The study formed part of the Combating Antimicrobial Resistance and Antimicrobial Residues in Zambian Poultry project, known as CAZAAP, which was established in 2022 with an ambitious target: reduce antimicrobial use and residues by at least 30 percent in intensively managed broiler systems over three years. To evaluate progress, the researchers surveyed the veterinary workforce in four districts chosen for their intensive poultry production: Chongwe and Chilanga in Lusaka Province, and Ndola and Kitwe in the Copperbelt Province. Because the eligible population of veterinary personnel serving these districts was small, the team invited every one of them to participate, enrolling 50 respondents at baseline in March and April 2024 and retaining 49 complete pairs at endline in December 2025. The cohort included registered veterinary surgeons holding bachelor-level qualifications and veterinary paraprofessionals, the certificate- and diploma-holding frontline staff who head the operational units called veterinary camps and who provide the first line of animal health services to farmers.

Between the two surveys, the CAZAAP project delivered a package of stewardship interventions. In August 2025, all veterinary professionals from both provinces attended week-long training workshops covering prudent prescribing, resistance awareness, and compliance with national guidelines. Every paraprofessional who took part in the survey also served as a trainer in farmer field schools, undergoing antimicrobial stewardship training before delivering instruction to farmers themselves. In November 2025, the project launched and disseminated poultry Standard Treatment Guidelines, with all survey participants present at the event. The researchers deliberately used the identical questionnaire at both time points, administered by the same team of six trained enumerators using the Kobo Collect digital platform with built-in validation, so that any observed differences would reflect genuine changes in respondents’ answers rather than changes in the instrument.

The quantitative results tell a story of measurable improvement in knowledge depth. At baseline, every respondent reported knowing what antibiotics are, but only 68 percent in the Copperbelt and 81 percent in Lusaka could provide a correct definition. By endline, those figures had climbed to 94 percent and 88 percent respectively. Correct definitions of antimicrobial resistance rose from 63 percent to 78 percent in the Copperbelt and from 44 percent to 75 percent in Lusaka. Awareness of antibiotic residues, a concept central to food safety because residues in meat and eggs can trigger allergic reactions in consumers, disrupt gut microbiota, and expose humans continuously to low levels of antibiotics that select for resistant bacteria, showed particularly marked gains: correct definitions jumped from 39 percent to 84 percent in the Copperbelt and from 33 percent to 80 percent in Lusaka. Understanding of withdrawal periods, the mandatory interval between the last antibiotic dose and slaughter or egg collection, also improved, reaching 85 percent correct in the Copperbelt and 88 percent in Lusaka at endline.

Attitudes toward stewardship were strongly positive across both provinces at both time points. Respondents overwhelmingly agreed that good biosecurity and hygiene can reduce antibiotic use, that vaccination of broilers can lower the need for antimicrobials, and that resistance is an important problem for both animal and public health. Every single respondent, in both surveys and both provinces, endorsed the necessity of a prescription before antibiotic sale. Yet the researchers observed a curious divergence over time: while the Copperbelt cohort maintained or strengthened its strong agreement on these items, Lusaka respondents shifted toward more moderate positions at endline, producing statistically significant provincial differences on several attitude items. The authors caution that these subgroup comparisons are exploratory, given that the study was powered only to detect large effects; with Lusaka numbering just 16 respondents, the minimum detectable difference between provinces was on the order of 38 to 41 percentage points.

Practice data revealed both encouraging shifts and stubborn gaps. The proportion of professionals reporting frequent use of antibiotics for viral infections, a biologically inappropriate practice since antibiotics have no effect on viruses, declined substantially in the Copperbelt, where those reporting they always prescribed for viral infections fell from 21 percent to just 3 percent. Prophylactic prescribing for disease prevention also dropped, with 88 percent of Copperbelt respondents and every Lusaka respondent reporting they never prescribed for this purpose at endline. Biosecurity practices improved as well: consistent use of farm-specific protective clothing rose from 41 percent to 73 percent in the Copperbelt, and footbath compliance was universal at both time points. However, laboratory diagnostics remained strikingly underused. By endline, 45 percent of Copperbelt respondents reported never sending samples for bacterial identification, a highly significant difference from Lusaka, where some improvement was seen. Access to treatment guidelines, though improved from a dismal 2.9 percent to 24 percent in the Copperbelt, remained unavailable to the majority of professionals in both provinces.

