Abstract
Background
The studies on knowledge, attitudes, and practices of Antimicrobial resistance (AMR) and use among adolescents and young people are largely from Europe and the Asia region. All such studies reported a low level of understanding of antibiotic resistance and the rational use of antibiotics among adolescents and young people who are at a formative stage when health behaviours are being shaped. There are limited such studies from West Africa, despite a high AMR burden in the region. We therefore conducted a study to assess the knowledge, attitude, and practice on antibiotic use and resistance among adolescents and young people in Sierra Leone.
Methods
This cross-sectional study was conducted among adolescents and young people (15–29 years) who participated in the National Girls Summit-2024 in Sierra Leone. A validated self-administered questionnaire with 29 questions was used to collect data: demography (4 questions); knowledge (14 questions); attitude (3 questions); and practice (8 questions). Data were analyzed using Stata version 15, with results presented using frequencies and percentages.
Results
Of the 235 participants, over half (133, 56.6%) had attained university education, and a smaller proportion (14, 6.0%) had completed vocational training. The majority (144, 61.3%) of the adolescents and young people had used an antibiotic within the last 30 days before the study. Over two-thirds (180, 76.6%) of adolescents and young people had heard about antibiotic resistance, and most of them got the information from their academic institutions (67, 37.2%) and the radio (15.0%). Almost half (110, 46.8%) had poor knowledge about antibiotic use and resistance. The majority (139, 59.1%) had a negative attitude towards antibiotic use and resistance, and most (205, 87.2%) of them demonstrated poor practices in antibiotic use.
Conclusion
Our study revealed that adolescents and young people in Sierra Leone have a limited understanding of antibiotic resistance. Limited knowledge may drive inappropriate antibiotic use, further increasing the AMR burden in the country. We recommend implementing school and university-based antimicrobial stewardship initiatives to enhance awareness and understanding of antibiotic resistance and promote rational use of antibiotics.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-025-25223-5.
Keywords: Antibiotic use, Antibiotic resistance, Antimicrobial resistance, Knowledge, Attitude and practice, Adolescents, Young people, Sierra leone
Background
Antimicrobials are medications used to treat infections caused by microorganisms such as bacteria, viruses, protozoa, or fungi. Antimicrobial resistance (AMR) occurs when these organisms fail to respond to the drugs that kill or inhibit their growth [1, 2]. AMR is a global public health problem that has both health and non-health implications, as it is associated with increased morbidity, mortality, disability, healthcare costs, and financial hardship [3]. Despite the risk of the general population from contracting resistance bugs, women, children, adolescents, young people, and populations in low socioeconomic and humanitarian settings are at increased risk of exposure to AMR [2, 4, 5]. More alarming is the fact that more adolescents are living in multi-burden countries, which include communicable diseases, maternal conditions, and others, which might increase their tendency to use antibiotics [6].
Infectious diseases, such as respiratory tract infections, sexually transmitted infections, and skin infections, are common among adolescents and young people [7, 8]. These infections may contribute to increased exposure to antibiotic use. Additionally, in countries like Sierra Leone with weak legislation and enforcement of over-the-counter antibiotic sales, the risk of self-medication and the inappropriate use of antibiotics among adolescents and young people remains high [9].
Understanding the use of antibiotics and AMR among the general population varies across African countries. Knowledge, attitudes, and practices (KAP) surveys conducted in countries in the African region have reported the inappropriate use of antibiotics, the acquisition of antibiotics without prescriptions, and a limited understanding of antibiotic use and AMR among the general population [10–12]. This pattern of low knowledge of antibiotic use and AMR is also seen globally among adolescents and young people, as reported from studies conducted in Italy, the United Kingdom, and Malaysia [9, 13, 14]. These findings reveal a considerable knowledge gap, emphasising the necessity for global and national initiatives to enhance awareness of the rational use of antibiotics and reduce antibiotic resistance.
The World Health Organization has developed a global action plan (GAP) to combat AMR that serves as a blueprint for countries to develop their national action plans. The first objective of the GAP is to improve the knowledge and understanding of AMR through effective communication, education, and training [15]. This entails assessing public awareness and attitudes toward the appropriate use of antibiotics and the dangers of AMR, including in adolescents and young people. In countries where antibiotic access is stringently regulated, most adolescents believe antibiotics should be used only on a physician’s advice [14]. Moreover, studies conducted in Malaysia and Jordan demonstrated that educational programmes and meaningful engagement with adolescents and young people improved attitudes toward antibiotic use and resistance [13, 16].
