Knowledge, Attitude and Practices Related to Antibiotic Use and Resistance Among Students in Kurunegala and Kadugannawa Midwifery Training Schools
Keywords:
Antibiotic Resistance (ABR), Knowledge, Attitude, and Practices (KAP) on antibiotic use, Public Health Midwives Sri Lanka, Health Profession Students.Abstract
Antibiotics are drugs designed to kill or inhibit the growth of harmful bacteria. They remain among the most significant advances in modern medicine for the management of bacterial infections. Antibiotic resistance (ABR) is a critical global health issue, severely exacerbated in low- and middle-income countries like Sri Lanka by factors such as over-the-counter sales, inappropriate prescriptions, and limited public awareness. Misuse, including self-medication and use for viral infections, is prevalent due to misconceptions. Public Health Midwives (PHM), as grassroots healthcare workers at the community level, directly influence antibiotic use. Developing PHMs with up-to-date knowledge on this aspect is vital to dispel misconceptions and promote responsible practices, empowering the audience to support educational efforts. This study aimed to assess the KAP regarding antibiotic use and resistance among students at midwifery training schools in Kurunegala and Kadugannawa. A cross-sectional descriptive study was conducted involving 140 PHM students, selected through stratified random sampling using a self-administered questionnaire. A remarkable 99.3% of respondents demonstrated high baseline awareness. However, 29.5% mistakenly believed antibiotics were effective against viral infections, highlighting common misconceptions. Knowledge of resistance mechanisms was notably inadequate, with 89.3% incorrectly assuming the human body becomes resistant. In contrast, 41.4% correctly identified that resistance develops through bacterial adaptation. While 98.6% followed the doctor's instructions, 40.4% resorted to self-medication. Additionally, 85.3% exhibited the correct attitude by completing the prescribed course, yet 23.6% prematurely discontinued their antibiotics. The study revealed that while PHM students had a general awareness of antibiotic use and ABR, significant knowledge gaps persisted. Misconceptions about the effectiveness and mechanisms of ABR development were common. Despite their positive attitudes, students displayed inconsistent practices. Targeted educational interventions are essential to address these gaps and can inspire the audience to advocate for curriculum enhancements and policy changes to bolster antibiotic stewardship.
Downloads
References
Adikari, P.S., Pathirathna, K., Kumarawansa, W., Koggalage, P.D., 2020. Role of MOH as a grassroots public health manager in preparedness and response for COVID-19 pandemic in Sri Lanka. AIMS Public Health 7, 606–619. https://doi.org/10.3934/publichealth.2020048
Akande-Sholabi, W., Ajamu, A.T., 2021. Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University. BMC Med. Educ. 21, 488. https://doi.org/10.1186/s12909-021-02912-4
Al-Taani, G.M., Karasneh, R.A., Al-Azzam, S., Bin Shaman, M., Jirjees, F., Al-Obaidi, H., Conway, B.R., Aldeyab, M.A., 2022. Knowledge, Attitude, and Behavior about Antimicrobial Use and Resistance among Medical, Nursing and Pharmacy Students in Jordan: A Cross Sectional Study. Antibiotics 11, 1559. https://doi.org/10.3390/antibiotics11111559
Corea, F., Hubert, G., Abilleira, S., 2017. Letter by Corea et al Regarding Article, “Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.” Stroke 48. https://doi.org/10.1161/STROKEAHA.117.016724
De Silva, M.D.K., Talagalla, N.I., Karthikeyan, P., Rubasinghe, M.S., 2020. Burden of work and workload indicator-based staffing needs of public health midwives in the primary health care system in Sri Lanka. J. Coll. Community Physicians Sri Lanka 26, 148. https://doi.org/10.4038/jccpsl.v26i3.8244
Dyar, O., Hills, H., Seitz, L.-T., Perry, A., Ashiru-Oredope, D., 2018. Assessing the Knowledge, Attitudes and Behaviors of Human and Animal Health Students towards Antibiotic Use and Resistance: A Pilot Cross-Sectional Study in the UK. Antibiotics 7, 10. https://doi.org/10.3390/antibiotics7010010
Feather, A., Randall, D., Waterhouse, M. (Eds.), 2021. Kumar & Clark’s clinical medicine, Tenth edition. ed. Elsevier, London.
Higuita-Gutiérrez, L.F., Roncancio Villamil, G.E., Jiménez Quiceno, J.N., 2020. Knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Colombia: a cross-sectional descriptive study. BMC Public Health 20, 1861. https://doi.org/10.1186/s12889-020-09971-0
Horvat, O., Petrović, A.T., Paut Kusturica, M., Bukumirić, D., Jovančević, B., Kovačević, Z., 2022. Survey of the Knowledge, Attitudes and Practice towards Antibiotic Use among Prospective Antibiotic Prescribers in Serbia. Antibiotics 11, 1084. https://doi.org/10.3390/antibiotics11081084
Jayatilleke, A.C., Yoshikawa, K., Yasuoka, J., Poudel, K.C., Fernando, N., Jayatilleke, A.U., Jimba, M., 2015. Training Sri Lankan public health midwives on intimate partner violence: a pre- and post-intervention study. BMC Public Health 15, 331. https://doi.org/10.1186/s12889-015-1674-9
Jayaweerasingham, M., Angulmaduwa, S., Liyanapathirana, V., 2019. Knowledge, beliefs and practices on antibiotic use and resistance among a group of trainee nurses in Sri Lanka. BMC Res. Notes 12, 601. https://doi.org/10.1186/s13104-019-4640-2
Lubwama, M., Onyuka, J., Ayazika, K.T., Ssetaba, L.J., Siboko, J., Daniel, O., Mushi, M.F., 2021. Knowledge, attitudes, and perceptions about antibiotic use and antimicrobial resistance among final year undergraduate medical and pharmacy students at three universities in East Africa. PLOS ONE 16, e0251301. https://doi.org/10.1371/journal.pone.0251301
Marino, A., Maniaci, A., Lentini, M., Ronsivalle, S., Nunnari, G., Cocuzza, S., Parisi, F.M., Cacopardo, B., Lavalle, S., La Via, L., 2025. The Global Burden of Multidrug-Resistant Bacteria. Epidemiologia 6, 21. https://doi.org/10.3390/epidemiologia6020021
Ministry of Health, Sri Lanka, 2024. National Strategic Plan for Combating Antimicrobial Resistance in Sri Lanka 2023 -2028.
