Abstract
BACKGROUND: Antimicrobial resistance (AMR) is an escalating health crisis, particularly in low- and middle-income countries (LMICs) where limited healthcare infrastructure and weak regulations contribute to the misuse of antibiotics. Many people unknowingly fuel this resistance by misusing antibiotics, whether for common colds or other viral (non-bacterial) infections. To address this challenge, we conducted a study to understand how communities perceive antimicrobial resistance (AMR) and their use of antibiotics. METHODS: As part of the World AMR Awareness Week (WAAW) in Ghana, we conducted an exploratory, quasi-experimental, mixed-method study design to assess the knowledge, attitudes, and practices of communities related to AMR. The study was conducted at four sites across rural and urban settings: St. Martin Catholic Hospital (Agroyesum, Amansie-South District), St Francis Xavier Hospital (Assin Foso, Assin Foso Municipal District), University Junction Taxi Terminal (Ayigya), and Kumasi Metropolis. We surveyed 102 participants before (pre-engagement) and after (post-engagement) targeted educational activities, exploring their familiarity with antibiotics, awareness of AMR, and changes in perception following the sensitisation sessions. RESULTS: Pre-engagement, 88% of participants were familiar with antibiotics, and 77% were aware of AMR; significant knowledge gaps persisted. Alarmingly, 21% believed antibiotics can treat viral infections and 64% reported antibiotic use in animal farming. Only 14% acquired antibiotics via formal healthcare, while 53% of the participants found them "very easy" to obtain. A substantial 45% reported personal experience of antibiotic therapeutic failure. Post-engagement of the educational activities, all participants demonstrated fair awareness of the concepts of antibiotics and AMR quantitatively (via closed-ended questions) and qualitatively (through more precise open-ended definitions), with increased confidence and improved understanding. A high proportion (91%) of this population also perceived AMR as a healthcare challenge, and 95% of them recognised antibiotic misuse. CONCLUSION: These findings revealed prevalent misconceptions and informal antibiotic acquisition channels in Ghana. The study demonstrates that targeted community engagement is a promising strategy for improving AMR knowledge and fostering responsible antibiotic use, highlighting the urgent need for multi-stakeholder, "One Health" approaches beyond traditional clinical settings.