Antimicrobial resistance (AMR) represents a critical global public health challenge, particularly in fragile and resource-constrained settings where health systems face structural and operational limitations. Primary healthcare (PHC) services in the Gaza Strip are especially vulnerable to inappropriate antibiotic use due to empirical prescribing practices, limited diagnostic capacity, disrupted supply chains, and weakened infection prevention and control infrastructure. These conditions contribute to antibiotic misuse and increase the risk of multidrug-resistant infections, ultimately affecting healthcare quality and system performance.
This study aimed to assess healthcare providers’ knowledge, attitudes, and practices (KAP) regarding antibiotic use and resistance in governmental PHC clinics in the Gaza Strip, identify individual, organizational, and system-level 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 (physicians, nurses, pharmacists, and pharmacy technicians). The second phase implemented a pre–post educational intervention among 102 physicians. Data were collected using a validated multidimensional KAP and antimicrobial stewardship questionnaire and analyzed using descriptive statistics, independent-samples t-tests, one-way ANOVA, correlation analysis, and pre–post comparisons at a significance level of p < 0.05.
The findings indicated generally high levels of knowledge and positive attitudes toward antimicrobial stewardship; however, prescribing practices remained moderate, with persistent gaps in culture-guided therapy and the routine use of local resistance data. Major barriers included limited diagnostic resources, recurrent antibiotic shortages, heavy workload, and inadequate training. The educational intervention resulted in significant improvements in physicians’ knowledge, attitudes, and self-reported prescribing practices. These findings underscore the need for integrated antimicrobial stewardship strategies that combine continuous professional education with strengthened diagnostics, prescribing governance, and health-system support to optimize antibiotic use in PHC settings