Since a third of Africa’s population comprises adolescents and young people (10–24 years), it is crucial to equip them with appropriate knowledge about antibiotic use and resistance to positively influence future health practices in adulthood [17]. Furthermore, given that adolescents and young people can be potential agents of social change in their families and academic institutions, they may encourage the adoption of healthy behaviours in their communities [18, 19].
Extensive literature searches have shown that minimal studies have been conducted in Africa to assess the KAP on antibiotic use and resistance among adolescents and young. The findings from this study are critical for the development of need-based health communication aids and the dissemination of targeted information to adolescents and young people. Therefore, we aimed to assess the KAP on antibiotic use and resistance among adolescents and young people who attended a national girls’ summit.
Methods
This is a cross-sectional survey using a self-administered questionnaire.
General setting
Sierra Leone is a country in West Africa, bordered by Guinea, Liberia, and the Atlantic Ocean, and is divided into 16 districts [20]. The estimated population is 8 million, with the majority (59%) living in rural areas. In 2021, the life expectancy for males was 60 years, and 62 years for females [21]. The adolescent and young people population is growing rapidly, and they form a critical mass for economic growth and development. The total expenditure on health as a percentage of the gross domestic product in 2022 was 7.95% [22].
Specific setting
National girls summit
The Girls Advocacy Network (GADNET), a youth-led organization, annually hosts the National Girls Summit in different parts of the country. It is one of the biggest gatherings of adolescents, particularly girls and young women from all 16 districts. GADNET sends out a call to youth-led organizations all over the country to nominate adolescents and young people to participate in the national summit. Furthermore, participants can self-register through a registration link that is shared on several adolescents and young people social media platforms.
Over the past years, they have trained and empowered over 2000 girls and 500 boys on global public health issues, such as sexual and reproductive health and rights, sexual and gender-based violence, prevention of sexually transmitted diseases, women’s empowerment, and basic life skills. During the summit, experts from diverse fields of public health provide training and guidance on issues pertinent to the health and wellbeing of adolescents and young people. Most of the initiatives of this organization are supported by United Nations (UN) agencies in the country, including the United Nations Population Fund (UNFPA), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the World Health Organization (WHO).
Study population and inclusion
We used a purposive sampling approach as only those who were invited to the national girls’ summit were included in the study. All 400 adolescents and young people who attended the national girls’ summit were invited to participate in the study. Study participants were older adolescent girls and boys aged between 15 and 19 years and young people aged between 20 and 29 years from all 16 districts across the country. Only those who were willing to participate in the study were given the self-administered questionnaire, and 239 participants completed the questionnaires.
Data collection
A paper-based, structured data collection questionnaire was used to collect data from consented and assented participants. Data was collected by organizers of the national girls’ summit, who have been trained on the different components of the data collection tool. Only anonymized data were collected, and participant identifiers, like names of schools or universities, and home addresses, were not collected.
Data collection tool
Currently, there is no globally recognized and validated tool to collect data on the knowledge, attitudes, and practices of antibiotic use and resistance among adolescents and young people. For this study, the research team developed a self-administered questionnaire with easy-to-read and understandable variables that capture information on antibiotic use and AMR among adolescents and young people (Supplementary file 1). The questions were framed using simple English to support the accurate completion of the form by participants. Face validity was evaluated by five researchers working in the field of AMR and adolescent health and well-being, as well as individuals outside the research field who assessed the questionnaire for clarity, style, ease of understanding, and layout. Furthermore, it was reviewed for content validity, including readability, clarity, comprehensiveness, and agreement on questions to be retained in the final questionnaire. This pre-validated questionnaire was then shared with ten randomly selected adolescents and young people for validation, which confirmed that the questions were straightforward and could be completed within 20 min or less. Furthermore, the Cronbach alpha was calculated to determine the reliability of the questionnaire. The Cronbach alpha indicates an acceptable internal reliability (∝ = 0.718).
The questionnaire has four sections: demography (4 questions); knowledge (14 questions); attitude (3 questions); and practice (8 questions) with “Yes” or “No” responses.
