Knowledge, attitudes and practices on antimicrobial resistance among healthcare workers in sub-Saharan Africa: a systematic review and meta-analysis

Background: Antimicrobial resistance (AMR) poses a significant threat to public health in sub-Saharan Africa (SSA). Healthcare workers (HCWs) are critical to preventing and controlling AMR. Objectives: This systematic review and meta-analysis aimed to synthesise evidence on the knowledge, attitude and practices (KAP) of HCWs regarding AMR in SSA. Design: Systematic review and meta-analysis. Data sources and methods: We conducted a comprehensive search of multiple databases (PubMed, Web of Science, APA PschINFO and CINAHL via EBSCOhost) for studies published between 2014 and 2024. Studies reporting KAP of HCWs regarding AMR in SSA were eligible. MeSH search terms and related keywords were used. Data extraction was conducted individually by each team member and then cross-verified to ensure accuracy. Quality appraisal was conducted using the Critical Appraisal Skills Programme Checklist to evaluate the methodological rigour of the included studies. Meta-analysis was performed using a random-effects model. All statistical data analyses were performed in the R software (version 4.5.0) using both the meta and metafor packages. Results: Thirty-one studies involving 8873 HCWs were included. The pooled proportions of AMR knowledge, attitude and practices were 65.4% (95% CI: 55.7–74.5), 69.2% (95% CI: 58.1–79.3) and 54.1% (95% CI: 44.1–63.9), respectively. Doctors had the highest knowledge (65.1%) yet poor practices (42.8%), while pharmacists and nurses showed lower knowledge and inconsistent practices. Despite favourable attitudes, especially among nurses, behavioural implementation remained weak, underscoring substantial knowledge–practice gaps across professional groups. Conclusion: HCWs demonstrated moderate knowledge and attitudes but poor practices, revealing a persistent knowledge–practice gap. Targeted, context-specific interventions and strengthened professional training are urgently needed to enhance evidence-based practice and improve healthcare quality and patient outcomes. Trial registration: The review protocol was prospectively registered with PROSPERO, CRD42024579356.