Antimicrobial Resistance Knowledge, Attitudes and Practices among Fulani Women Vendors in Informal Dairy Markets of Sabon‑gari and Zaria, Nigeria: A One Health Perspective

Antimicrobial Resistance Knowledge, Attitudes and Practices among Fulani Women Vendors in Informal Dairy Markets of Sabon‑gari and Zaria, Nigeria: A One Health Perspective | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Antimicrobial Resistance Knowledge, Attitudes and Practices among Fulani Women Vendors in Informal Dairy Markets of Sabon‑gari and Zaria, Nigeria: A One Health Perspective Muhammad Muhsin Fathuddin, Rafeedah Fathuddin, Linda Elsee Ofeh Ameh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9545172/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Antimicrobial resistance (AMR) has emerged as a defining global health challenge, yet informal food systems remain critically under-examined. This study assessed AMR-related knowledge, attitudes, and practices (KAP) among Fulani women milk vendors in Zaria, Nigeria—an underrepresented group whose daily decisions shape microbial risks along the dairy continuum. Methods: A cross-sectional survey of 77 vendors was conducted using a WHO-aligned questionnaire administered in English, Hausa, and Fulfulde. Responses were analysed using descriptive statistics and composite KAP scores, with transparency ensured through supplementary datasets. Findings: Knowledge was fragmented: 55.8% had heard of AMR, 63.6% recognised incomplete courses as risky, and 67.5% understood dosing errors, yet only 24.7% were familiar with Nigeria’s AMR Action Plan, and fewer than half (49.4%) recognised residues in milk as resistance pathways. Attitudes were moderately favourable (mean 4.89/7; 69.9%), with 57.2% acknowledging AMR as a serious threat, 57.2% endorsing biosecurity, and 54.6% expressing willingness to modify practices. Misconceptions persisted, with 44.2% believing treatment should cease once animals appeared clinically healthy. Practices revealed stewardship gaps: 24.7% always administered antibiotics without consultation, 42.9% reused courses, and only 44.2% consistently observed withdrawal periods. Unsafe storage was reported by 18.2% (bedrooms), and informal transport was common (45.5% never used structured means). Composite domain means were 50.5% for knowledge, 69.9% for attitudes, and 45.5% for practices, yielding a calculated composite KAP score of 55.3%. Conclusion: Fulani women milk vendors occupy a strategically sensitive position in AMR ecology. Their partial understanding coexists with behaviours that may accelerate resistance, underscoring the urgency of culturally anchored, gender-responsive stewardship interventions. Embedding these women within One Health surveillance and training frameworks is essential to transform attitudinal readiness into sustained behavioural change. Animal Science Food Science & Technology Bioinformatics Antimicrobial resistance (AMR) Knowledge attitudes and practices (KAP) Informal dairy markets Fulani women vendors Milk safety One Health stewardship Nigeria Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 What was already known Antimicrobial resistance (AMR) is a growing global health crisis, with LMICs bearing a disproportionate burden. Informal dairy supply chains in West Africa carry undercharacterised AMR transmission risks through antibiotic misuse, residues, and poor biosecurity. Fulani women are central actors in Nigerian informal dairy networks but have been entirely absent from AMR surveillance and KAP research. What this study adds This is the first study to document AMR-related KAP specifically among Fulani women milk vendors in Nigeria, filling a critical evidence gap. A composite KAP score of 51.1 with attitudes (56.1) above, and knowledge (47.5) and practices (49.6) below the midpoint reveals an attitudinal readiness that has not yet translated into consistent stewardship behaviour. Findings provide actionable, gender-sensitive entry points for culturally grounded One Health stewardship interventions in Nigeria's informal dairy sector. Introduction Antimicrobial resistance (AMR) has emerged as one of the defining health challenges of the twenty-first century, transforming once-manageable infections into therapeutic dead ends. In 2019, resistant bacterial infections were implicated in millions of deaths worldwide, underscoring the waning efficacy of antibiotics as the “magic bullets” of modern medicine ( 1 , 2 ). AMR is not simply a microbiological anomaly; it is a systemic stress test for universal health coverage, exposing fissures in access, regulation, and accountability across health systems ( 3 , 4 ). Where health systems are fragile, AMR strikes hardest, eroding gains in food security, nutrition, and poverty reduction ( 5 , 6 ). As Fulfulde wisdom reminds us, Ko fii no gorko, ko fii no dow , “where there is a person, there is a community”. Survival depends on stewardship, and stewardship endures only through collective responsibility. Low- and middle-income countries (LMICs) shoulder a disproportionate burden, as antibiotics circulate through dense human, animal, and environmental networks that are only partially governed by formal systems ( 7 , 8 ). Surveillance across Africa remains uneven, with alarming resistance documented in foodborne pathogens, livestock production, and dairy value chains ( 9 , 10 ). Without decisive cross-sectoral action, AMR threatens to undermine One Health goals and compromise sustainable development. Nigeria epitomises these challenges. As Africa’s most populous nation, it faces escalating AMR across human, animal, and environmental domains, compounded by widespread, unregulated antimicrobial use in livestock and informal food systems ( 11 , 12 ). National policy instruments, including the One Health AMR National Action Plan, have charted a course forward, yet implementation remains incomplete and under-resourced ( 13 ). Informal dairy systems, particularly those managed by Fulani women, remain conspicuously absent from AMR surveillance despite their centrality to household food security and consumer supply ( 14 , 15 ). Within these systems, Fulani pastoralists are pivotal actors, and Fulani women constitute the vital core of milk collection, processing, and vending. Their roles are shaped by gendered norms, socioeconomic constraints, and shifting pastoral livelihoods, yet their perspectives remain largely absent from AMR research ( 16 , 17 , 18 ). This omission is striking given evidence that gender dynamics profoundly influence antimicrobial use and stewardship outcomes in LMICs ( 19 , 20 ). This study addresses that gap by assessing AMR-related knowledge, attitudes, and practices (KAP) among Fulani women milk vendors in Zaria, Nigeria. By embedding AMR questions within the lived realities of informal dairy livelihoods, we capture how resistance is understood and negotiated in everyday practices rather than in clinical or laboratory settings. Complementary analyses of antibiotic use behaviours, residue-related risks, and hygiene practices are reported in three companion manuscripts ( 21 , 22 , 23 ), but here we focus specifically on the AMR KAP profile. The calculated composite score of 55.3% situates Fulani women vendors at a fragile threshold between awareness and stewardship, underscoring the urgency of culturally grounded, gender-responsive interventions. Methods Study design and setting This study reports the antimicrobial resistance (AMR) knowledge, attitudes, and practices (KAP) component of a multidomain cross-sectional survey conducted in Zaria, Kaduna State, northern Nigeria. The research was situated within informal dairy systems in which Fulani women collect, process, and retail raw and fermented milk through dense, largely unregulated networks linking pastoral households to peri-urban consumers. Embedding AMR KAP questions within this context enabled the capture of how resistance is understood and negotiated in everyday livelihoods rather than in clinical or laboratory settings. Comparable food systems in Kenya and Zimbabwe have highlighted food safety risks and AMR exposure, underscoring the relevance of this approach ( 24 , 25 ). The study adhered to the World Medical Association Declaration of Helsinki (Seoul 2008) and complied with STROBE guidelines. Sex disaggregation was inherent, consistent with SAGER principles. Study population and sampling The study population comprised Fulani women actively engaged in milk vending. Seventy-seven respondents were enrolled through purposive sampling, consistent with AMR KAP surveys in Nigeria, Malawi, and Uganda ( 26 , 27 , 28 ). Eligibility criteria included self-identification as Fulani, female