Data analysis
Data was entered, cleaned, and coded on Microsoft Excel Professional Plus 2016. The analysis was done using JASP (Version 0.95.1). Respondents’ demographic data were analyzed using descriptive statistics, and results were presented as frequencies and percentages. Unspecified responses, meaning no data was provided, account for a small fraction of the responses, well within the recommended and acceptable threshold for data accuracy (< = 10% missing data). The grading thresholds for knowledge, attitude, and practice were determined based on the distribution of scores in the dataset. For each KAP domain, we examined the spread and clustering of percentage scores to identify natural breakpoints that best distinguished between low, moderate, and high levels of performance. Correct responses were scored 1, and wrong responses were scored 0.
For knowledge, three scores were created to measure the level of knowledge on antibiotic use and resistance. Correct answers were counted, and a percentage was calculated for each respondent. Poor knowledge, moderate knowledge, and good knowledge were assigned scores of 0–49%, 50–79%, and 80% and above, respectively. Attitude was grouped into two categories. Out of the three responses, two or more selected correct answers/responses were assigned “positive attitude”, and those with fewer than two correct/responses answers were assigned “negative attitude”. For practice, three scores were created to measure antibiotic use practice. Correct answers were counted, and a percentage was calculated for each respondent. Poor practice, fair practice, and good practice were assigned scores of 0–49%, 50–74%, and 75% and above, respectively.
For inferential analysis, logistic regression was employed to identify factors associated with knowledge, attitudes, and practices. Before modeling, key independent variables were recoded to ensure meaningful interpretation and model stability. Age was collapsed into two groups (< 20 years and ≥ 20 years) to address sparse cell counts observed in some categories. Similarly, education level was recoded into two categories (≤ secondary education and > secondary education) to reduce sparsity and facilitate clearer comparisons. Bivariate logistic regressions were first conducted, and variables with a p-value < 0.20 were included in multivariable models to control for potential confounding. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, and statistical significance was set at p < 0.05.
Results
Characteristics of participants
Of the 235 participants, the majority (194, 82.6%) were female, and about half (110, 46.8%) of the participants were aged 20–24 years. The majority (133, 56.6%) of them had attained university education, and a smaller proportion (14, 6.0%) had completed vocational training. The majority (144, 61.3%) of the adolescents and young people had used an antibiotic within the last 30 days before the study (Table 1). Over two-thirds (180, 76.6%) of adolescents and young people had heard about antibiotic resistance, and most of them got the information from their academic institutions (67, 37.2%) and the radio (15.0%) (Fig. 1).
Table 1.
Sociodemographic characteristics of the study participants (N = 235)
| Variables | Frequency | % |
|---|---|---|
| Sex | ||
| Male | 41 | 17.4 |
| Female | 194 | 82.6 |
| Age Group (years) | ||
| 15–19 | 98 | 41.7 |
| 20–24 | 110 | 46.8 |
| 25–29 | 25 | 10.6 |
| Unspecified | 2 | 0.9 |
| Education Level (currently enrolled) | ||
| Primary | 3 | 1.3 |
| Secondary | 85 | 36.2 |
| Vocational | 14 | 6.0 |
| University | 133 | 56.6 |
| Ever heard about antibiotic resistance | ||
| Yes | 180 | 76.6 |
| No | 43 | 18.3 |
| Unspecified | 12 | 5.1 |
| Used antibiotics in the last month. | ||
| Yes | 144 | 61.3 |
| No | 78 | 33.2 |
| Unspecified | 13 | 5.5 |
Fig. 1.
Sources of information about antibiotic resistance among adolescents and young people in Sierra Leone, 2024
Knowledge about antibiotic use and resistance among adolescents and young people
Almost half (110, 47%) of the adolescents and young people had poor knowledge about antibiotic use and resistance, even though they reported having heard about antibiotic resistance. However, most (198, 88.6%) of them correctly identified that antibiotics kill bacteria, and most (174, 79.5%) were also able to identify amoxicillin as an antibiotic. On the other hand, misconceptions were common, as over a third (94, 40.3%) of participants believed that antibiotics could kill viruses and treat viral illnesses such as flu, and over a third (91, 39.6%) thought they could use antibiotics to treat malaria. Additionally, a huge proportion (93, 41.5%) believed that antibiotics could be used to treat a fever, and half (112, 50.5%) of them believed antibiotics could be used to terminate or prevent (118, 64.1%) unwanted pregnancies. Most (179, 79.6%) of them recognized that the unnecessary use of antibiotics can make them less effective, and about two-thirds (156, 70.9%) knew that antibiotic overuse can lead to resistance (Table 2).
