Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: 
A Bayesian Estimation and Posterior Predictive Analysis

Ochieng O Anthony; Sultan Khamis Muki

doi:doi:10.11648/j.cajph.20261205.12

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Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: A Bayesian Estimation and Posterior Predictive Analysis

Ochieng O Anthony^*

, Sultan Khamis Muki

Published in Central African Journal of Public Health (Volume 12, Issue 5)

Received: 17 August 2026 Accepted: 26 August 2026 Published: 22 September 2026

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Abstract

Antimicrobial resistance (AMR) is driven partly by inappropriate antibiotic use, including premature treatment discontinuation, antibiotic sharing, and inappropriate treatment decisions. This study assessed antibiotic-use practices, AMR awareness, and the knowledge–practice gap among community inhabitants and community health workers in Magharibi A District, Zanzibar, while applying Bayesian analysis to project the persistence of inappropriate antibiotic-use behaviours under comparable conditions. A cross-sectional study was conducted from 16 December 2025 to 24 June 2026 among 60 respondents, comprising 44 community inhabitants and 16 community health workers. Data were collected using a structured questionnaire and analysed using descriptive statistics, Bayesian estimation, and posterior predictive analysis to quantify uncertainty and estimate the likely occurrence of selected antibiotic-use behaviours in comparable populations. All community inhabitants (44/44, 100%) reported previous antibiotic use, and none reported obtaining antibiotics without a prescription. However, all (44/44, 100%) reported discontinuing antibiotic treatment before completing the prescribed course. Economic constraints were the leading reported reason for discontinuation (22/44, 50.0%), while 7/22 (31.8%) of those reporting economic constraints also reported antibiotic sharing. Traditional or herbal remedies were subsequently used by 25/44 (56.8%) inhabitants, including 7/44 (15.9%) following hospital discharge. AMR awareness was lower among community inhabitants (29/44, 65.0%) than among community health workers (16/16, 100%), highlighting a substantial knowledge–practice gap. Bayesian posterior predictive analysis indicated that inappropriate antibiotic-use behaviours may remain prevalent in comparable communities if underlying social, economic, and behavioural conditions remain unchanged. These findings highlight the need to strengthen community-based AMR education, antibiotic-use counselling, and socioeconomic support, with active involvement of community health workers, to promote rational antibiotic use and strengthen antimicrobial stewardship in Zanzibar.

Published in	Central African Journal of Public Health (Volume 12, Issue 5)
DOI	10.11648/j.cajph.20261205.12
Page(s)	270-282
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Antimicrobial Resistance, Antibiotic Use, Antibiotic Sharing, Treatment Adherence, Traditional Medicine, Community Health Workers, Bayesian Statistics, Zanzibar

References

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APA Style

Anthony, O. O., Muki, S. K. (2026). Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: A Bayesian Estimation and Posterior Predictive Analysis. Central African Journal of Public Health, 12(5), 270-282. https://doi.org/10.11648/j.cajph.20261205.12

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ACS Style

Anthony, O. O.; Muki, S. K. Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: A Bayesian Estimation and Posterior Predictive Analysis. Cent. Afr. J. Public Health 2026, 12(5), 270-282. doi: 10.11648/j.cajph.20261205.12

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AMA Style

Anthony OO, Muki SK. Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: A Bayesian Estimation and Posterior Predictive Analysis. Cent Afr J Public Health. 2026;12(5):270-282. doi: 10.11648/j.cajph.20261205.12

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@article{10.11648/j.cajph.20261205.12,
  author = {Ochieng O Anthony and Sultan Khamis Muki},
  title = {Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: 
A Bayesian Estimation and Posterior Predictive Analysis},
  journal = {Central African Journal of Public Health},
  volume = {12},
  number = {5},
  pages = {270-282},
  doi = {10.11648/j.cajph.20261205.12},
  url = {https://doi.org/10.11648/j.cajph.20261205.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20261205.12},
  abstract = {Antimicrobial resistance (AMR) is driven partly by inappropriate antibiotic use, including premature treatment discontinuation, antibiotic sharing, and inappropriate treatment decisions. This study assessed antibiotic-use practices, AMR awareness, and the knowledge–practice gap among community inhabitants and community health workers in Magharibi A District, Zanzibar, while applying Bayesian analysis to project the persistence of inappropriate antibiotic-use behaviours under comparable conditions. A cross-sectional study was conducted from 16 December 2025 to 24 June 2026 among 60 respondents, comprising 44 community inhabitants and 16 community health workers. Data were collected using a structured questionnaire and analysed using descriptive statistics, Bayesian estimation, and posterior predictive analysis to quantify uncertainty and estimate the likely occurrence of selected antibiotic-use behaviours in comparable populations. All community inhabitants (44/44, 100%) reported previous antibiotic use, and none reported obtaining antibiotics without a prescription. However, all (44/44, 100%) reported discontinuing antibiotic treatment before completing the prescribed course. Economic constraints were the leading reported reason for discontinuation (22/44, 50.0%), while 7/22 (31.8%) of those reporting economic constraints also reported antibiotic sharing. Traditional or herbal remedies were subsequently used by 25/44 (56.8%) inhabitants, including 7/44 (15.9%) following hospital discharge. AMR awareness was lower among community inhabitants (29/44, 65.0%) than among community health workers (16/16, 100%), highlighting a substantial knowledge–practice gap. Bayesian posterior predictive analysis indicated that inappropriate antibiotic-use behaviours may remain prevalent in comparable communities if underlying social, economic, and behavioural conditions remain unchanged. These findings highlight the need to strengthen community-based AMR education, antibiotic-use counselling, and socioeconomic support, with active involvement of community health workers, to promote rational antibiotic use and strengthen antimicrobial stewardship in Zanzibar.},
 year = {2026}
}