gender, age ≥ 18 years, and ≥ 6 months of milk-vending experience. Of 100 women approached at homesteads, collection points, and small urban nono joints, 77 consented and completed the full questionnaire; 23 declined, citing time constraints or discomfort with medication-related questions. Instrument development Data were collected using a structured questionnaire aligned with WHO KAP guidance and One Health principles ( 29 , 30 ). Domains included husbandry context, AMR knowledge, attitudes, and practices related to antimicrobial use, storage, transport, consultation, withdrawal compliance, and manure management. Items were adapted from validated AMR KAP tools used among veterinarians, farmers, healthcare workers, and rural communities ( 31 , 32 , 33 ). A multidisciplinary panel ensured content validity and cultural sensitivity, following precedents in Namibia and Ethiopia ( 34 , 35 ). The questionnaire was translated into Hausa and Fulfulde for semantic accuracy, consistent with participatory AMR research ( 36 ). Data collection procedures Trained field researchers fluent in Hausa and Fulfulde conducted face-to-face interviews at homesteads, collection points, or market stalls, minimising disruption. Neutral prompts and culturally sensitive engagement were emphasised, consistent with gender-responsive frameworks ( 20 , 37 ). No financial incentives were provided, though refreshments were offered where culturally appropriate. Variables and measurements General information items captured visitor access, wild animal presence, water sources, cleaning frequency, footbath availability, and vaccination schedules. Knowledge items assessed prior awareness of AMR, definitions, drivers, residues, familiarity with Nigeria’s AMR Plan, training exposure, and biosecurity awareness. Attitudes were measured using Likert-scale statements on resistance drivers, severity, and willingness to modify use. Practices included consultation, reuse of leftovers, monitoring, compliance with withdrawal requirements, and manure disposal, reflecting food safety determinants along African value chains ( 10 , 38 ). Data management and analysis Completed questionnaires were checked and double-entered. Descriptive statistics summarised categorical variables, and composite domain scores were calculated for AMR-related knowledge, attitudes, and practices. Chi-square tests examined associations between demographic variables (e.g., education level, prior training) and AMR KAP categories, with statistical significance set at p < 0.05. Visualisation through stacked bar charts, heatmaps, and radar plots followed systematic review practices for foodborne pathogens ( 39 , 40 ). Bias was minimised through anonymous coding, neutral prompts, and administration in Hausa or Fulfulde. Analyses were performed using Python (SciPy v1.13). Ethical considerations The protocol was approved by the Ahmadu Bello University Committee on Use of Human Subjects for Research (ABUCUHSR/2022/29). Community entry followed local norms, including engagement with leaders and gatekeepers. Written informed consent was obtained; for participants with limited literacy, forms were read aloud in Hausa, questions answered, and thumbprints accepted. Ethical safeguards aligned with gender equality and rights frameworks in Africa ( 19 , 20 ), ensuring trust and cultural sensitivity. Results General information and husbandry conditions Of the 100 Fulani women vendors approached, 77 completed the AMR KAP interview (response rate 77%). All respondents combined household livestock responsibilities with the vending of raw and fermented milk, positioning them at the interface between animal care and consumer supply. Husbandry environments were mixed. Visitor access was reported by 51.9%, stray-animal incursions by 31.2%, and reliance on direct water sources by 41.6%. Cleaning routines were common but not universal: 49.4% cleaned troughs daily, while 58.4% removed faeces daily. Functional footbaths were available to 41.6%, whereas vaccination adherence was comparatively robust (72.7%). These distributions are shown in Fig. 1 . Knowledge of antimicrobial resistance Knowledge resembled a patchwork of clarity and confusion. Just over half (55.8%) had heard of AMR, yet only 36.4% defined it correctly. Awareness of drivers was stronger: 63.6% recognised incomplete courses as risky, and 67.5% understood dosing errors. Fewer than half (49.4%) recognised residues in food as resistance pathways—a striking blind spot given their role in milk vending. Familiarity with Nigeria’s AMR Action Plan was minimal (24.7%), though 55.8% reported formal training. Only 16.9% linked biosecurity to reduced antimicrobial use. The calculated mean knowledge score was 50.5%, as illustrated in Fig. 2 . Attitudes towards AMR Attitudes were generally favourable, with a calculated mean score of 69.9%. Respondents recognised AMR as a serious threat (57.2% agreed/strongly agreed), endorsed biosecurity (57.2%), and expressed willingness to modify practices (54.6%). Yet misconceptions persisted: 44.2% believed treatment should stop once animals appeared healthy, and 37.7% assumed antimicrobials could cure all diseases. These findings are presented in Fig. 3 . Practices related to AMR Practices painted a sobering picture, with a calculated mean score of 45.5%. Unsupervised use was common: 24.7% admitted administering antimicrobials without consultation, while 36.4% never sought advice. Reuse of incomplete courses was widespread (42.9%). Withdrawal compliance was uneven: 44.2% always observed withdrawal, but 19.4% never did. Unsafe storage was notable: 18.2% kept antibiotics in bedrooms, while informal transport was frequent (45.5% never used structured means). Manure management introduced environmental risks: 48.1% used manure as fertiliser, while 9.1% reported unsafe disposal. These distributions are shown in Fig. 4 . Composite KAP profile Knowledge (50.5%), attitudes (69.9%), and practices (45.5%) yielded a calculated composite score of 55.3%. The categorical distribution of respondents across domains is presented in Table 1, highlighting that knowledge was predominantly poor (70.1%), attitudes were largely permissive (84.4%), and practices were predominantly poor (63.6%). A radar plot of the composite profile is provided in Fig. 5 , contrasting observed scores against the 50% benchmark threshold. The Results demonstrate that while attitudes provide a foundation for stewardship, knowledge remains incomplete and practices are inconsistent. The calculated composite score of 55.3% underscores the fragile balance between awareness and behaviour, underscoring the need for urgent, culturally grounded interventions. Inferential analysis Chi-square analyses did not identify significant associations between education level or prior training and KAP categories (all p > 0.05). Suboptimal AMR KAP was widespread across sociodemographic groups. The absence of significant associations suggests current training formats are insufficient to translate awareness into sustained behaviour. Discussion The AMR KAP profile documented here portrays Fulani women milk vendors as navigating uneven understanding and fragile stewardship behaviours. As shown in Table 1, knowledge was predominantly poor (70.1%), attitudes were largely permissive (84.4%), and practices were weak (63.6% poor). The calculated composite score of 55.3% situates respondents at a precarious threshold between awareness and action. This echoes global findings that AMR is both a biomedical and systemic challenge, eroding therapeutic efficacy and exposing fissures in governance and accountability ( 1 , 2 ). Knowledge: illuminated yet incomplete Knowledge was fragmented, with 55.8% reporting prior awareness of AMR and 63.6% recognising incomplete courses as risky (Fig. 2 ). However, only 36.4% could correctly define resistance, and fewer than half (49.4%) recognised residues in milk as a resistance pathway. Awareness of Nigeria’s AMR Action Plan was minimal (24.7%) ( 13 ). These blind spots are particularly concerning given vendors’ central role in milk safety and consumer health, consistent with evidence that informal food systems in Africa remain under-characterised in AMR surveillance ( 8 , 9 ). Attitudes: fertile ground for stewardship Attitudes were comparatively stronger, with a calculated mean of 69.9% (Fig. 3 ). Respondents acknowledged AMR as a serious threat (57.2% agreed/strongly agreed), endorsed biosecurity (57.2%), and expressed willingness to modify practices (54.6%). This attitudinal readiness provides fertile ground for stewardship interventions. Yet misconceptions persisted: 44.2% believed treatment should stop once animals