Bridging knowledge and practice gaps in antimicrobial stewardship among veterinary professionals in Zambia's poultry sector: a mixed-methods pre-post intervention study.

Antimicrobial resistance (AMR) poses a major threat to animal health, food security, and public health globally, with poultry production systems recognized as important contributors to antimicrobial use. Veterinary professionals and veterinary paraprofessionals play a central role in antimicrobial stewardship through prescribing practices, farmer education and disease prevention strategies. This mixed-methods pre-post intervention study assessed changes in knowledge, attitudes and practices related to antimicrobial stewardship among veterinary personnel involved in poultry production in selected districts of Zambia, before and after implementation of antimicrobial stewardship interventions under the Combating antimicrobial resistance and antimicrobial residues in Zambian Poultry (CAZAAP) project. Baseline and endline quantitative KAP surveys were conducted among veterinary professionals and paraprofessionals in Lusaka Province (Chongwe, Chilanga district) and Copperbelt Province (Ndola, Kitwe districts), complemented by qualitative key informant interviews exploring contextual drivers of antimicrobial use and stewardship practices. Knowledge of antibiotics and AMR was generally high across both provinces, with improvements observed in correct definitions of AMR, antibiotic residues, and withdrawal periods between baseline and endline. Positive attitudes toward antimicrobial stewardship were widely reported, including recognition that AMR was an important animal and public health issue and that biosecurity and vaccination can result in reduced antibiotic use. Changes were observed in several stewardship-related practices, including reductions in inappropriate antibiotic use for viral infections, decreased prophylactic antimicrobial use, and improved biosecurity practices. However, important gaps persisted, particularly limited access to treatment guidelines, inconsistent prescription practices, and low utilization of laboratory diagnostics. Qualitative findings revealed widespread farmer self-medication, over-the-counter access to antibiotics through agrovet shops and pharmacies, weak regulatory enforcement, and economic pressures influencing antimicrobial use practices. Overall, the findings suggest that although awareness of AMR among veterinary professionals is generally high, antimicrobial stewardship challenges in Zambia's poultry sector are driven not only by knowledge limitations but also by broader structural and governance constraints. Strengthening antimicrobial stewardship will therefore require integrated One Health interventions combining professional training, improved diagnostics, regulatory strengthening, and farmer-centered education.