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TY  - JOUR
T1  - Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: 
A Bayesian Estimation and Posterior Predictive Analysis
AU  - Ochieng O Anthony
AU  - Sultan Khamis Muki
Y1  - 2026/09/22
PY  - 2026
N1  - https://doi.org/10.11648/j.cajph.20261205.12
DO  - 10.11648/j.cajph.20261205.12
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 270
EP  - 282
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20261205.12
AB  - Antimicrobial resistance (AMR) is driven partly by inappropriate antibiotic use, including premature treatment discontinuation, antibiotic sharing, and inappropriate treatment decisions. This study assessed antibiotic-use practices, AMR awareness, and the knowledge–practice gap among community inhabitants and community health workers in Magharibi A District, Zanzibar, while applying Bayesian analysis to project the persistence of inappropriate antibiotic-use behaviours under comparable conditions. A cross-sectional study was conducted from 16 December 2025 to 24 June 2026 among 60 respondents, comprising 44 community inhabitants and 16 community health workers. Data were collected using a structured questionnaire and analysed using descriptive statistics, Bayesian estimation, and posterior predictive analysis to quantify uncertainty and estimate the likely occurrence of selected antibiotic-use behaviours in comparable populations. All community inhabitants (44/44, 100%) reported previous antibiotic use, and none reported obtaining antibiotics without a prescription. However, all (44/44, 100%) reported discontinuing antibiotic treatment before completing the prescribed course. Economic constraints were the leading reported reason for discontinuation (22/44, 50.0%), while 7/22 (31.8%) of those reporting economic constraints also reported antibiotic sharing. Traditional or herbal remedies were subsequently used by 25/44 (56.8%) inhabitants, including 7/44 (15.9%) following hospital discharge. AMR awareness was lower among community inhabitants (29/44, 65.0%) than among community health workers (16/16, 100%), highlighting a substantial knowledge–practice gap. Bayesian posterior predictive analysis indicated that inappropriate antibiotic-use behaviours may remain prevalent in comparable communities if underlying social, economic, and behavioural conditions remain unchanged. These findings highlight the need to strengthen community-based AMR education, antibiotic-use counselling, and socioeconomic support, with active involvement of community health workers, to promote rational antibiotic use and strengthen antimicrobial stewardship in Zanzibar.
VL  - 12
IS  - 5
ER  -

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Author Information

Ochieng O Anthony

Department of Life Sciences, Zanzibar University, Zanzibar, Tanzania

Contact Email

http://orcid.org/0000-0002-1463-5280
Sultan Khamis Muki

Department of Nursing & Health Science, Zanzibar University, Zanzibar, Tanzania

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APA Style

Anthony, O. O., Muki, S. K. (2026). Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: A Bayesian Estimation and Posterior Predictive Analysis. Central African Journal of Public Health, 12(5), 270-282. https://doi.org/10.11648/j.cajph.20261205.12

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ACS Style

Anthony, O. O.; Muki, S. K. Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: A Bayesian Estimation and Posterior Predictive Analysis. Cent. Afr. J. Public Health 2026, 12(5), 270-282. doi: 10.11648/j.cajph.20261205.12

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AMA Style

Anthony OO, Muki SK. Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: A Bayesian Estimation and Posterior Predictive Analysis. Cent Afr J Public Health. 2026;12(5):270-282. doi: 10.11648/j.cajph.20261205.12

