Knowledge, attitude, and practice of antifungal resistance and stewardship among pharmacy students in Zambia : a cross-sectional study to inform antifungal stewardship programs

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Mudenda, Steward and Chibwe, Bweupe and Mukosha, Moses and Mufwambi, Webrod and Daka, Victor and Nachalwe, Precious Nkumbu and Kasanga, Maisa and Kamvuma, Kingsley and Mwaba, Martha and Fadare, Joseph and Lubanga, Adriano Focus and Mugenyi, Nathan and Gondwe, Moses and Chimbala, Adron Mweshi and Mohamed, Shafiq and Mukumbuta, Jean and Mwanza, Boris and Hampango, Muchindu and Muyenga, Tumelo and Chimombe, Tadious and Makasa, Mubanga and Mwaba, Florence and Tembo, Rabecca and Zulu, Mildred and Hangoma, Jimmy and Massele, Amos Yared and Sefah, Israel Abebrese and Sartelli, Massimo and Elshenawy, Rasha Abdelsalam and Jamshed, Shazia and Muma, John Bwalya and Godman, Brian (2026) Knowledge, attitude, and practice of antifungal resistance and stewardship among pharmacy students in Zambia : a cross-sectional study to inform antifungal stewardship programs. Frontiers in Education, 11. 1846353. ISSN 2504-284X (https://doi.org/10.3389/feduc.2026.1846353)

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Abstract

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.

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