Antibiotic Misuse and Determinants in Primary Healthcare Settings in the Gaza Strip: Baseline Assessment and Intervention Implications

This study aimed to assess healthcare providers’ knowledge, attitudes, and practices (KAP) regarding antibiotic use and antimicrobial resistance in governmental primary healthcare (PHC) clinics in the Gaza Strip, identify multilevel determinants of antibiotic misuse, and evaluate the impact of a tailored educational intervention on physicians’ prescribing practices. A mixed-methods, two-phase design was employed. The first phase consisted of a descriptive-analytic cross-sectional survey involving 280 PHC healthcare providers, including physicians, nurses, pharmacists, and pharmacy technicians. The second phase implemented a pre–post educational intervention among 102 physicians. Data were collected using a validated multidomain KAP and antimicrobial stewardship questionnaire with high internal consistency and construct validity. Statistical analysis included descriptive statistics, independent-samples t-tests, one-way ANOVA with post-hoc comparisons, correlation analysis, and pre–post comparisons at a significance level of p < 0.05, So The findings revealed generally high levels of knowledge and positive attitudes toward antimicrobial stewardship; however, physicians demonstrated only moderate prescribing practices, with notable gaps in culture-guided therapy and the use of local resistance data. Organisational constraints—including limited diagnostic capacity, drug shortages, heavy workload, and inadequate infection-prevention infrastructure—were identified as major barriers to appropriate antibiotic use. The educational intervention produced statistically significant improvements in physicians’ knowledge, attitudes, and prescribing practices. The study recommends strengthening antimicrobial stewardship through integrated strategies, including continuous professional training, improved diagnostic services, strengthened infection-prevention systems, and effective prescribing governance within PHC settings