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@article{10.11648/j.cajph.20261205.12,
  author = {Ochieng O Anthony and Sultan Khamis Muki},
  title = {Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: 
A Bayesian Estimation and Posterior Predictive Analysis},
  journal = {Central African Journal of Public Health},
  volume = {12},
  number = {5},
  pages = {270-282},
  doi = {10.11648/j.cajph.20261205.12},
  url = {https://doi.org/10.11648/j.cajph.20261205.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20261205.12},
  abstract = {Antimicrobial resistance (AMR) is driven partly by inappropriate antibiotic use, including premature treatment discontinuation, antibiotic sharing, and inappropriate treatment decisions. This study assessed antibiotic-use practices, AMR awareness, and the knowledge–practice gap among community inhabitants and community health workers in Magharibi A District, Zanzibar, while applying Bayesian analysis to project the persistence of inappropriate antibiotic-use behaviours under comparable conditions. A cross-sectional study was conducted from 16 December 2025 to 24 June 2026 among 60 respondents, comprising 44 community inhabitants and 16 community health workers. Data were collected using a structured questionnaire and analysed using descriptive statistics, Bayesian estimation, and posterior predictive analysis to quantify uncertainty and estimate the likely occurrence of selected antibiotic-use behaviours in comparable populations. All community inhabitants (44/44, 100%) reported previous antibiotic use, and none reported obtaining antibiotics without a prescription. However, all (44/44, 100%) reported discontinuing antibiotic treatment before completing the prescribed course. Economic constraints were the leading reported reason for discontinuation (22/44, 50.0%), while 7/22 (31.8%) of those reporting economic constraints also reported antibiotic sharing. Traditional or herbal remedies were subsequently used by 25/44 (56.8%) inhabitants, including 7/44 (15.9%) following hospital discharge. AMR awareness was lower among community inhabitants (29/44, 65.0%) than among community health workers (16/16, 100%), highlighting a substantial knowledge–practice gap. Bayesian posterior predictive analysis indicated that inappropriate antibiotic-use behaviours may remain prevalent in comparable communities if underlying social, economic, and behavioural conditions remain unchanged. These findings highlight the need to strengthen community-based AMR education, antibiotic-use counselling, and socioeconomic support, with active involvement of community health workers, to promote rational antibiotic use and strengthen antimicrobial stewardship in Zanzibar.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - Antibiotic Use, Antimicrobial Resistance Awareness and Knowledge–Practice Gaps in Magharibi A, Zanzibar: 
A Bayesian Estimation and Posterior Predictive Analysis
AU  - Ochieng O Anthony
AU  - Sultan Khamis Muki
Y1  - 2026/09/22
PY  - 2026
N1  - https://doi.org/10.11648/j.cajph.20261205.12
DO  - 10.11648/j.cajph.20261205.12
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 270
EP  - 282
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20261205.12
AB  - Antimicrobial resistance (AMR) is driven partly by inappropriate antibiotic use, including premature treatment discontinuation, antibiotic sharing, and inappropriate treatment decisions. This study assessed antibiotic-use practices, AMR awareness, and the knowledge–practice gap among community inhabitants and community health workers in Magharibi A District, Zanzibar, while applying Bayesian analysis to project the persistence of inappropriate antibiotic-use behaviours under comparable conditions. A cross-sectional study was conducted from 16 December 2025 to 24 June 2026 among 60 respondents, comprising 44 community inhabitants and 16 community health workers. Data were collected using a structured questionnaire and analysed using descriptive statistics, Bayesian estimation, and posterior predictive analysis to quantify uncertainty and estimate the likely occurrence of selected antibiotic-use behaviours in comparable populations. All community inhabitants (44/44, 100%) reported previous antibiotic use, and none reported obtaining antibiotics without a prescription. However, all (44/44, 100%) reported discontinuing antibiotic treatment before completing the prescribed course. Economic constraints were the leading reported reason for discontinuation (22/44, 50.0%), while 7/22 (31.8%) of those reporting economic constraints also reported antibiotic sharing. Traditional or herbal remedies were subsequently used by 25/44 (56.8%) inhabitants, including 7/44 (15.9%) following hospital discharge. AMR awareness was lower among community inhabitants (29/44, 65.0%) than among community health workers (16/16, 100%), highlighting a substantial knowledge–practice gap. Bayesian posterior predictive analysis indicated that inappropriate antibiotic-use behaviours may remain prevalent in comparable communities if underlying social, economic, and behavioural conditions remain unchanged. These findings highlight the need to strengthen community-based AMR education, antibiotic-use counselling, and socioeconomic support, with active involvement of community health workers, to promote rational antibiotic use and strengthen antimicrobial stewardship in Zanzibar.
VL  - 12
IS  - 5
ER  -

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