1.0 INTRODUCTION.

1.1 BACKGROUND INFORMATION.

Antimicrobial resistance (AMR) represents one of the biggest threats to health globally. The threat has been named among the top ten WHO Global Health Risk. According to the WHO the burden of drug resistance is responsible for about 700,000 deaths globally, mainly being the resistance towards the Antibiotics. [4] The WHO has encouraged that each country in the world to try to combat the problem, and this is because it’s the WHO speculations that by 2050 the problem of Antimicrobial resistance will contribute to at least 10 million deaths globally. [4] So high income countries have really tried to tackle the problem, but the challenges still remain in the Low-middle income countries (LMIC). [4] AMR has been attributed by both health care workers’ and community’s poor knowledge, attitude, and practice towards Antimicrobial use (AMU), but a big contribution is the one attributed by the community’s poor knowledge, attitude, and practice towards antimicrobial use

Tanzania being among the low- and middle-income countries also faces a great burden when it comes to the issue of Antimicrobial use among the country’s communities and eventually a great burden when it comes to Antimicrobial resistance (AMR). Different laboratory studies have proven that the antimicrobial resistance burden in Tanzania is rising exponentially. In a study done in 2016, it stated that in clinical settings in Tanzania, the prevalence to Multi drug Resistant bacteria ranges from 25% to 50% and this has increased since 2000. [1,2] Also, in the latest study done in 2020, it stated that, about two third of the isolates from the wound infections at Muhimbili National Referral Hospital were found to be resistant to at least three classes of antimicrobials. [1,2] Also, at the BMC Hospital in Tanzania, the rate of extended spectrum beta-lactamase (ESBL) producing E. Coli increased from 25% to 50%, and that of MRSA increased from 16% to 44% between 2009 to 2014. [2] This in Tanzania is contributed by; first, limited community knowledge, secondly is poverty, and lastly is unavailability of healthcare services close to the community that the people are residing in. [3]

1.2 PROBLEM STATEMENT.
In Tanzania, there has been an increase in prevalence towards Multi Drug resistance bacteria to a range of 25% to 50% as from 2000, also there was a study that stated that about 2/3 of the isolates from wound infections at Muhimbili National Referral Hospital were found to be resistant to at least three classes of Antimicrobials. [1] Also, according to the National Action Plan on Antimicrobial resistance (2017-2022),Resistance of S. pneumoniae to Trimethoprim and Sulfamethazole in under 5yrs has risen from 25% (2006) to 80% (2014) and resistance of Ampicillin in UTI patients shows 90% resistance and 30-45% resistance to other antibiotics. [6,9] This is mainly postulated to be caused by poor Knowledge, Attitude of the community towards antimicrobial use and resistance and poor Practices of the community towards antimicrobial use. [3,7-8] Limited community knowledge, poverty, unavailability of healthcare services has been associated mostly with increasing the severity of the various factors that lead to Antimicrobial Resistance, like; lack of or low adherence rates to the therapeutic protocols based on local sensitivities, self-medication, and poor waste pollution. [3,7-8]

1.3 RATIONALE OF THE STUDY.
Much is not known on the community’s knowledge, awareness, and practice on Antimicrobial use and Antimicrobial Resistance here in Mwanza. But it being in Tanzania where the community is filled with poverty, less equipped to a lot of information about health issues, ignorance, and it’s an area in a country less supplied with Immediate Healthcare Services, the study aims to provide, with evidence, a thorough Community’s knowledge and practice on antimicrobial usage, the awareness of the existence of antimicrobial resistance and the attitude towards antimicrobial resistance.

1.4 RESEARCH QUESTION.
What is the Knowledge, Attitude towards antimicrobial use and resistance and Practices towards Antimicrobial use among people in the community of Nyamagana District in Mwanza, Tanzania?

1.5 OBJECTIVES.
1.5.1 Broad Objectives;
To determine the Knowledge and Attitude on antimicrobial use and resistance and Practices towards Antimicrobial use among people in the community of Nyamagana District in Mwanza, Tanzania.

1.5.2 Specific Objectives;
a. To determine the understanding of the community about the Antimicrobial agents.
b. To determine the community awareness and understanding on existence of Antimicrobial resistance.
c. To determine the community practices on Antimicrobial use.