Published in PLOS One on 2026-01-09, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Anica Buckel, Clovice Kankya, Mark A. Caudell, Tabitha Kimani, Alice Namatovu, Lordrick Alinaitwe, James Natweta Baguma, Rogers Musiitwa, Methodius Tubihemukama, Junxia Song, Emmanuel Kabali, Jorge Pinto Ferreira, Jeffrey LeJeune
Source: PLOS One • DOI 10.1371/journal.pone.0339969
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Antimicrobial resistance (AMR) presents a growing threat to global health and food security, accelerated by human behaviours such as suboptimal use patterns. While the negative consequences of AMR will be particularly severe in low- and middle-income countries, relatively little is known about the extent and frequency of behaviours that contribute to AMR in these regions. This mixed-methods study, which included a cross-sectional survey, examines knowledge, attitudes, and practices related to antimicrobial use (AMU) among 417 smallholder dairy farmers in Uganda’s Wakiso, Kampala, and Mukono districts. We found that (1) farmers’ AMU practices were associated with attitudes toward veterinarians and access barriers, with many relying on private veterinarians due to challenges accessing public animal health services; and; and (2) findings support the concept of a ‘knowledge-action gap,’ as AMR knowledge and belief items were weakly associated with prudent antimicrobial use and related practices in our exploratory models, These findings highlight the need to rethink the current reliance on conventional knowledge-attitude-practice (KAP) interventions alone. Instead, behaviour-centred approaches informed by theory-driven behaviour change frameworks, along with interdisciplinary collaboration, may offer more profound insight into the multifaceted factors that shape AMR-associated practices and inform more tailored interventions. Finally, given the prominent role of private veterinary service providers as trusted points of contact for farmers, there is a clear need to foster partnerships that formally recognise and engage these actors in stewardship efforts while ensuring alignment with national policy and regulatory oversight.
Introduction
Antimicrobial resistance (AMR) is one of the most pressing public health threats and development challenges of our time and threatens the attainment of many of the United Nations 2030 Sustainable Development Goals (SDGs), including those focused on health, food security, and poverty reduction, by undermining both human and animal health systems (xx). This study therefore investigates antimicrobial use behaviours that contribute to this global challenge among smallholder dairy farmers in Uganda.
AMR occurs when microorganisms that cause infections become resistant to the effects of antimicrobial drugs, making it difficult to treat common infections in people and animals effectively. The increasing prevalence of this evolutionary process is fuelled by anthropogenic factors [1], particularly the over- and sub-optimal use of antimicrobials.
In agriculture, antimicrobials play a crucial role beyond therapeutic use and are often considered an economic asset as they limit the financial risks and labour costs when used for prophylaxis (the preventive use of antimicrobials to treat at-risk herds or animals) and metaphylaxis (the treatment of clinically healthy animals in a group that have been exposed to an infectious agent, following the diagnosis of the disease in other animals within the same group). However, these practices have emerged as major contributors to AMR development [2]. The potential transfer of resistant bacterial strains from animals to humans through agrifood systems [3] via direct contact between humans and animals, consumption of animal products, or contaminated environmental sources is a significant public health concern.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Anica Buckel, Clovice Kankya, Mark A. Caudell, Tabitha Kimani, Alice Namatovu, Lordrick Alinaitwe, James Natweta Baguma, Rogers Musiitwa, Methodius Tubihemukama, Junxia Song, Emmanuel Kabali, Jorge Pinto Ferreira, Jeffrey LeJeune. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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- Evidence brief: Knowledge, attitudes and practices related to antimicrobial use and resistance among fish farmers in Dar es Salaam, Tanzania
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- Evidence brief: Patterns of inpatient antibiotic use and antimicrobial resistance in the surgical wards of a Ugandan tertiary hospital: A mixed methods study
