Moderate Knowledge, Negative Attitudes and Suboptimal Practices Regarding Antibiotic Use in a Rural South African Community

Background: The inappropriate use of antibiotics contributes to the development and spread of antibiotic resistance. Community education plays an important role in mitigating this threat; however, community-derived data required to inform the co-creation of solutions and development of awareness packages remain limited. This study assessed knowledge, attitudes, and practices (KAP) regarding antibiotic use in a community participating in a longitudinal enteric antibiotic resistance research project to inform targeted community interventions. Methods: This cross-sectional study included 917 residents of nine villages in a rural community in Limpopo Province, South Africa. Data on antibiotic use and resistance were collected using a structured questionnaire comprising closed-ended items and two open-ended questions. The four-point Likert-scale responses were scored based on appropriateness, with possible scores ranging from 0 to 14 for knowledge, 0 to 7 for attitudes and 0 to 5 for practice. Quantitative data were analysed using descriptive statistics, bivariate and multivariable logistic regression, while qualitative responses were analysed thematically. Results: The median age of participants was 34 years (IQR: 22), and the majority were females (61.5%), unemployed (67.0%), single (69.1%) and had less than Grade 12 education (60.0%). The mean percentage KAP scores were 67.9 ± 9.3%, 27.3 ± 22.5%, and 61.9 ± 11.0%, respectively. Most participants had moderate knowledge (82.9%), negative attitudes (83.8%) and suboptimal practices (83.2%). Major knowledge misconceptions concerned the effectiveness of antibiotics against viruses and most coughs and colds. More than 70% expressed inappropriate attitudes towards obtaining antibiotics without a prescription or from relatives or friends, keeping antibiotics for future use, and stopping treatment when they felt better. Notable inappropriate practices included obtaining antibiotics based on the experiences of family or friends (77.8%) and stopping the medication when symptoms disappear (94.7%). Unemployed participants had higher odds of having at least moderate knowledge compared to the employed (aOR = 1.48, 95% CI: 1.02–2.14), those aged ≥50 years had lower odds of a positive attitude than those aged 16–24 years (aOR = 0.35, 95% CI: 0.19–0.68), and participants with less than Grade 12 education had lower odds of good practice than those with Grade 12 education (aOR = 0.62, 95% CI: 0.42–0.91). Positive attitudes were associated with higher odds of good antibiotic-use practice than negative attitudes (aOR = 2.21, 95% CI: 1.46–3.34). Qualitative findings supported the quantitative results by revealing perceptions of antibiotic effectiveness alongside persistent misconceptions, including beliefs that antibiotics treat viral infections or should be used frequently. Conclusions: Although participants demonstrated moderate overall knowledge, important misconceptions coexisted with predominantly negative attitudes and poor reported practices. These findings identify priority areas for subsequent responsive dialogues with stakeholders to co-create locally appropriate community antimicrobial stewardship interventions.