Table 2.
Knowledge about antibiotic use and resistance among adolescents and young people in Sierra Leone, 2024
| Statements | Yes n (%) | No n (%) | Not sure n (%) | Correct Answer |
|---|---|---|---|---|
| Can antibiotics kill bacteria | 198 (84.6%) | 20 (8.5%) | 16 (6.8%) | Yes |
| Can antibiotics kill viruses | 94 (40.3%) | 98 (42.1%) | 41 (17.6%) | No |
| Antibiotics can be used to treat malaria | 91 (39.6%) | 118 (51.3%) | 21 (9.1%) | No |
| Antibiotics can cure common cold or flu | 126 (56%) | 71 (31.6%) | 28 (12.4%) | No |
| Unnecessary use of antibiotics can make them less effective | 179 (79.6%) | 27 (12%) | 19 (8.4%) | Yes |
| Antibiotics can treat fever | 93 (41.5%) | 114 (50.9%) | 17 (7.6%) | No |
| Antibiotics can treat pain | 89 (39.9%) | 111 (49.8%) | 23 (10.3%) | No |
| Antibiotics can treat diarrhoea | 78 (35.5%) | 82 (37.3%) | 60 (27.3%) | No |
| Antibiotics can be used to end a pregnancy | 112 (50%) | 67 (29.9%) | 35 (15.6%) | No |
| Antibiotic resistance means the bacteria will not be killed by the antibiotics | 111 (50%) | 56 (25.2%) | 55 (24.8%) | Yes |
| When antibiotics are not taken as prescribed, it can lead to antibiotic resistance | 151 (68%) | 31 (14%) | 40 (18%) | Yes |
| Overuse of antibiotics can lead to antibiotic resistance | 156 (70.9%) | 27 (12.3%) | 37 (16.8%) | Yes |
| Bacteria that are resistant to antibiotics can be spread from person to person | 124 (57.1%) | 48 (22.1%) | 45 (20.7%) | Yes |
| Antibiotics can be taken to prevent pregnancy after unprotected sex | 118 (64.1%) | 66 (35.9%) | 34 (18.5%) | No |
| Is Amoxicillin an antibiotic? | 174 (79.5%) | 35 (16%) | 10 (4.6%) | Yes |
Attitude towards antibiotic use and resistance among adolescents and young people
The majority (139, 55.8%) of the adolescents and young people had a unfavorable attitude towards antibiotic use and resistance. Almost a third of them believed that antibiotic resistance is not a problem in Sierra Leon. More than half (92, 55.8%) of them expect to receive an antibiotic for the treatment of a common cold infection. The majority (110, 52%) believed that antibiotic resistance affects adolescents and young people (Table 3).
Table 3.
Attitude towards antibiotic use and resistance among adolescents and young people in Sierra Leone, 2024
| Statements | n (%) |
|---|---|
| I usually expect a prescription of antibiotics from a healthcare worker when I have a cold (n = 208) | |
| Yes | 92 (55.8%) |
| No | 116 (44.2%) |
| Antibiotic resistance is not a problem in Sierra Leone (n = 194) | |
| Yes | 61 (31.4%) |
| No | 71 (36.6%) |
| Not sure | 62 (32%) |
| Antibiotic resistance does not affect adolescents and young people in Sierra Leone (n = 211) | |
| Yes | 46 (21.8%) |
| No | 110 (52.1%) |
| Not sure | 56 (26.1%) |
Practice of antibiotic use among adolescents and young people
Most of the adolescents and young people demonstrated poor practices in antibiotic use (205, 87.0%). More than half (131, 55.7%) of them did not complete the antibiotics given to them during their last illness, and the majority (125, 53.2%) took an antibiotic for abdominal pain. For females, more than half of them (102, 52.6%) took antibiotics during their monthly periods, and over a third (95, 40.4%) took an antibiotic after unprotected sex to prevent pregnancy (Table 4).
Table 4.
