Knowledge, attitudes and practices of smallholder dairy farmers on antimicrobial use in selected districts of Zambia: implications for antimicrobial stewardship

Background The improper use of antibiotics in dairy farming contributes significantly to the development of antibiotic resistance (AMR), posing a global public health risk. Antimicrobial stewardship (AMS) in dairy production can reduce the spread of AMR. Smallholder dairy farmers (SHDFs) in low- and middle-income countries (LMICs) are particularly critical stakeholders in this context, given their significant contribution to the dairy sector. Consequently, AMS in dairy production can reduce the spread of AMR. This study aimed to examine the knowledge, attitudes, and practices (KAP) related to antibiotic use (AMU) and AMR among SHDFs in selected districts of Zambia to guide AMS interventions in the given contexts. Methods A cross-sectional survey was conducted using a structured questionnaire administered to 360 SHDFs conveniently identified at Milk Collection Centers (MCCs) across six purposively selected districts of Southern and Lusaka provinces. Results In total, 75.8% of respondents had poor overall KAP scores. While attitudes were positive toward the need to consult a veterinarian (99.2%), some practices were misaligned, including self-administration (38.6%), failure to observe withdrawal periods (24.2%) and selling (20%) and consuming milk (19.7%) from drug-treated animals. Whereas 42% could define AMR only 25.6% of participants knew the effects of misusing antibiotics. Good KAP was associated with level of education ( p < 0.001) and geographic location ( p < 0.001). Districts with a more urban setup in their respective provinces had higher overall KAP scores compared to those that were not (Monze District of Southern Province and Chilanga District of Lusaka Province). Those who had received prior training in appropriate antibiotic use and animal health management had higher odds of having good KAP ( p < 0.036). Conclusion This study gave insights into the KAP among SHDFs regarding AMU and AMR with implications for AMS. Educational programmes that shape correct attitudes based on increased Knowledge are encouraged. Geographical disparities in KAP scores emphasize the need for targeted context-specific AMS interventions. Our findings also revealed that financial barriers undermined prudent antimicrobial use. Addressing these gaps through training, economic support, and district-focused One Health interventions is essential to strengthening AMS in Zambia.