appeared clinically healthy, and 37.7% assumed antimicrobials could cure all diseases. Similar misconceptions have been documented among farmers in Malawi, Namibia, and Uganda ( 27 , 28 , 34 ). Practices: the weakest link Daily behaviours revealed sobering gaps (Fig. 4 ). Nearly one quarter (24.7%) admitted to administering antimicrobials without consultation, and 42.9% reused leftover courses. Withdrawal compliance was uneven, with 44.2% always observing withdrawal but 19.4% never doing so. Unsafe storage was notable, with 18.2% keeping antibiotics in bedrooms, while informal transport was frequent (45.5% never used structured means). Manure management practices highlight the environmental dimension of AMR, consistent with UNEP’s emphasis on environmental pathways ( 41 ). Policy implications Fulani women milk vendors occupy a delicate intersection between culture and commerce. They are custodians of food safety and household income, yet remain absent from policy dialogues. Integrating them into stewardship programmes would strengthen surveillance and anchor interventions in lived realities. The calculated composite score of 55.3% underscores that, while attitudinal readiness exists, translating it into consistent practice remains elusive. This aligns with calls for One Health approaches that embed gender and informal food systems into AMR governance ( 11 , 17 , 30 ). Training and stewardship outcomes Chi-square analyses revealed no significant association between reported training exposure and composite KAP performance (all p > 0.05). This suggests current formats are insufficient to translate awareness into sustained behaviour. Community-based training, iterative reinforcement, and culturally sensitive communication in Hausa and Fulfulde are essential, as participatory interventions in LMICs have demonstrated ( 36 , 42 , 43 ). Conclusion and Recommendations The AMR KAP profile among Fulani women milk vendors is characterised by a partial yet fragile understanding. As demonstrated in Table 1 and Figs. 1 – 4 , these women appreciate the seriousness of resistance and recognise some of its drivers, but lack a coherent grasp of how everyday practices and policy frameworks shape AMR risks. The calculated composite score of 55.3% underscores that attitudinal readiness coexists with weak stewardship behaviours. This finding resonates with global evidence that AMR is both a biomedical and systemic crisis, eroding therapeutic efficacy and exposing governance gaps ( 1 , 3 ). Strengthening stewardship in this context will require participatory, gender-sensitive communication that translates abstract AMR concepts into concrete decisions about antibiotic use, residue management, and hygiene in informal dairy work. Similar community-based interventions have proven effective in LMICs, where participatory training and culturally resonant messaging improved stewardship outcomes ( 36 , 42 ). Recommendations Reposition Fulani women vendors at the centre of One Health surveillance and action. Their pivotal role in shaping household and market practices demands recognition in national AMR strategies ( 11 , 13 ). Deliver participatory, gender-sensitive training in Hausa and Fulfulde. Iterative reinforcement, peer-to-peer learning, and structural support are essential to ensure knowledge translates into behaviour ( 27 , 28 ). Address infrastructure gaps with low-cost, context-appropriate tools. Safe storage containers, functional footbaths, and structured manure disposal systems should be supported by cooperatives or women’s groups, consistent with UNEP’s emphasis on environmental pathways ( 41 ). Embed stewardship within broader agendas of food safety, nutrition, and women’s economic empowerment. AMR should not be treated as an isolated technical issue but as integral to sustaining livelihoods and consumer trust ( 12 , 17 ). Expand surveillance to capture environmental pathways and extend KAP studies. Comparative evidence across pastoral and informal food systems in Africa will consolidate policy and practice ( 8 , 9 , 10 ). The calculated composite score of 55.3% highlights the fragile balance between awareness and stewardship. Fulani women milk vendors are not peripheral actors in the AMR crisis; they are active agents whose daily decisions shape households and markets. Effective stewardship in this context requires interventions that are scientifically rigorous, culturally resonant, and gender-responsive, ensuring these women are engaged as informed partners rather than overlooked stakeholders ( 30 , 43 ). As Hausa wisdom reminds us, Ba a raina kobo, shi ne ke tara naira , that is “do not despise the Kobo, for it gathers into Naria”, so small acts of stewardship accumulate into powerful defences against resistance. Declarations Funding Statement This research received no specific grant from any funding agency in the public, commercial, or not‑for‑profit sectors. Competing Interests All authors declare that they have no competing interests. The views expressed in this article are solely those of the authors and do not represent the positions of any institution or organisation with which they are affiliated. Authors’ Contributions (CRediT Taxonomy) CRediT Role Author(s) Conceptualisation MMF Methodology MMF Data curation MMF, RF, LEOA, IMH, BSA Formal analysis MMF, RF, LEOA, IMH, BSA Investigation MMF Resources MMF Visualisation MMF Writing – original draft MMF, RF Writing – review & editing MMF, RF, LEOA, IMH, BSA Project administration MMF, RF, LEOA, IMH, BSA Supervision Not Applicable Funding acquisition Not Applicable Acknowledgements We extend our profound gratitude to Prof. S.A. Ado, Prof. M.B. Tijjani, and Prof. H.M. Kazeem, whose vision for integrating gender, food safety, and One Health principles guided this study. We thank the Fulani women vendors of Sabon Gari and Zaria markets for their participation and candour, and the community leaders for ensuring culturally respectful engagement. Special thanks are due to the field researchers and assistants for their diligence and translation support in Hausa, Fulfulde, and English. We acknowledge the Ahmadu Bello University Committee on Human Subjects Research (ABUCUHSR/2022/29) for ethical approval, and the institutional support provided by the Departments of Microbiology, Water Resources and Environmental Engineering, and Pharmaceutical Microbiology at Ahmadu Bello University, together with partner institutions at Modibbo Adama University and Kaduna State University. Data Availability Statement The data supporting the findings of this study are available within the article and its supplementary files. Supplementary File S2 provides the complete empirical response dataset (44). Additional de‑identified data are available from the corresponding author upon reasonable request, subject to compliance with the ethical approval conditions under which the study was conducted (ABUCUHSR/2022/29). Use of Artificial Intelligence Tools In preparing this manuscript, the authors made use of the following artificial intelligence (AI)–assisted tools: Grammarly (Grammarly Inc., San Francisco, CA, USA) for grammar checking, spelling correction, and stylistic refinement; Quillbot (Course Hero Inc., Redwood City, CA, USA) for paraphrasing assistance and sentence restructuring; Paperpal (Cactus Communications Pvt. Ltd., Mumbai, India) for academic language enhancement and journal readiness checking; Perplexity AI (Perplexity AI Inc., San Francisco, CA, USA) for literature identification, reference verification, and manuscript drafting support; and Microsoft Copilot (Microsoft Corporation, Redmond, WA, USA) for writing assistance and text refinement during manuscript preparation. 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BMC Res Notes 16(1):290. 10.1186/s13104-023-06449-1 Ash R, Wachira J, Hassan R et al (2025) Gender-sensitive approaches improve characterisation of resilience in African pastoral systems. Nomadic Peoples 29(2):278–310. 10.3828/whpnp.63837646691082 Lautan O, Cheng YH, Pranata R et al (2025) Antimicrobial resistant bacteria in the food chain: current challenges and global mitigation strategies. One Health 21:101273. 10.1016/j.onehlt.2025.101273 Mebrahtu AR, Likulunga LE, Chauwa A et al (2025) A systematic review and meta-analysis of antibiotic resistance of foodborne pathogenic bacteria. BMC Infect Dis 25(1):535. 10.1186/s12879-025-10779-9 Albukhari AF (2025) The global burden of antimicrobial resistance: a systematic review of trends, drivers and effective interventions. Int J Linguistics Appl Psychol Technol 2(2):35–54. 