Knowledge, Attitudes, and Practices Related to Antimicrobial Resistance Across the One Health Sector in Ghana: A Cross-Sectional Study

Introduction:
Antimicrobial resistance (AMR) is a growing public health threat that spans human, animal, and environmental health systems. In Ghana, limited multisectoral evidence exists on how knowledge, attitudes, and practices related to AMR vary across these interconnected sectors. This study assessed AMR-related knowledge, attitudes, and practices across the One Health sectors in selected districts of Ghana and examined factors associated with appropriate antimicrobial-related behaviours.

Methods:
A cross-sectional analytical study was conducted among adults working in human health, animal health, and environmental health sectors in Sunyani West Municipality, Techiman Metropolitan Area, and Offinso North District. A stratified random sampling approach was used to recruit 450 participants, of whom 448 completed a structured questionnaire. Data on sociodemographic characteristics and AMR-related knowledge, attitudes, and practices were collected through face-to-face interviews. Descriptive statistics summarized outcomes, while chi-square tests and multivariable logistic regression identified factors associated with good knowledge and appropriate practices.

Results:
Overall, 63% of participants demonstrated good knowledge of AMR, with significant variation across sectors (p < 0.001). Positive attitudes toward prudent antimicrobial use were reported by 85% of respondents; however, only 40% exhibited appropriate practices. Good knowledge was significantly associated with tertiary education (adjusted odds ratio [aOR] = 2.8; 95% CI: 1.7–4.6) and employment in the human health sector (aOR = 2.5; 95% CI: 1.4–4.4). Appropriate practices were independently predicted by good knowledge (aOR = 3.6; 95% CI: 2.2–5.9) and positive attitudes toward antimicrobial stewardship (aOR = 2.1; 95% CI: 1.3–3.2).

Conclusion:
Knowledge and practices related to antimicrobial resistance vary substantially across One Health sectors in Ghana, with notable gaps between awareness and behaviour. Strengthening multisectoral training, regulation of antimicrobial use, and district-level stewardship interventions are essential to promote responsible antimicrobial use and reduce AMR risks.