Practice on antibiotic use among adolescents and young people in Sierra Leone, 2024
| Statements | n (%) |
|---|---|
| I did not finish all the antibiotics given to me by a healthcare worker during my last illness | |
| Yes | 131 (55.7%) |
| No | 83 (35.5%) |
| Unspecified | 21 (8.9%) |
| I have received and taken antibiotics from family and friends before | |
| Yes | 168 (71.5%) |
| No | 43 (18.3%) |
| Unspecified | 24 (10.2%) |
| I use antibiotics during my periods | |
| Yes | 102 (52.6%) |
| No | 59 (30.4%) |
| Unspecified | 38 (29.4%) |
| I take antibiotics when I have abdominal pain | |
| Yes | 125 (53.2%) |
| No | 87 (37.0%) |
| Unspecified | 23 (9.8%) |
| I take antibiotics after unprotected sex | |
| Yes | 95 (40.4%) |
| No | 71 (30.2%) |
| Unspecified | 69 (29.4%) |
| I use antibiotics to treat an infection with white, non-smelly discharge from my private parts | |
| Yes | 142 (60.4%) |
| No | 42 (17.9%) |
| Unspecified | 51 (21.7%) |
| I buy antibiotics without a prescription from a healthcare worker/drug store | |
| Yes | 134 (60.4%) |
| No | 72 (17.9%) |
| Unspecified | 29(21.7%) |
Factors associated with knowledge, attitudes, and practices on antibiotic use and resistance
Knowledge
Multivariable logistic regression including age, sex, and education did not show a statistically significant model fit (Nagelkerke R² = 0.055, p = 0.21) (Table 5). Although females had 64% lower odds of good knowledge compared to males (AOR = 0.36, 95% CI: 0.12–1.2, p = 0.07), this association was not statistically significant. Similarly, participants aged 20 years and above had slightly lower odds of good knowledge compared to their younger counterparts (AOR = 0.9, 95% CI: 0.33–2.44, p = 0.83). Education level was also not significantly associated with good knowledge (AOR = 1.85, 95% CI: 0.61–5.54, p = 0.28).
Table 5.
Predictors of knowledge
| Variables | AOR | 95% CI | p-value |
|---|---|---|---|
| Sex | |||
| Male (reference) | 1 | - | - |
| Female | 0.36 | 0.12–1.1 | 0.07 |
| Age | |||
| < 20yrs (reference) | 1 | - | - |
| > = 20yrs | 0.90 | 0.33–2.44 | 0.84 |
| Education | |||
| < = Secondary (reference) | 1 | - | - |
| > Secondary | 1.85 | 0.61–5.60 | 0.28 |
Attitude
Multivariable logistic regression including sex, education, and knowledge did not show a statistically significant model fit (Nagelkerke R² = 0.030, p = 0.16) (Table 6). The model indicated that females had lower odds of having a good attitude compared to their male counterparts (AOR = 0.45, 95% CI: 0.15–1.34, p = 0.15). Knowledge as a predictor was statistically insignificant; however, participants with good knowledge were about twice as likely to have a good attitude compared to those with poor knowledge (AOR = 2.01, 95% CI: 0.79–5.08, p = 0.14). Lastly, higher education was not significantly associated with a good attitude; if anything, the odds were slightly lower (AOR = 0.91, 95% CI: 0.43–1.92, p = 0.80).
Table 6.
Predictors of attitude for attitude
| Variables | AOR | 95% CI | p-value |
|---|---|---|---|
| Sex | |||
| Male (reference) | 1 | - | - |
| Female | 0.45 | 0.15–1.34 | 0.15 |
| Education | |||
| <=Secondary (reference) | 1 | - | - |
| > Secondary | 0.91 | 0.43–1.92 | 0.80 |
| Knowledge | |||
| < Poor knowledge (reference) | 1 | - | - |
| > Good knowledge | 2.01 | 0.79–5.08 | 0.14 |
Practice
Multivariable logistic regression including knowledge and practice showed a statistically significant model fit (Nagelkerke R² = 0.26, p = 0.01) (Table 7). The model showed that a good attitude greatly and significantly increased the odds of good practice (AOR = 23.12, 95% CI: 2.95–181.46, p = 0.03). Participants with good knowledge additionally had a higher odd of good practice, although not statistically significant (AOR = 2.71, 95% CI: 0.83–8.85, p = 0.1).
