KAP REGARDING ANTIMICROBIAL RESISTANCE IN PAKISTAN: A SYSTEMATIC REVIEW OF SOCIAL DETERMINANTS

Abstract

Antimicrobial resistance (AMR) is a serious and growing public health problem in Pakistan. There are several individual-level, social-level, economic, and health care-related factors that fuel inappropriate antibiotic use. This systematic review discusses knowledge, attitudes, and practices (KAP) related to AMR and antibiotic use and describes the factors related to inappropriate antibiotic-related behavior. A systematic search of PubMed/MEDLINE and Scopus was conducted for peer-reviewed articles published from January 2015 to December 2025. The studies were conducted from Pakistan and provided evidence related to KAP on AMR and associated behavioral and social factors. The proccess was done according to the PRISMA 2020 statement. Evaluation of methodological quality was based on the assessment instruments. The summary of results was done by quantitative and thematic synthesis. Ten studies were selected. The mean of appropriate knowledge was 59.88%, while the mean of positive attitudes was 68.52%. Inappropriate practices persisted at the level of 40.38%. Self-medication, informal use of antibiotics, inadequate adherence to treatment, inappropriate dispensing, and empirical prescribing were reported. Knowledge and attitudes were more appropriate than practices. Multiple social and economic factors, limited access to health care, patient expectations, pressure on commerce, and professional factors and poor regulation influenced antibiotic use. To address AMR in Pakistan, multiple strategies other than education are required. These include strengthened pharmacy practice regulation, training, and awareness along with Public education, affordable healthcare, and improved diagnostics and antimicrobial stewardship.