10.69889/ijlapt.v2i02 (Feb).98 Bracing for superbugs: summary for policymakers – environmental dimensions of antimicrobial resistance. Nairobi: United Nations Environment Programme (2023) Available from: https://www.unep.org/resources/superbugs/environmental-action [accessed 2026 Apr 23] Mathew P, Chandy SJ, Ranjalkar J (2024) Community engagement to mitigate antimicrobial resistance in low-and middle-income countries – an essential strategy for implementation of national action plans on AMR. Lancet Reg Health SE Asia 24:100123. 10.1016/j.lansea.2024.100379 Altevogt BM, Taylor P, Akwar HT et al (2025) A One Health framework for global and local stewardship across the antimicrobial lifecycle. Commun Med 5:414. 10.1038/s43856-025-01090-4 Fathuddin MM, Fathuddin R, Ameh LEO, Mohammed Hussaini I, Sulaiman AN (2026) Supplementary Data – Antimicrobial Resistance Knowledge, Attitudes and Practices among Fulani Women Vendors in Informal Dairy Markets of Sabon gari and Zaria, Nigeria: A One Health Perspective. 10.5281/zenodo.19827578 . Zenodo Table Table 1. Composite KAP Scores on Antimicrobial Resistance (AMR) Domain Category Frequency (n) Percent (%) Knowledge Good (≥80%) 3 3.9 Moderate (50–79%) 20 26.0 Poor (<50%) 54 70.1 Attitudes Permissive (mean ≥4.0) 65 84.4 Stewardship-oriented (mean <4.0) 12 15.6 Practices Good (≥80%) 6 7.8 Moderate (50–79%) 22 28.6 Poor (<50%) 49 63.6 This table summarises knowledge, attitudes, and practices concerning antimicrobial resistance. Knowledge is assessed by correct understanding and awareness, attitudes by perception of AMR as a threat, and practices by adherence to stewardship behaviours. Additional Declarations The authors declare no competing interests. Supplementary Files S1AMRQuestionnaire.pdf Questionnaire S2AMRQuestionnaire.xlsx Response S3STROBEChecklistAMR.docx.pdf STROBE Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9545172","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":630554805,"identity":"8c9bf2d7-379a-4b1c-877d-8ffb894527ba","order_by":0,"name":"Muhammad Muhsin Fathuddin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYFACHgaGBAY5BgYJIOIxALEYGA48IKzFmIEHqsUYrCWBkBYGuBYGhsQGEB+fFt0ZuYc/PNxhIG8v3WN4403BnfT5YYcfAm2xk9NtwK7F7EZemkTiGQPDHpkzxpZzDJ7lbrydZgDUkmxsdgCXlhwzhsS2P4w9Ejlm0jwGh3M3zk4AaTmQuA23FuMPiW0G9jAt6Yaz0z8Q0mIgAdSSCNOSIC+dQ8CWM2/MQFqSe26kFQP9cthwg3ROwYEEAzx+OZ5j/PFnm4Ft+4zkjTfe/DksLz87ffOHDxV2cri0YAIDsEoDYpWDgHwDKapHwSgYBaNgJAAAMx5iYl7pVPwAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-9948-4081","institution":"Ahmadu Bello University","correspondingAuthor":true,"prefix":"","firstName":"Muhammad","middleName":"Muhsin","lastName":"Fathuddin","suffix":""},{"id":630554806,"identity":"bb0be9a6-23ed-4823-9b8c-b4d50e967591","order_by":1,"name":"Rafeedah Fathuddin","email":"","orcid":"https://orcid.org/0000-0001-6528-3089","institution":"B. S. Abdur Rahman Crescent Institute of Science \u0026 Technology","correspondingAuthor":false,"prefix":"","firstName":"Rafeedah","middleName":"","lastName":"Fathuddin","suffix":""},{"id":630554807,"identity":"09a9634b-a45c-470a-8244-816a72070166","order_by":2,"name":"Linda Elsee Ofeh Ameh","email":"","orcid":"https://orcid.org/0009-0002-6983-9210","institution":"Edo University","correspondingAuthor":false,"prefix":"","firstName":"Linda","middleName":"Elsee Ofeh","lastName":"Ameh","suffix":""},{"id":630554808,"identity":"3552471a-d1b8-4126-938c-738b2106e2ac","order_by":3,"name":"Mohammed Hussaini Ibrahim","email":"","orcid":"https://orcid.org/0000-0003-1230-248X","institution":"Ahmadu Bello University","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"Hussaini","lastName":"Ibrahim","suffix":""},{"id":630554809,"identity":"c87abcae-9ff5-4c50-a0af-7ebf140428d5","order_by":4,"name":"Asmau Nna Suleiman","email":"","orcid":"https://orcid.org/0000-0003-2544-2764","institution":"Ahmadu Bello University","correspondingAuthor":false,"prefix":"","firstName":"Asmau","middleName":"Nna","lastName":"Suleiman","suffix":""}],"badges":[],"createdAt":"2026-04-27 18:20:49","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9545172/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9545172/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108085472,"identity":"534c9686-7db2-42c3-98d1-1b85ba47606b","added_by":"auto","created_at":"2026-04-29 08:29:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70645,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGeneral Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003eDistribution of responses to seven general information items (GI‑AMR1–GI‑AMR7) among dairy hawkers in Nigeria. Bars represent percentages for each category (Yes, No, Don’t know, No response, or frequency options). Data reflect practices related to visitor access, wild animal entry, water source, trough cleaning, faeces removal, footbath availability, and vaccination consistency.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/05a620eb928de78ef62b23bb.png"},{"id":108085473,"identity":"d45d6382-71bb-4eb0-8206-841b50dc1e9f","added_by":"auto","created_at":"2026-04-29 08:29:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":71215,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKnowledge About Antimicrobial Resistance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e Percentage distribution of responses to eight knowledge items (K‑AMR1–K‑AMR8). Categories include Yes/No and multiple‑choice definitions. The figure illustrates awareness of AMR, recognition of risk factors (incomplete courses, inappropriate dosing, residues), familiarity with the National AMR Plan, training exposure, and acknowledgement of biosecurity measures.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/f653cff684e1a1860ecd09ce.png"},{"id":108182271,"identity":"920decdd-d0fa-47b1-94ec-6ecfe78a43c4","added_by":"auto","created_at":"2026-04-30 08:59:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":126883,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAttitudes Toward Antimicrobial Resistance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e Horizontal stacked bars show the distribution of responses to seven attitude statements (A‑AMR1–A‑AMR7) on a 7‑point Likert scale (Strongly Agree → Strongly Disagree). Percentages are displayed within each segment. Items cover perceptions of AMR as a threat, biosecurity, willingness to modify practices, discontinuation of treatment, and misconceptions about antimicrobials.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/bf5c206ce29bcc518222c436.png"},{"id":108182119,"identity":"c602fd09-cfdf-4b99-b92f-4f38904d549a","added_by":"auto","created_at":"2026-04-30 08:59:09","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":59130,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePractices About Antimicrobial Resistance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e Clustered bars depict responses to eight practice items (P‑AMR1–P‑AMR8). Categories include Always, Sometimes, Rarely, and Never, plus specific options for storage, transport, and manure management. Percentages highlight patterns of unsupervised antibiotic use, reuse of courses, monitoring, withdrawal compliance, seller influence, storage conditions, transport methods, and manure disposal.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/bd46a7f4ba7480cf0ef370c8.png"},{"id":108181506,"identity":"9e000510-463b-4ae3-b535-1ee81362ae18","added_by":"auto","created_at":"2026-04-30 08:58:42","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":121837,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComposite KAP Scores on AMR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e Radar chart comparing observed composite scores for Knowledge (50.5%), Attitudes (69.9%), Practices (45.5%), and overall Composite (55.3%) against a 50% benchmark. The green polygon represents observed scores; the red dashed line indicates the stewardship threshold.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/42a696d77a44ceaa6832f232.png"},{"id":108182269,"identity":"aae1f925-ec71-4789-95e8-4df4616ccaa5","added_by":"auto","created_at":"2026-04-30 08:59:17","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":42748,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComposite Category Summary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e Clustered bars show categorical distributions of Good, Moderate, and Poor across Knowledge, Attitudes, and Practices. Percentages are derived from Table 1: Knowledge (3.9% Good, 26.0% Moderate, 70.1% Poor), Attitudes (15.6% Good, 84.4% Moderate, 0.0% Poor), Practices (7.8% Good, 28.6% Moderate, 63.6% Poor). The figure provides a comparative visualization of overall KAP performance.