Table 7.
Predictors for practice
| Variables | AOR | 95% CI | p-value |
|---|---|---|---|
| Knowledge | |||
| Poor knowledge (reference) | 1 | - | - |
| Good practice | 2.71 | 0.83–8.85 | 0.10 |
| Attitude | |||
| Negative attitude (reference) | 1 | - | - |
| Good attitude | 23.12 | 2.95–181.46 | 0.14 |
Discussion
This is the first study conducted in Sierra Leone to assess the KAP of antibiotic use and resistance among adolescents and young people. Furthermore, to the best of our knowledge, this is one of the few studies to evaluate the KAP of antibiotic use and resistance among adolescents and young people, as most studies have focused on medical, pharmacy, and nursing students as well as the general population.
Our study revealed that about half of the adolescents and young people had poor knowledge about antibiotic use and resistance. Many adolescents and young people had a negative attitude towards antibiotic use and resistance, and most of them demonstrated poor practice in antibiotic use.
Most of the adolescents and young people in this study believed that antibiotics can be used to prevent pregnancy. This misconception that antibiotics serve as contraceptives is also seen among university students in Nigeria and Tanzania who used Ampiclox and Metronidazole, respectively [23, 24]. Reflecting a knowledge gap in contraceptive use, this may provide insight into the high rate of teenage pregnancy in Sierra Leone [25]. Therefore, reproductive health and family planning programmes should address and dispel the misconception that antibiotics have contraceptive properties during modern awareness-raising campaign initiatives that target adolescents and young people. Additionally, over a third of the participants indicated that antibiotics should be used to treat malaria. Similar to our finding, a study conducted across six low- and middle-income countries across Africa and Asia, also documented that participants believed that antibiotics can be used to treat malaria [26]. Since malaria is endemic in Sierra Leone, this high rate of antibiotic misuse among adolescents and young people has the potential to continue if urgent strategic actions are not developed and implemented, increasing the development and transmission of resistant infections and the burden of AMR in the country.
Therefore, a clear approach should be developed on how the myth of using antibiotics to treat common cold, abdominal pain, fever, malaria, and termination of pregnancy can be debunked. We recommend the development and popularization of easy-to-read information and education materials on the appropriate use of antibiotics in academic institutions and communal grounds in Sierra Leone. Additionally, the National School and Adolescent Health Programme, the Ministry of Basic and Senior Secondary School Education, and the national AMR unit should embark on antibiotic use and resistance awareness campaigns in schools and universities to improve the knowledge and understanding of antibiotic use and resistance among adolescents and young people.
Many adolescents and young people recognize that the overuse of antibiotics can lead to increased resistance; however, they do not believe that antibiotic resistance is a problem in Sierra Leone, nor do they think it affects their age group. This lack of concern regarding AMR among adolescents is also reflected in a study conducted in England [9]. However, unlike the findings in Sierra Leone, English adolescents view AMR as a societal issue. There is a need to develop an antimicrobial resistance learning framework for children and young people in Sierra Leone.
Changing these perceptions should be a concerted effort to ensure that adolescents and young people better understand that antibiotic resistance is a global problem, not just in Sierra Leone. Evidence on the impact of AMR, such as resistance pattern studies conducted in Sierra Leone, can be summarized in plain English or presented as infographics, making them easily understood, and should be used during AMR awareness-raising campaigns targeting schools, vocational institutions, and universities in the country.
Many adolescents and young people do not complete the antibiotics given to them during their last illness. This problem is a common phenomenon even among adults, as most of the time, patients will stop taking their medications as soon as they start feeling better [27]. Exposing a bug to a non-lethal dose of an antibiotic or not completing the antibiotic treatment duration is directly related to the bug developing resistance against the agent we use to kill them or inhibit their growth. We recommend that adolescents and young people be given detailed information on the development of resistance and the benefits of taking medications that are only prescribed by a registered healthcare professional. Furthermore, it should be emphasized that antibiotics should be taken as prescribed in the correct dosage, correct intervals, and correct duration, called “The Big 3 Cs” for adolescents and young people to ensure the appropriate use of antibiotics.
