🟠 Moderate Evidence
Healthcare professionals in Mogadishu, Somalia demonstrate moderate knowledge of antimicrobial stewardship despite endorsing stewardship-aligned practices, according to a cross-sectional study published in PLOS Global Public Health. The research, conducted among 426 healthcare workers across seven hospitals, reveals critical gaps in understanding antibiotic use and resistance mechanisms that could undermine efforts to combat this escalating threat in fragile health systems.
Key takeaways
- Healthcare professionals in Mogadishu scored 69.3% on general antibiotic knowledge and 72.1% on antimicrobial stewardship awareness, despite 78.6% endorsing stewardship-aligned attitudes
- Knowledge correlated significantly with both attitudes (correlation coefficient 0.46) and awareness (0.53), suggesting education gaps directly impact practice intentions
- Many respondents held misconceptions about antibiotic use despite moderate overall scores, indicating educational interventions must address specific knowledge deficits
Study at a Glance
| Source | PLOS Global Public Health |
| Study type | Cross-sectional survey |
| Sample size | N = 426 healthcare professionals |
| Population | Physicians, nurses, midwives, pharmacists, laboratory technicians, and allied clinical staff |
| Country | Somalia (Mogadishu) |
Knowledge, Attitudes, and Awareness Scores Among Mogadishu Healthcare Professionals
Composite mean scores (as percentage of maximum) across three stewardship domains, n=426
Source: Garba et al., PLOS Global Public Health, 2024 | Georgian Medical Journal News
The Knowledge-Practice Gap in Fragile Health Systems
Antimicrobial resistance poses a critical threat in low-resource settings where laboratory capacity is limited and access to antibiotics remains variable. According to research published in PLOS Global Public Health, conducted by Bashiru Garba and colleagues, healthcare professionals in Mogadishu demonstrated attitudes aligned with antimicrobial stewardship principles—78.6% endorsed stewardship-aligned actions—yet knowledge deficits persisted. This discrepancy between intention and understanding represents a significant implementation challenge in fragile health systems where training resources are scarce.
The study surveyed 426 healthcare professionals across seven hospitals using a structured questionnaire assessing attitudes, knowledge of antibiotics, and awareness of antimicrobial resistance and stewardship. Responses were scored on five-point scales and analyzed for correlations across domains. The mean attitude score reached 58.93 out of 74 (78.6%), while knowledge scored 38.10 out of 55 (69.3%), and awareness achieved 36.07 out of 49 (72.1%). These moderate-to-good composite scores masked underlying misconceptions that could translate into inappropriate prescribing decisions in clinical practice.
Knowledge of antimicrobial stewardship correlated significantly with both attitudes (Spearman ρ = 0.46, p
— Bashiru Garba, Lead Investigator (PLOS Global Public Health, 2024)
Misconceptions Undermine Implementation Efforts
Despite moderate overall knowledge scores, the Mogadishu study identified significant misconceptions among respondents about antibiotic use, resistance mechanisms, and appropriate stewardship actions. Many healthcare professionals held beliefs inconsistent with evidence-based practice, a pattern documented across fragile health systems where professional development opportunities are limited. These misconceptions are particularly concerning because they reflect not merely gaps in awareness but actively harmful beliefs that could drive inappropriate prescribing.
The research suggests that standard educational approaches focused on general awareness may be insufficient. Instead, targeted interventions must address specific misconceptions prevalent in the local context—such as beliefs about antibiotic efficacy, resistance transmission, and the role of individual prescribers in combating resistance. This finding aligns with clinical updates on stewardship implementation showing that context-specific education yields better outcomes than generic training programs.
Sociodemographic Factors Shape Stewardship Readiness
The Garba team’s analysis identified sociodemographic and professional characteristics that predicted attitudes, knowledge, and awareness scores. Linear regression analysis revealed that certain professional groups and experience levels showed differential preparedness for stewardship adoption. These variations suggest that a one-size-fits-all training approach will miss workforce heterogeneity—physicians, nurses, pharmacists, and laboratory technicians face different prescribing pressures and information needs. Understanding these predictors enables targeted workforce development strategies tailored to specific professional roles.
In fragile health systems like Somalia’s, where laboratory confirmation of infections remains limited and over-the-counter antibiotic access is common, the role of professional knowledge becomes even more critical. Healthcare workers must make clinical decisions with incomplete diagnostic information, making their understanding of stewardship principles essential. The moderate correlation between knowledge and attitudes (ρ = 0.46) suggests that closing knowledge gaps could strengthen stewardship-aligned decision-making across the entire workforce.
What this means
Frequently asked questions
Why do healthcare workers endorse stewardship but lack knowledge?
Good intentions without sufficient knowledge reflect exposure to stewardship messaging without deep understanding of mechanisms. According to the Mogadishu study, many respondents could recognize stewardship-aligned statements as desirable while holding misconceptions about how antibiotics work or how resistance spreads—a common pattern in settings with limited formal training infrastructure.
How does laboratory capacity affect stewardship implementation?
In fragile health systems with limited diagnostic testing, healthcare workers must prescribe antibiotics based on clinical suspicion alone, making their stewardship knowledge even more critical. Without culture results or rapid diagnostics to guide therapy, prescribers rely on judgment and training—underscoring why the Mogadishu study emphasizes the urgency of knowledge-focused interventions.
Should training target all healthcare professionals equally?
The Garba team found that sociodemographic factors predicted knowledge and awareness, suggesting that physicians, pharmacists, nurses, and technicians should receive role-specific stewardship training. Pharmacists, for example, need detailed knowledge of drug interactions and resistance patterns, while nurses need understanding of infection control and compliance monitoring.
The Mogadishu findings reflect a broader challenge in global antimicrobial stewardship: translating policy endorsement into practice change requires sustained, evidence-based education addressing both knowledge deficits and locally prevalent misconceptions. As Somalia rebuilds its health system, embedding stewardship training into professional curricula and licensing requirements could prevent the emergence of widespread resistance that threatens treatment of common infections across the region. The study provides a blueprint for needs assessment that other fragile health systems can replicate to tailor interventions to local contexts.
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