National AMR Context
Antimicrobial resistance is a major public health and development challenge in Lesotho. Lesotho has a particularly high AMR burden and that inappropriate antimicrobial use is compounded by health-system constraints, high HIV/TB prevalence and inadequate infection prevention measures. Drivers occur across One Health sectors and include inappropriate prescribing and dispensing, self-medication, poor treatment adherence, weak regulation of antimicrobial access, pharmaceutical waste disposal, and antimicrobial use in animal health and agriculture. Lesotho developed a five-year, costed multisectoral National Action Plan on AMR for 2021–2026 using a One Health approach. The NAP identifies knowledge, attitudes and practices assessments as an important strategic activity to improve antimicrobial stewardship and awareness. However, the planned multisectoral baseline among One Health professionals and the general public has not yet been completed. This limits the country’s ability to design behaviourally informed and context-specific interventions and to use evidence in the forthcoming review of the National Action Plan.
Problem
Lesotho lacks sufficient empirical evidence on how antimicrobials are used by One Health professionals and the general public, and on why inappropriate antimicrobial-use behaviours persist. There is limited information on knowledge and perceptions of appropriate use and on practices related to prescribing, dispensing, administering, purchasing, storing, sharing, completing or discontinuing treatment, and disposal. Knowledge gaps alone do not explain behaviour: antimicrobial use may also be shaped by access to diagnostics and guidelines, medicine availability, patient or client pressure, regulation, costs, social norms, workplace constraints, confidence and habitual practice. Without evidence on these capability, opportunity and motivation factors, interventions may focus narrowly on awareness rather than the practical and behavioural drivers of inappropriate use. This project addresses the gap by generating a multisectoral behavioural baseline across human health, animal health, environmental settings and communities using the COM-B framework.
“This study comes at a critical time for Lesotho, creating an opportunity to remind ourselves of the importance of AMR as a national issue and collective responsibility. By gaining insight into what influences the use of antimicrobials by professionals and the general population, we hope to generate evidence locally which will aid the design and implementation of effective strategies to address the rising problem of AMR.” Mapoloko Letša, Senior Lecturer, NHTC
Project overview
The study will assess knowledge, attitudes and practices related to antimicrobial use among One Health professionals and the public in Lesotho, using the COM-B model to identify capability, opportunity and motivation factors influencing behaviour. A mixed-methods design will combine a primary cross-sectional quantitative survey with a nested qualitative component. KAP items will be embedded within COM-B domains, and priority antimicrobial-use behaviours identified in the survey will be explored further through focus group discussions. Data will be collected in selected human, animal and environmental settings in Maseru, Leribe and Mafeteng, representing central, northern and southern regions. Quantitative analyses will describe patterns and test associations between COM-B factors and priority behaviours, while qualitative analysis will explore contextual and system-level determinants. Findings will be triangulated and validated with multisectoral stakeholders through Lesotho’s existing AMR governance structures.
Intended outcomes
The project will establish a national multisectoral baseline on antimicrobial-use knowledge, attitudes, practices and behavioural determinants among professionals and the public. It will identify priority inappropriate AMU behaviours and the capability limitations, opportunity barriers and motivational drivers associated with them across One Health sectors. The findings will support evidence-based recommendations for antimicrobial stewardship, professional training, public education, access to guidelines, counselling materials, infection prevention, One Health coordination and targeted behaviour-change interventions. Sector-disaggregated evidence will help policymakers identify priority areas for resource allocation and future implementation research. The study will also provide evidence for the planned review of Lesotho’s National Action Plan on AMR and support development of a practical action plan and roadmap with national stakeholders. Outputs will include a final report, dissemination and validation activities, presentations and manuscripts for publication.
About the Team Europe Initiative
This project is funded through the Team Europe Initiative (TEI) Action on Fighting Antimicrobial Resistance and Strengthening the One Health Workforce in Africa, a collaborative effort to support locally led, evidence-informed action on antimicrobial resistance (AMR) across the continent. Through work on AMR mitigation, implementation research, workforce development, health economics, and One Health, the initiative aims to strengthen capacity and generate practical, context-specific approaches that can support sustainable AMR action in African countries.