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/dae80c452d04d0379bbc6565.png"},{"id":108184597,"identity":"1ecc2ee5-465b-4486-b8db-f0bf7de050a2","added_by":"auto","created_at":"2026-04-30 09:04:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":702385,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/54a8e576-6d23-4bb0-8c66-c4a3ec3feb57.pdf"},{"id":108181955,"identity":"4f6ac4f3-de02-49fe-bc3f-be9077f4eb82","added_by":"auto","created_at":"2026-04-30 08:59:02","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":184734,"visible":true,"origin":"","legend":"\u003cp\u003eQuestionnaire\u003c/p\u003e","description":"","filename":"S1AMRQuestionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/10a46ce952f51c0d0698c872.pdf"},{"id":108181448,"identity":"d03844f2-231d-44ef-9642-24f4c0579931","added_by":"auto","created_at":"2026-04-30 08:58:39","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15805,"visible":true,"origin":"","legend":"\u003cp\u003eResponse\u003c/p\u003e","description":"","filename":"S2AMRQuestionnaire.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/5d8b54ea352e0e726a728000.xlsx"},{"id":108085477,"identity":"fb0d3f94-8e79-447a-93a7-d7a770f171ec","added_by":"auto","created_at":"2026-04-29 08:29:26","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":4030700,"visible":true,"origin":"","legend":"\u003cp\u003eSTROBE\u003c/p\u003e","description":"","filename":"S3STROBEChecklistAMR.docx.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9545172/v1/82c126154a89f259f6df96da.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eAntimicrobial Resistance Knowledge, Attitudes and Practices among Fulani Women Vendors in Informal Dairy Markets of Sabon‑gari and Zaria, Nigeria: A One Health Perspective\u003c/p\u003e","fulltext":[{"header":"What was already known","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eAntimicrobial resistance (AMR) is a growing global health crisis, with LMICs bearing a disproportionate burden.\u003c/li\u003e\n \u003cli\u003eInformal dairy supply chains in West Africa carry undercharacterised AMR transmission risks through antibiotic misuse, residues, and poor biosecurity.\u003c/li\u003e\n \u003cli\u003eFulani women are central actors in Nigerian informal dairy networks but have been entirely absent from AMR surveillance and KAP research.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this study adds\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eThis is the first study to document AMR-related KAP specifically among Fulani women milk vendors in Nigeria, filling a critical evidence gap.\u003c/li\u003e\n \u003cli\u003eA composite KAP score of 51.1 with attitudes (56.1) above, and knowledge (47.5) and practices (49.6) below the midpoint reveals an attitudinal readiness that has not yet translated into consistent stewardship behaviour.\u003c/li\u003e\n \u003cli\u003eFindings provide actionable, gender-sensitive entry points for culturally grounded One Health stewardship interventions in Nigeria\u0026apos;s informal dairy sector.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eAntimicrobial resistance (AMR) has emerged as one of the defining health challenges of the twenty-first century, transforming once-manageable infections into therapeutic dead ends. In 2019, resistant bacterial infections were implicated in millions of deaths worldwide, underscoring the waning efficacy of antibiotics as the \u0026ldquo;magic bullets\u0026rdquo; of modern medicine (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). AMR is not simply a microbiological anomaly; it is a systemic stress test for universal health coverage, exposing fissures in access, regulation, and accountability across health systems (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Where health systems are fragile, AMR strikes hardest, eroding gains in food security, nutrition, and poverty reduction (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). As Fulfulde wisdom reminds us, \u003cem\u003eKo fii no gorko, ko fii no dow\u003c/em\u003e, \u0026ldquo;where there is a person, there is a community\u0026rdquo;. Survival depends on stewardship, and stewardship endures only through collective responsibility.\u003c/p\u003e \u003cp\u003eLow- and middle-income countries (LMICs) shoulder a disproportionate burden, as antibiotics circulate through dense human, animal, and environmental networks that are only partially governed by formal systems (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Surveillance across Africa remains uneven, with alarming resistance documented in foodborne pathogens, livestock production, and dairy value chains (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Without decisive cross-sectoral action, AMR threatens to undermine One Health goals and compromise sustainable development.\u003c/p\u003e \u003cp\u003eNigeria epitomises these challenges. As Africa\u0026rsquo;s most populous nation, it faces escalating AMR across human, animal, and environmental domains, compounded by widespread, unregulated antimicrobial use in livestock and informal food systems (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). National policy instruments, including the One Health AMR National Action Plan, have charted a course forward, yet implementation remains incomplete and under-resourced (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Informal dairy systems, particularly those managed by Fulani women, remain conspicuously absent from AMR surveillance despite their centrality to household food security and consumer supply (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWithin these systems, Fulani pastoralists are pivotal actors, and Fulani women constitute the vital core of milk collection, processing, and vending. Their roles are shaped by gendered norms, socioeconomic constraints, and shifting pastoral livelihoods, yet their perspectives remain largely absent from AMR research (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This omission is striking given evidence that gender dynamics profoundly influence antimicrobial use and stewardship outcomes in LMICs (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study addresses that gap by assessing AMR-related knowledge, attitudes, and practices (KAP) among Fulani women milk vendors in Zaria, Nigeria. By embedding AMR questions within the lived realities of informal dairy livelihoods, we capture how resistance is understood and negotiated in everyday practices rather than in clinical or laboratory settings. Complementary analyses of antibiotic use behaviours, residue-related risks, and hygiene practices are reported in three companion manuscripts (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), but here we focus specifically on the AMR KAP profile. The calculated composite score of 55.3% situates Fulani women vendors at a fragile threshold between awareness and stewardship, underscoring the urgency of culturally grounded, gender-responsive interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eThis study reports the antimicrobial resistance (AMR) knowledge, attitudes, and practices (KAP) component of a multidomain cross-sectional survey conducted in Zaria, Kaduna State, northern Nigeria. The research was situated within informal dairy systems in which Fulani women collect, process, and retail raw and fermented milk through dense, largely unregulated networks linking pastoral households to peri-urban consumers. Embedding AMR KAP questions within this context enabled the capture of how resistance is understood and negotiated in everyday livelihoods rather than in clinical or laboratory settings. Comparable food systems in Kenya and Zimbabwe have highlighted food safety risks and AMR exposure, underscoring the relevance of this approach (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The study adhered to the World Medical Association Declaration of Helsinki (Seoul 2008) and complied with STROBE guidelines. Sex disaggregation was inherent, consistent with SAGER principles.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population and sampling\u003c/h3\u003e\n\u003cp\u003eThe study population comprised Fulani women actively engaged in milk vending. Seventy-seven respondents were enrolled through purposive sampling, consistent with AMR KAP surveys in Nigeria, Malawi, and Uganda (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Eligibility criteria included self-identification as Fulani, female gender, age\u0026thinsp;\u0026ge;\u0026thinsp;18 years, and \u0026ge;\u0026thinsp;6 months of milk-vending experience. Of 100 women approached at homesteads, collection points, and small urban \u003cem\u003enono\u003c/em\u003e joints, 77 consented and completed the full questionnaire; 23 declined, citing time constraints or discomfort with medication-related questions.