Antimicrobial resistance and stewardshipin clinical practice: A cross-sectional study of healthcare professionals in Mogadishu, Somalia.

Antimicrobial resistance is an escalating threat that undermines the effective treatment of common infections and increases morbidity, mortality, and healthcare costs. In fragile health systems such as Somalia's, limited laboratory capacity, variable prescribing practices, and easy access to antibiotics can accelerate inappropriate use and resistance. This study assessed attitudes, general knowledge about antibiotics, and awareness of AMR and antimicrobial stewardship (AMS) among healthcare professionals in Mogadishu and examined associated socio‑demographic and professional factors. A cross‑sectional survey was conducted among 426 healthcare professionals from seven hospitals in Mogadishu. Participants included physicians, nurses and midwives, pharmacists, laboratory technicians, and other patient-care professionals, including radiology and allied clinical staff. Data were collected using a structured, self‑administered questionnaire covering socio‑demographic characteristics, attitudes towards actions to combat AMR, general knowledge about antibiotics, and awareness of AMR and AMS. Likert‑scale responses (1-5) were summed to generate composite scores. Descriptive statistics summarized scores, Spearman correlations assessed relationships between domains, and linear regression identified predictors of attitudes, knowledge, and awareness. Mean (SD) scores were 58.93 (7.73)/74 for attitudes (78.6%), 38.10 (6.90)/55 for knowledge (69.3%), and 36.07 (5.31)/49 for awareness (72.1%). Knowledge correlated with attitudes (ρ = 0.46, p < 0.001) and awareness (ρ = 0.53, p < 0.001); awareness also correlated with attitudes (ρ = 0.40, p < 0.001). While most respondents endorsed stewardship‑aligned actions, many held misconceptions, including using antibiotics for all infections, stopping treatment when feeling better, and reusing leftover antibiotics. Holding a master's degree predicted higher attitude scores; being 25-30 years old and working in specific hospitals predicted higher knowledge. Having 6-10 years of practice was negatively associated with knowledge and awareness. Healthcare professionals in Mogadishu show strong pro‑stewardship attitudes and reasonable awareness but important knowledge gaps, especially among mid‑career staff, highlighting priority targets for context-adapted AMS interventions, particularly by years of experience, education level, and facility context.