The qualitative strand of the study, three key informant interviews with senior veterinary professionals including a district coordinator in Chongwe, a District Veterinary Officer in Ndola, and a Senior Veterinary Officer for the Copperbelt Province, exposed the disconnect between headline awareness and applied competence. One informant estimated that functional knowledge of resistance among professionals ranged from only 40 to 60 percent, a figure that initially appears to contradict the survey’s near-universal awareness claims but converges with the survey when matched against the correct-definition rates rather than the binary awareness items. The Chongwe district coordinator captured the paradox starkly: professionals may claim to know more, but in practice they are at times the ones who perpetuate the emergence and transmission of resistance. Informants described empirical prescribing without diagnostic confirmation, repeated switching of antibiotics after treatment failure, and reliance on prior experience or peer advice rather than laboratory-guided therapy.

Beyond the professional workforce, the interviews painted a picture of a farmer ecosystem in which self-medication is widespread and antibiotics flow freely through weakly regulated channels. Poultry farmers commonly obtain drugs directly from agrovet shops without prescriptions, guided by peer recommendations or previous experience. One informant recounted a farmer who decided to buy and administer a particular drug before his animals got sick, based on the fact that his pigs had died the previous time. Withdrawal periods, despite over 90 percent of professionals reporting they educate clients on them, appear to be routinely ignored: informants described farmers as shocked to learn that withdrawal periods exist at all. Agrovet shops, driven by commercial targets, dispense whatever the farmer needs without asking for prescriptions, and veterinary drugs even enter the supply chain through general farmers’ shops. Economic pressures compound the problem, with farmers underdosing to save money and offloading stock onto the market under pressure, while the cost of veterinary consultations and laboratory testing discourages professional engagement.

The convergent mixed-methods integration, in which each quantitative result was juxtaposed with corresponding qualitative findings and assigned a fit category of convergence, divergence, or expansion, yielded a central meta-inference: stewardship challenges in Zambia’s poultry sector are driven less by professional awareness than by applied competence and the structural environment in which professionals operate. The qualitative strand expanded on the survey’s hints by supplying the mechanisms, unregulated agrovet dispensing, weak prescription enforcement, cold-chain and storage failures, and economic pressures on both farmers and professionals, that the survey could only gesture toward through items such as antibiotic selling and guideline access. An instructive divergence arose on withdrawal periods, where provider-reported education did not correspond to farmer comprehension or adherence, indicating a transmission and efficacy gap that message delivery alone cannot close.

The authors are careful to acknowledge the limitations of their pre-post design. Without a concurrent control group, the observed changes cannot be causally attributed to the CAZAAP interventions specifically; during the study period Zambia was simultaneously implementing its multisectoral National Action Plan on Antimicrobial Resistance, and resistance received sustained national and international attention. Repeated testing with the same questionnaire may itself have contributed to observed changes through familiarisation, and all practice data were self-reported, with no direct observation of prescribing behaviour or verification against dispensing records, creating a risk of social desirability bias that may have been heightened at endline after respondents had received stewardship training. The triangulation with qualitative interviews partly mitigates this, showing that stated awareness exceeded applied competence and that professional self-reports of improved practice coexisted with persistent inappropriate use in the wider farmer ecosystem. Nonetheless, the findings point toward a coordinated One Health response: finalising and systematically disseminating national veterinary treatment guidelines, improving diagnostic access and functional resistance surveillance, strengthening regulation and inspection of veterinary drug outlets, enforcing prescription requirements, and designing farmer-centred education around uptake and retention rather than message delivery alone. These measures are mutually reinforcing and unlikely to succeed in isolation, the authors conclude, highlighting that the binding constraints on antimicrobial stewardship in Zambia’s poultry sector are structural, not merely knowledge-based.

Subject of Research: Bridging knowledge and practice gaps in antimicrobial stewardship among veterinary professionals in Zambia’s poultry sector: a mixed-methods pre–post intervention study

Article Title: Bridging knowledge and practice gaps in antimicrobial stewardship among veterinary professionals in Zambia’s poultry sector: a mixed-methods pre–post intervention study

Article References: Chileshe, C., Mumba, C., Chazya, R., Ngosa, W., Mudenda, S., Chishimba, V., Sinyawa, T., Chawinga, K., Shawa, M., Mainda, G., Muchepa, I., Chizimu, J. Y., Nchima, G., Hang’ombe, B. M., Goma, F., Muleya, W., & Mudenda, N. B. (2026). Bridging knowledge and practice gaps in antimicrobial stewardship among veterinary professionals in Zambia’s poultry sector: a mixed-methods pre–post intervention study. Frontiers in Antibiotics, 5, Article 1898867. https://doi.org/10.3389/frabi.2026.1898867

Image Credits: AI Generated

DOI: 10.3389/frabi.2026.1898867

Keywords: Bridging, knowledge, practice, gaps, antimicrobial, stewardship, veterinary, professionals, Zambia, poultry, sector, mixed-methods