\u003c/p\u003e\n\u003ch3\u003eInstrument development\u003c/h3\u003e\n\u003cp\u003eData were collected using a structured questionnaire aligned with WHO KAP guidance and One Health principles (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Domains included husbandry context, AMR knowledge, attitudes, and practices related to antimicrobial use, storage, transport, consultation, withdrawal compliance, and manure management. Items were adapted from validated AMR KAP tools used among veterinarians, farmers, healthcare workers, and rural communities (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). A multidisciplinary panel ensured content validity and cultural sensitivity, following precedents in Namibia and Ethiopia (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The questionnaire was translated into Hausa and Fulfulde for semantic accuracy, consistent with participatory AMR research (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData collection procedures\u003c/h3\u003e\n\u003cp\u003eTrained field researchers fluent in Hausa and Fulfulde conducted face-to-face interviews at homesteads, collection points, or market stalls, minimising disruption. Neutral prompts and culturally sensitive engagement were emphasised, consistent with gender-responsive frameworks (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). No financial incentives were provided, though refreshments were offered where culturally appropriate.\u003c/p\u003e\n\u003ch3\u003eVariables and measurements\u003c/h3\u003e\n\u003cp\u003eGeneral information items captured visitor access, wild animal presence, water sources, cleaning frequency, footbath availability, and vaccination schedules. Knowledge items assessed prior awareness of AMR, definitions, drivers, residues, familiarity with Nigeria\u0026rsquo;s AMR Plan, training exposure, and biosecurity awareness. Attitudes were measured using Likert-scale statements on resistance drivers, severity, and willingness to modify use. Practices included consultation, reuse of leftovers, monitoring, compliance with withdrawal requirements, and manure disposal, reflecting food safety determinants along African value chains (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eCompleted questionnaires were checked and double-entered. Descriptive statistics summarised categorical variables, and composite domain scores were calculated for AMR-related knowledge, attitudes, and practices. Chi-square tests examined associations between demographic variables (e.g., education level, prior training) and AMR KAP categories, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Visualisation through stacked bar charts, heatmaps, and radar plots followed systematic review practices for foodborne pathogens (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Bias was minimised through anonymous coding, neutral prompts, and administration in Hausa or Fulfulde. Analyses were performed using Python (SciPy v1.13).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e The protocol was approved by the Ahmadu Bello University Committee on Use of Human Subjects for Research (ABUCUHSR/2022/29). Community entry followed local norms, including engagement with leaders and gatekeepers. Written informed consent was obtained; for participants with limited literacy, forms were read aloud in Hausa, questions answered, and thumbprints accepted. Ethical safeguards aligned with gender equality and rights frameworks in Africa (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), ensuring trust and cultural sensitivity.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eGeneral information and husbandry conditions\u003c/h2\u003e \u003cp\u003eOf the 100 Fulani women vendors approached, 77 completed the AMR KAP interview (response rate 77%). All respondents combined household livestock responsibilities with the vending of raw and fermented milk, positioning them at the interface between animal care and consumer supply.\u003c/p\u003e \u003cp\u003eHusbandry environments were mixed. Visitor access was reported by 51.9%, stray-animal incursions by 31.2%, and reliance on direct water sources by 41.6%. Cleaning routines were common but not universal: 49.4% cleaned troughs daily, while 58.4% removed faeces daily. Functional footbaths were available to 41.6%, whereas vaccination adherence was comparatively robust (72.7%). These distributions are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge of antimicrobial resistance\u003c/h2\u003e \u003cp\u003eKnowledge resembled a patchwork of clarity and confusion. Just over half (55.8%) had heard of AMR, yet only 36.4% defined it correctly. Awareness of drivers was stronger: 63.6% recognised incomplete courses as risky, and 67.5% understood dosing errors. Fewer than half (49.4%) recognised residues in food as resistance pathways\u0026mdash;a striking blind spot given their role in milk vending. Familiarity with Nigeria\u0026rsquo;s AMR Action Plan was minimal (24.7%), though 55.8% reported formal training. Only 16.9% linked biosecurity to reduced antimicrobial use. The calculated mean knowledge score was 50.5%, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes towards AMR\u003c/h2\u003e \u003cp\u003eAttitudes were generally favourable, with a calculated mean score of 69.9%. Respondents recognised AMR as a serious threat (57.2% agreed/strongly agreed), endorsed biosecurity (57.2%), and expressed willingness to modify practices (54.6%). Yet misconceptions persisted: 44.2% believed treatment should stop once animals appeared healthy, and 37.7% assumed antimicrobials could cure all diseases. These findings are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePractices related to AMR\u003c/h2\u003e \u003cp\u003ePractices painted a sobering picture, with a calculated mean score of 45.5%. Unsupervised use was common: 24.7% admitted administering antimicrobials without consultation, while 36.4% never sought advice. Reuse of incomplete courses was widespread (42.9%). Withdrawal compliance was uneven: 44.2% always observed withdrawal, but 19.4% never did. Unsafe storage was notable: 18.2% kept antibiotics in bedrooms, while informal transport was frequent (45.5% never used structured means). Manure management introduced environmental risks: 48.1% used manure as fertiliser, while 9.1% reported unsafe disposal. These distributions are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eComposite KAP profile\u003c/h2\u003e \u003cp\u003eKnowledge (50.5%), attitudes (69.9%), and practices (45.5%) yielded a calculated composite score of 55.3%. The categorical distribution of respondents across domains is presented in Table\u0026nbsp;1, highlighting that knowledge was predominantly poor (70.1%), attitudes were largely permissive (84.4%), and practices were predominantly poor (63.6%). A radar plot of the composite profile is provided in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, contrasting observed scores against the 50% benchmark threshold.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe Results demonstrate that while attitudes provide a foundation for stewardship, knowledge remains incomplete and practices are inconsistent. The calculated composite score of 55.3% underscores the fragile balance between awareness and behaviour, underscoring the need for urgent, culturally grounded interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eInferential analysis\u003c/h2\u003e \u003cp\u003eChi-square analyses did not identify significant associations between education level or prior training and KAP categories (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Suboptimal AMR KAP was widespread across sociodemographic groups. The absence of significant associations suggests current training formats are insufficient to translate awareness into sustained behaviour.