Our study has several strengths. First, this is the few studies to be conducted in Africa to assess the KAP on antibiotic use and resistance among adolescents and young people. Second, it captures the different views of different adolescents and young people as participants who attended the summit came from all 16 districts/regions in the country. Third, we have developed a self-administered questionnaire that can be adapted by other researchers to assess KAP on antibiotic use and resistance among adolescents and young people. However, additional questions should be included in the demographic and attitude sections to ensure deeper analytic analysis. Fourth, we report our findings using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Irrespective of our strengths, the study has a few limitations. First, even though the study is limited by the lack of standardisation KAP questionnaire on antibiotic use and resistance among adolescents and young people, the fact that we have developed a self-administered questionnaire that can be adopted and used by other researchers in future studies is a strength that cannot be overlooked. Second, since we use a convenient sampling approach, it is possible that the comprehensive views of adolescents and young people have not been captured. Third, the small sample size and the limited number of questions on the attitude section limit the statistical power of the analysis and might have influenced inferential analysis and preventing deeper analytical insights into the nature of KAP among this group. Third, there may be recall bias by participants in self-reported responses on the questionnaire. Fourth, looking at the characteristics of the participants, we were unable to do a gender analysis as most of the participants were female. Further research is needed to understand the gender difference in antibiotic resistance and use among adolescent girls and boys.
Conclusion
Our study revealed that adolescents and young people had limited knowledge about antibiotic use and resistance. They hold misconceptions about the effective use of antibiotics in treating non-bacterial infections and other illnesses. Additionally, they demonstrated negative attitudes towards antibiotic use and resistance, believing it is not a significant issue in Sierra Leone and does not affect them. This lack of knowledge, easy access to antibiotics, coupled with negative attitudes and bad practices regarding antibiotic use, can increase the AMR burden in Sierra Leone. We recommend the development and implementation of age-specific health education and promotion initiatives focused on antibiotic use and resistance for adolescents and young people.
Supplementary Information
Acknowledgements
We extend our sincere gratitude to the Girls Advocacy Network (GADNET) for their invaluable support throughout the data collection process.
Abbreviations
- AMR
Antimicrobial resistance
- GAP
Global action plan
- GADNET
Girls advocacy network
- KAP
Knowledge, attitude, and practice
- UN
United Nations
- UNAIDS
United Nations Programme on HIV/AIDS
- UNFPA
United Nations Population Fund
- WHO
World Health Organization
Authors’ contributions
IFK and SMT designed the study. IFK and SMT were responsible for writing the original draft. SMT, PA, BH, TMM, BDF were responsible for visualization; IFK, FBK, BM, PTK, MM, MS, YA, and GA were responsible for validation. IFK, SMT, TMM, BA, PTK, and GA contributed to the methods; IFK, SMT, PA, BH, TMM, BDF, FBK, BM, PTK, MM, MS, YA, and GA reviewed and edited the manuscript until final approval. IFK is the guarantor.
Funding
No funding was received for the conduct of this study.
Data availability
Data are available upon reasonable request.
Declarations
Ethics approval and consent to participate
The study was conducted in accordance with the Declaration of Helsinki. Permission to conduct the survey was obtained from the youth-led organization, who serve as gatekeepers for all participants, 15–18 years, as they are under the umbrella of the youth organization. Information on the purpose of the study was provided to adolescents and young people before the self-administered questionnaire was shared with respondents. They were informed that participation in the study is voluntary, and no consequences will be suffered for refusal to participate. No incentives were offered to participate in the survey. Participants 18 years and above gave written informed consent, and those below 18 years were asked for written informed assent. The youth-led organization provided informed consent for all participants below the age of 18 years as their legal guardians. This is in keeping with global standards, as the youth-led organization is the caring body for these adolescents during the summit due to the permission they had received from their parents/caregivers and academic institutions to participate in the summit. Although the youth-led organization was asked for permission for their temporary wards to participate in the survey, assent was also obtained from all adolescents between the ages of 15 and 18 years. Furthermore, the questions asked in the survey about antibiotic use and resistance are not considered as sensitive as they only focus on general knowledge and globally available information about antibiotic use and resistance that can be obtained from schools, radio, television, and other social media platforms. No specific identifiers, for example, names and home addresses, were collected.
Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee (dated 21 February 2025).
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Data Availability Statement
Data are available upon reasonable request.