the rise of social media.
The authors acknowledge important limitations. The online, convenience-sampled design skewed the cohort toward young, female, urban, highly educated and medically trained respondents, with adults over 64 comprising just 0.4% of participants. Selection and self-reporting biases, along with social desirability effects, may limit generalizability to the broader populations of the surveyed countries. The authors also highlight a contextual factor not directly measured: the underuse of antimicrobial susceptibility testing, or antibiograms, before prescribing, which drives empirical therapy and selective pressure for resistance. Despite these caveats, the study provides comprehensive baseline data across seven populous MENA nations and underscores an urgent need for targeted, culturally adapted public health campaigns and stricter regulatory enforcement to close the gap between knowing the words and understanding the threat.
Subject of Research: A cross-sectional survey of 12,729 people in seven Middle Eastern and North African countries found high recognition of the term antibiotic resistance but only 42.6% had good antibiotic knowledge, with 29.3% of recent users obtaining antibiotics without a prescription.
Article Title: Assessing awareness and attitudes among Middle Eastern and North African populations regarding antimicrobial drug resistance: a regional cross-sectional study
Article References: Abdel-Qader, D. H., Taha, T. A.-E. A., Abd-eltawab, A. K., Abdelsattar, N. K., Nourelden, A. Z., Elshanbary, A. A., Elsayed, S. M., Darwish, M. Y., Basheti, I., & Matar, S. G. (2026). Assessing awareness and attitudes among Middle Eastern and North African populations regarding antimicrobial drug resistance: a regional cross-sectional study. Pharmacia, 73, Article e188437. https://doi.org/10.3897/pharmacia.73.e188437
Image Credits: AI Generated
DOI: 10.3897/pharmacia.73.e188437
Keywords: antimicrobial resistance, antibiotics, MENA, public health, self-medication, survey, knowledge gaps, Egypt, Jordan, WHO, Assessing, awareness
News Source: Ophelia Keating. (October 15, 2026). Antibiotic resistance awareness runs deep in MENA but knowledge gaps and self-medication persist across seven countries. Scienmag.
