TY - JOUR
T1 - Knowledge, attitude, and practice of antifungal resistance and stewardship among pharmacy students in Zambia
T2 - a cross-sectional study to inform antifungal stewardship programs
AU - Mudenda, Steward
AU - Chibwe, Bweupe
AU - Mukosha, Moses
AU - Mufwambi, Webrod
AU - Daka, Victor
AU - Nachalwe, Precious Nkumbu
AU - Kasanga, Maisa
AU - Kamvuma, Kingsley
AU - Mwaba, Martha
AU - Fadare, Joseph
AU - Lubanga, Adriano Focus
AU - Mugenyi, Nathan
AU - Gondwe, Moses
AU - Chimbala, Adron Mweshi
AU - Mohamed, Shafiq
AU - Mukumbuta, Jean
AU - Mwanza, Boris
AU - Hampango, Muchindu
AU - Muyenga, Tumelo
AU - Chimombe, Tadious
AU - Makasa, Mubanga
AU - Mwaba, Florence
AU - Tembo, Rabecca
AU - Zulu, Mildred
AU - Hangoma, Jimmy
AU - Massele, Amos Yared
AU - Sefah, Israel Abebrese
AU - Sartelli, Massimo
AU - Abdelsalam Elshenawy, Rasha
AU - Jamshed, Shazia
AU - Muma, John Bwalya
AU - Godman, Brian
N1 - Publisher Copyright:
© 2026 Mudenda, Chibwe, Mukosha, Mufwambi, Daka, Nachalwe, Kasanga, Kamvuma, Mwaba, Fadare, Lubanga, Mugenyi, Gondwe, Chimbala, Mohamed, Mukumbuta, Mwanza, Hampango, Muyenga, Chimombe, Makasa, Mwaba, Tembo, Zulu, Hangoma, Massele, Sefah, Sartelli, Abdelsalam Elshenawy, Jamshed, Muma and Godman.
PY - 2026
Y1 - 2026
N2 - Background – Antifungal resistance (AFR) is a growing global health threat, particularly in low- and middle-income countries such as Zambia, where antifungals are often accessed without prescription. Antifungal stewardship (AFS) programs aim to optimise antifungal use, yet limited data exist on pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS. This study evaluated pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS in Zambia. Methods – A descriptive cross-sectional survey was conducted among 288 randomly selected pharmacy students between August and September 2024 using a structured questionnaire. Descriptive statistics summarised demographics and KAP responses. Associations were analysed using Chi-square and Fisher's Exact Tests, while multivariable logistic regression identified predictors of good KAP (p < 0.05). Results – Among respondents (55.2% female; 76.7% aged 18–25 years), most students (94.1%) knew how to define AFR, and 90.3% recognized antifungal misuse as a factor driving resistance. Nevertheless, only 18.1% showed good knowledge, 67.7% held positive attitudes (especially among fourth-year students, p < 0.001), and merely 2.4% practiced appropriately. Multivariable analysis found that being a fourth-year student increased the likelihood of a good attitude (aOR = 5.10, 95% CI: 2.28–11.43). Married students were more likely to demonstrate good practices (aOR = 2.75, 95% CI: 1.13–6.68) towards AFR and antifungal stewardship (AFS) compared to unmarried ones. Additionally, age above 33 years was not significantly associated with better knowledge (aOR = 1.29, 95% CI: 0.32–5.18). Conclusion – Pharmacy students in Zambia demonstrated positive attitudes towards AFR and AFS, but significant gaps in knowledge and practice remain. Strengthening AFR and AFS-related content and experiential training within the pharmacy curriculum is urgently needed to improve preparedness for clinical practice.
AB - Background – Antifungal resistance (AFR) is a growing global health threat, particularly in low- and middle-income countries such as Zambia, where antifungals are often accessed without prescription. Antifungal stewardship (AFS) programs aim to optimise antifungal use, yet limited data exist on pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS. This study evaluated pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS in Zambia. Methods – A descriptive cross-sectional survey was conducted among 288 randomly selected pharmacy students between August and September 2024 using a structured questionnaire. Descriptive statistics summarised demographics and KAP responses. Associations were analysed using Chi-square and Fisher's Exact Tests, while multivariable logistic regression identified predictors of good KAP (p < 0.05). Results – Among respondents (55.2% female; 76.7% aged 18–25 years), most students (94.1%) knew how to define AFR, and 90.3% recognized antifungal misuse as a factor driving resistance. Nevertheless, only 18.1% showed good knowledge, 67.7% held positive attitudes (especially among fourth-year students, p < 0.001), and merely 2.4% practiced appropriately. Multivariable analysis found that being a fourth-year student increased the likelihood of a good attitude (aOR = 5.10, 95% CI: 2.28–11.43). Married students were more likely to demonstrate good practices (aOR = 2.75, 95% CI: 1.13–6.68) towards AFR and antifungal stewardship (AFS) compared to unmarried ones. Additionally, age above 33 years was not significantly associated with better knowledge (aOR = 1.29, 95% CI: 0.32–5.18). Conclusion – Pharmacy students in Zambia demonstrated positive attitudes towards AFR and AFS, but significant gaps in knowledge and practice remain. Strengthening AFR and AFS-related content and experiential training within the pharmacy curriculum is urgently needed to improve preparedness for clinical practice.
KW - Zambia
KW - antifungal resistance
KW - antifungal stewardship
KW - antifungal stewardship programs
KW - antimicrobial resistance
KW - fungal infections
KW - pharmacy students
UR - https://www.scopus.com/pages/publications/105050171481
U2 - 10.3389/feduc.2026.1846353
DO - 10.3389/feduc.2026.1846353
M3 - Article
AN - SCOPUS:105050171481
SN - 2504-284X
VL - 11
JO - Frontiers in Education
JF - Frontiers in Education
M1 - 1846353
ER -