This study demonstrates a gap in knowledge, attitude, and practice among healthcare professionals. Knowledge was low, while attitudes were high, and self-reported practices were generally good. This pattern suggests a strong recognition of antimicrobial stewardship as a priority among professionals, but practical stewardship tools may not be understood and consistently integrated into everyday clinical decision-making.

Low knowledge has also been reported across hospital settings in Ghana and other African countries, although estimates vary by tool, cadre-mix, and scoring thresholds. A recent multicentre survey in Ghana reported even lower proportions of “good” knowledge, with moderate practice levels, despite generally positive attitudes [12]. Similarly, in a Ghanaian tertiary hospital, healthcare providers described limited familiarity with AMS strategies and guideline-based decision-making before targeted educational activities [13]. These findings indicate that knowledge deficits are common and may persist even when national AMR policies and institutional messaging have improved awareness of the threat of AMR.

The domain of knowledge evaluated by this study included practical stewardship processes such as prospective audit-and-feedback, the use of antibiograms, prior authorisation, / stop orders, and point-prevalence surveys, and current global stewardship in use, like the WHO AWaRe framework and Access antibiotic targets. These are not theoretical but ‘working bits’ of stewardship programmes allowing prescribers and teams to choose narrower agents when it is suitable, where to review, de-escalate under the results, and review progress. Hence, the observed knowledge gap in this study could be due to inadequate exposure to organised stewardship processes, insufficient access to local decision support resources, and inconsistent diagnostic support-barriers, which repeatedly emerge in Low- and Middle-Income Countries (LMIC) stewardship studies [14].

In our cohort, we found that formal education in AMR/AMS and increased professional experience were associated with higher odds of good knowledge and attitudes. This is consistent with the intervention evidence from Ghana, indicating that targeted stewardship training can enhance confidence and perceived competence in AMS roles in clinicians and other professionals [15]. However, “updated training in the last year” was not independently associated with KAP outcomes. This could be due to heterogeneity in training content, duration, and reinforcement; brief, didactic sessions. This may increase awareness without meaningfully building applied competence.

Recent studies show that AMR stewardship education is most effective when it is ongoing, case-based, linked to local guidance and feedback, and embedded within a wider package of enabling interventions [14, 16, 17].

Positive attitudes were high in this current study, and align with other surveys of African hospitals where healthcare workers usually support AMR stewardship objectives despite variable knowledge and practice [12, 18, 19]. However, high attitude scores do not translate into behaviour when stewardship roles in multidisciplinary groups are not well defined, as widely reported in LMIC settings [14, 20].

Professional role differences were prominent for practice. Nurses had lower odds of good stewardship practice compared with medical doctors, while pharmacists had higher odds. This aligns with evidence that nursing engagement in AMS is often under-recognized and constrained by role ambiguity, hierarchical decision-making, and limited access to prescribing discussions [21, 22].

The high reported practice among pharmacists in this study supports the evidence of pharmacistled stewardship activities in sub-Saharan Africa [23]. A systematic review of pharmacist-led AMS programs in sub-Saharan Africa concluded that pharmacists can deliver improvements in antimicrobial use and stewardship indicators [23].

From an implementation standpoint, findings from this study point to a need for stewardship strategies that go beyond awareness-raising. The WHO practical toolkit for AMS in healthcare facilities emphasises a stepwise approach: establish governance and a multidisciplinary team, implement context-appropriate interventions, and build monitoring systems [24].