Ministry of Health, Sri Lanka, 2017. National Strategic Plan for Combating Antimicrobial Resistance in Sri Lanka 2017 – 2022.
Nakato, G., Adongo, P.R., Iramiot, J.S., Epuitai, J., 2023. Practices and drivers of self-medication with antibiotics among undergraduate medical students in Eastern Uganda: A cross-sectional study. PLOS ONE 18, e0293685. https://doi.org/10.1371/journal.pone.0293685
Ortega-Paredes, D., Larrea-Álvarez, C.M., Torres-Elizalde, L., De Janon, S., Vinueza-Burgos, C., Hidalgo-Arellano, L., Šefcová, M.A., Molina-Cuasapaz, G., Fernandez-Moreira, E., Larrea-Álvarez, M., 2022. Antibiotic Resistance Awareness among Undergraduate Students in Quito, Ecuador. Antibiotics 11, 197. https://doi.org/10.3390/antibiotics11020197
Owusu-Ofori, A.K., Darko, E., Danquah, C.A., Agyarko-Poku, T., Buabeng, K.O., 2021. Self-Medication and Antimicrobial Resistance: A Survey of Students Studying Healthcare Programmes at a Tertiary Institution in Ghana. Front. Public Health 9, 706290. https://doi.org/10.3389/fpubh.2021.706290
Raees, I., Atif, H.M., Aslam, S., Mustafa, Z.U., Meyer, J.C., Hayat, K., Salman, M., Godman, B., 2023. Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications. Antibiotics 12, 135. https://doi.org/10.3390/antibiotics12010135
Ritter, J.M., MacEwan, D., Flower, R., Robinson, E., Henderson, G., Fullerton, J., Loke, Y.K., 2024. Rang & Dale’s pharmacology, Tenth edition. ed. Elsevier, London New York Oxford Philadelphia St. Louis Sydney.
Sakeena, M.H., Bennett, A.A., Mohamed, F., Herath, H.M., Gawarammane, I., McLachlan, A.J., 2018. Investigating knowledge regarding antibiotics among pharmacy and allied health sciences students in a Sri Lankan university. J. Infect. Dev. Ctries. 12, 726–732. https://doi.org/10.3855/jidc.10388
Sanooz, A.R.M., 2025. Over-the-Counter Medicines: A Narrative Review in the Global and Sri Lankan Context. Batticaloa Med. J. 19, 57–61. https://doi.org/10.4038/bmj.v19i1.77
Scaioli, G., Gualano, M.R., Gili, R., Masucci, S., Bert, F., Siliquini, R., 2015. Antibiotic Use: A Cross-Sectional Survey Assessing the Knowledge, Attitudes and Practices amongst Students of a School of Medicine in Italy. PLOS ONE 10, e0122476. https://doi.org/10.1371/journal.pone.0122476
Ulfah, I.N., Dethan, R.D.A.S.S., Realita, F., Rosyidah, H., 2021. Learning method comparison between small-group discussion (SGD) and conventional to the knowledge improvement of midwifery department students. J. Health Technol. Assess. Midwifery 4, 8–14. https://doi.org/10.31101/jhtam.1727
Vázquez-Lago, J.M., Montes-Villalba, R.A., Vázquez-Cancela, O., Otero-Santiago, M., López-Durán, A., Figueiras, A., 2023. Knowledge, Perceptions, and Perspectives of Medical Students Regarding the Use of Antibiotics and Antibiotic Resistance: A Qualitative Research in Galicia, Spain. Antibiotics 12, 558. https://doi.org/10.3390/antibiotics12030558
Wagachchi, W.P., Wijekoon, W.M.C.D., Kommalage, M., 2019. Drug costs of patients admitted to a government hospital; share of public and private expenditure. Galle Med. J. 24, 8. https://doi.org/10.4038/gmj.v24i1.8001
Wahsheh, M.A., Hassan, Z.M., Hasan, F.M., 2024. Antibiotics Self-remedy Use among Health and Nonhealth Undergraduate Students: An Application of the Theory of Planned Behavior. Am. J. Health Behav. 48, 1368–1377. https://doi.org/10.5993/AJHB.48.5.16
World Health Organization, 2018. Global Framework for Development & Stewardship to Combat Antimicrobial Resistance.
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Pamila Sadeeka Adikari, Shayanthini Silambanathan, Lelum Wannisinghe , Mihiri Thalgahagoda, Charith Wijethilake, Sandeep Lakshan

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Journal of Health Technology Assessment in Midwifery agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY-SA 4.0) that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.

Journal of Health Technology Assessment in Midwifery is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License..