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe AMR KAP profile documented here portrays Fulani women milk vendors as navigating uneven understanding and fragile stewardship behaviours. As shown in Table\u0026nbsp;1, knowledge was predominantly poor (70.1%), attitudes were largely permissive (84.4%), and practices were weak (63.6% poor). The calculated composite score of 55.3% situates respondents at a precarious threshold between awareness and action. This echoes global findings that AMR is both a biomedical and systemic challenge, eroding therapeutic efficacy and exposing fissures in governance and accountability (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge: illuminated yet incomplete\u003c/h2\u003e \u003cp\u003eKnowledge was fragmented, with 55.8% reporting prior awareness of AMR and 63.6% recognising incomplete courses as risky (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, only 36.4% could correctly define resistance, and fewer than half (49.4%) recognised residues in milk as a resistance pathway. Awareness of Nigeria\u0026rsquo;s AMR Action Plan was minimal (24.7%) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These blind spots are particularly concerning given vendors\u0026rsquo; central role in milk safety and consumer health, consistent with evidence that informal food systems in Africa remain under-characterised in AMR surveillance (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes: fertile ground for stewardship\u003c/h2\u003e \u003cp\u003eAttitudes were comparatively stronger, with a calculated mean of 69.9% (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Respondents acknowledged AMR as a serious threat (57.2% agreed/strongly agreed), endorsed biosecurity (57.2%), and expressed willingness to modify practices (54.6%). This attitudinal readiness provides fertile ground for stewardship interventions. Yet misconceptions persisted: 44.2% believed treatment should stop once animals appeared clinically healthy, and 37.7% assumed antimicrobials could cure all diseases. Similar misconceptions have been documented among farmers in Malawi, Namibia, and Uganda (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePractices: the weakest link\u003c/h2\u003e \u003cp\u003eDaily behaviours revealed sobering gaps (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Nearly one quarter (24.7%) admitted to administering antimicrobials without consultation, and 42.9% reused leftover courses. Withdrawal compliance was uneven, with 44.2% always observing withdrawal but 19.4% never doing so. Unsafe storage was notable, with 18.2% keeping antibiotics in bedrooms, while informal transport was frequent (45.5% never used structured means). Manure management practices highlight the environmental dimension of AMR, consistent with UNEP\u0026rsquo;s emphasis on environmental pathways (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ePolicy implications\u003c/h2\u003e \u003cp\u003eFulani women milk vendors occupy a delicate intersection between culture and commerce. They are custodians of food safety and household income, yet remain absent from policy dialogues. Integrating them into stewardship programmes would strengthen surveillance and anchor interventions in lived realities. The calculated composite score of 55.3% underscores that, while attitudinal readiness exists, translating it into consistent practice remains elusive. This aligns with calls for One Health approaches that embed gender and informal food systems into AMR governance (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eTraining and stewardship outcomes\u003c/h2\u003e \u003cp\u003eChi-square analyses revealed no significant association between reported training exposure and composite KAP performance (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This suggests current formats are insufficient to translate awareness into sustained behaviour. Community-based training, iterative reinforcement, and culturally sensitive communication in Hausa and Fulfulde are essential, as participatory interventions in LMICs have demonstrated (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eConclusion and Recommendations\u003c/h2\u003e \u003cp\u003eThe AMR KAP profile among Fulani women milk vendors is characterised by a partial yet fragile understanding. As demonstrated in Table\u0026nbsp;1 and Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, these women appreciate the seriousness of resistance and recognise some of its drivers, but lack a coherent grasp of how everyday practices and policy frameworks shape AMR risks. The calculated composite score of 55.3% underscores that attitudinal readiness coexists with weak stewardship behaviours. This finding resonates with global evidence that AMR is both a biomedical and systemic crisis, eroding therapeutic efficacy and exposing governance gaps (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStrengthening stewardship in this context will require participatory, gender-sensitive communication that translates abstract AMR concepts into concrete decisions about antibiotic use, residue management, and hygiene in informal dairy work. Similar community-based interventions have proven effective in LMICs, where participatory training and culturally resonant messaging improved stewardship outcomes (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eReposition Fulani women vendors at the centre of One Health surveillance and action.\u003c/b\u003e Their pivotal role in shaping household and market practices demands recognition in national AMR strategies (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDeliver participatory, gender-sensitive training in Hausa and Fulfulde.\u003c/b\u003e Iterative reinforcement, peer-to-peer learning, and structural support are essential to ensure knowledge translates into behaviour (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eAddress infrastructure gaps with low-cost, context-appropriate tools.\u003c/b\u003e Safe storage containers, functional footbaths, and structured manure disposal systems should be supported by cooperatives or women\u0026rsquo;s groups, consistent with UNEP\u0026rsquo;s emphasis on environmental pathways (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eEmbed stewardship within broader agendas of food safety, nutrition, and women\u0026rsquo;s economic empowerment.\u003c/b\u003e AMR should not be treated as an isolated technical issue but as integral to sustaining livelihoods and consumer trust (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eExpand surveillance to capture environmental pathways and extend KAP studies.\u003c/b\u003e Comparative evidence across pastoral and informal food systems in Africa will consolidate policy and practice (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe calculated composite score of 55.3% highlights the fragile balance between awareness and stewardship. Fulani women milk vendors are not peripheral actors in the AMR crisis; they are active agents whose daily decisions shape households and markets. Effective stewardship in this context requires interventions that are scientifically rigorous, culturally resonant, and gender-responsive, ensuring these women are engaged as informed partners rather than overlooked stakeholders (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). As Hausa wisdom reminds us, \u003cem\u003eBa a raina kobo, shi ne ke tara naira\u003c/em\u003e, that is \u0026ldquo;do not despise the Kobo, for it gathers into Naria\u0026rdquo;, so small acts of stewardship accumulate into powerful defences against resistance.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not‑for‑profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests. The views expressed in this article are solely those of the authors and do not represent the positions of any institution or organisation with which they are affiliated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions (CRediT Taxonomy)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCRediT Role\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor(s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eConceptualisation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMethodology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eData curation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF, RF, LEOA, IMH, BSA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFormal analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF, RF, LEOA, IMH, BSA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInvestigation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eResources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVisualisation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWriting \u0026ndash; original draft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF, RF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWriting \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF, RF, LEOA, IMH, BSA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProject administration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMF, RF, LEOA, IMH, BSA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSupervision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot Applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFunding acquisition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot Applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our profound gratitude to Prof. S.A. Ado, Prof. M.B. Tijjani, and Prof. H.M. Kazeem, whose vision for integrating gender, food safety, and One Health principles guided this study. We thank the Fulani women vendors of Sabon Gari and Zaria markets for their participation and candour, and the community leaders for ensuring culturally respectful engagement. Special thanks are due to the field researchers and assistants for their diligence and translation support in Hausa, Fulfulde, and English. We acknowledge the Ahmadu Bello University Committee on Human Subjects Research (ABUCUHSR/2022/29) for ethical approval, and the institutional support provided by the Departments of Microbiology, Water Resources and Environmental Engineering, and Pharmaceutical Microbiology at Ahmadu Bello University, together with partner institutions at Modibbo Adama University and Kaduna State University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available within the article and its supplementary files. Supplementary File S2 provides the complete empirical response dataset (44). Additional de‑identified data are available from the corresponding author upon reasonable request, subject to compliance with the ethical approval conditions under which the study was conducted (ABUCUHSR/2022/29).