Knowing is not enough: A mixed-methods study of antimicrobial resistance knowledge, attitudes, and practices among Maasai pastoralists

Global, national, and local efforts to limit antimicrobial resistance often stress the importance of raising awareness among users, sellers, and prescribers of antimicrobial drugs. This emphasis is founded upon two assumptions. First, awareness is limited, particularly concerning the links between antimicrobial use and antimicrobial resistance. Second, “filling the awareness gaps” will motivate practices that will limit antimicrobial resistance. The first assumption is supported by knowledge, attitudes, and practices surveys but these same studies provide mixed support for the second, with several studies finding that knowledge and attitudes are not correlated with related practices. This disconnect may arise as these surveys typically do not collect data on the cultural or historical contexts that pattern antimicrobial use. To explore how these contexts impact knowledge, attitudes and practices related to antimicrobial use and resistance, we use a mixed-methods approach to examine veterinary practices among Maasai pastoralists in Tanzania.