Healthcare workers knowledge, attitudes, and practices towards antimicrobial resistance in sub-Saharan Africa: a systematic review and meta-analysis

Background The rising prevalence of antimicrobial resistance (AMR) poses a critical global health challenge. Healthcare workers (HCWs) play a pivotal role in combating AMR by implementing effective preventive strategies and adhering to good clinical practices. This systematic review and meta-analysis aimed to evaluate the pooled prevalence of knowledge, attitudes, and practices (KAP) of HCWs towards AMR in sub-Saharan Africa (SSA). Methods A comprehensive search of literature published until August 10, 2025 was conducted on PubMed, EMBASE, CINHAL, Web of Science, and Google Scholar database without language restriction. Observational study designs which reported KAP related to AMR among HCWs were included. This study conducted by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Statistical analyses were performed using R software version 4.5. Random effect model was used to analysis the pooled estimate of HCWs KAP toward AMR. Heterogeneity among studies was assessed using the I² statistic. Subgroup analyses and meta-regression were conducted to explore potential sources of heterogeneity. Publication bias was evaluated graphically by funnel plot and using Egger’s and Begg’s tests. Joanna Briggs Institute (JBI) Critical Appraisal Checklist for prevalence study. Results A meta-analysis of 44 studies involving 11,008 HCWs assessed for knowledge, 20 studies with 4,049 HCWs for attitudes, and 15 studies with 2,621 HCWs for practices regarding AMR. The pooled prevalence of good knowledge, positive attitude, good prevention practice toward AMR among HCWs was 63% (95% CI: 56–70%, I² = 97%), 74% (95% CI: 61–83%, I² = 97.2%) and 44% (95% CI: 25–65%, I² = 97.1%) respectively. Subgroup analysis revealed significant variability across SSA region, study setting and experience of HCWs. Conclusion Healthcare workers in SSA show moderate knowledge and positive attitudes toward AMR, but their preventive practices remain low. Bridging this knowledge-practice gap requires targeted training, policy support, and one health approaches. Future research should focus on community health workers and use longitudinal and observational methods to generate actionable evidence for effective AMR stewardship.