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUse of Artificial Intelligence Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn preparing this manuscript, the authors made use of the following artificial intelligence (AI)\u0026ndash;assisted tools: Grammarly (Grammarly Inc., San Francisco, CA, USA) for grammar checking, spelling correction, and stylistic refinement; Quillbot (Course Hero Inc., Redwood City, CA, USA) for paraphrasing assistance and sentence restructuring; Paperpal (Cactus Communications Pvt. Ltd., Mumbai, India) for academic language enhancement and journal readiness checking; Perplexity AI (Perplexity AI Inc., San Francisco, CA, USA) for literature identification, reference verification, and manuscript drafting support; and Microsoft Copilot (Microsoft Corporation, Redmond, WA, USA) for writing assistance and text refinement during manuscript preparation.\u003c/p\u003e\n\u003cp\u003eAll AI‑generated or AI‑assisted content was critically reviewed, verified, and edited by the authors, who take full and sole responsibility for the accuracy, integrity, originality, and ethical compliance of the final manuscript. No AI tool was used to generate, fabricate, or manipulate data, figures, or references. The use of these tools did not involve the processing of any participant data beyond what is reported in the manuscript and its supplementary files. In accordance with ICMJE guidelines and the WHO Bulletin editorial policy, no AI tool is listed in the Acknowledgements section.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMurray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A et al (2022) Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 399(10325):629\u0026ndash;655. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0140-6736(21)02724-0\u003c/span\u003e\u003cspan address=\"10.1016/s0140-6736(21)02724-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDadgostar P (2019) Antimicrobial resistance: implications and costs. 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Nairobi: United Nations Environment Programme (2023) Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unep.org/resources/superbugs/environmental-action\u003c/span\u003e\u003cspan address=\"https://www.unep.org/resources/superbugs/environmental-action\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [accessed 2026 Apr 23]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathew P, Chandy SJ, Ranjalkar J (2024) Community engagement to mitigate antimicrobial resistance in low-and middle-income countries \u0026ndash; an essential strategy for implementation of national action plans on AMR. Lancet Reg Health SE Asia 24:100123. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.lansea.2024.100379\u003c/span\u003e\u003cspan address=\"10.1016/j.lansea.2024.100379\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltevogt BM, Taylor P, Akwar HT et al (2025) A One Health framework for global and local stewardship across the antimicrobial lifecycle. Commun Med 5:414. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s43856-025-01090-4\u003c/span\u003e\u003cspan address=\"10.1038/s43856-025-01090-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFathuddin MM, Fathuddin R, Ameh LEO, Mohammed Hussaini I, Sulaiman AN (2026) Supplementary Data \u0026ndash; Antimicrobial Resistance Knowledge, Attitudes and Practices among Fulani Women Vendors in Informal Dairy Markets of Sabon gari and Zaria, Nigeria: A One Health Perspective. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5281/zenodo.19827578\u003c/span\u003e\u003cspan address=\"10.5281/zenodo.19827578\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Zenodo\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Composite KAP Scores on Antimicrobial Resistance (AMR)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eGood (\u0026ge;80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eModerate (50\u0026ndash;79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003ePoor (\u0026lt;50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e70.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttitudes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003ePermissive (mean \u0026ge;4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eStewardship-oriented (mean \u0026lt;4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePractices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eGood (\u0026ge;80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eModerate (50\u0026ndash;79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003ePoor (\u0026lt;50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e63.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003eThis table summarises knowledge, attitudes, and practices concerning antimicrobial resistance. Knowledge is assessed by correct understanding and awareness, attitudes by perception of AMR as a threat, and practices by adherence to stewardship behaviours.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Ahmadu Bello University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antimicrobial resistance (AMR), Knowledge, attitudes, and practices (KAP), Informal dairy markets, Fulani women vendors, Milk safety, One Health stewardship, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-9545172/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9545172/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003eAntimicrobial resistance (AMR) has emerged as a defining global health challenge, yet informal food systems remain critically under-examined. This study assessed AMR-related knowledge, attitudes, and practices (KAP) among Fulani women milk vendors in Zaria, Nigeria\u0026mdash;an underrepresented group whose daily decisions shape microbial risks along the dairy continuum.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA cross-sectional survey of 77 vendors was conducted using a WHO-aligned questionnaire administered in English, Hausa, and Fulfulde. Responses were analysed using descriptive statistics and composite KAP scores, with transparency ensured through supplementary datasets.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003eKnowledge was fragmented: 55.8% had heard of AMR, 63.6% recognised incomplete courses as risky, and 67.5% understood dosing errors, yet only 24.7% were familiar with Nigeria\u0026rsquo;s AMR Action Plan, and fewer than half (49.4%) recognised residues in milk as resistance pathways. Attitudes were moderately favourable (mean 4.89/7; 69.9%), with 57.2% acknowledging AMR as a serious threat, 57.2% endorsing biosecurity, and 54.6% expressing willingness to modify practices. Misconceptions persisted, with 44.2% believing treatment should cease once animals appeared clinically healthy. Practices revealed stewardship gaps: 24.7% always administered antibiotics without consultation, 42.9% reused courses, and only 44.2% consistently observed withdrawal periods. Unsafe storage was reported by 18.2% (bedrooms), and informal transport was common (45.5% never used structured means). Composite domain means were 50.5% for knowledge, 69.9% for attitudes, and 45.5% for practices, yielding a calculated composite KAP score of 55.3%.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eFulani women milk vendors occupy a strategically sensitive position in AMR ecology. Their partial understanding coexists with behaviours that may accelerate resistance, underscoring the urgency of culturally anchored, gender-responsive stewardship interventions. Embedding these women within One Health surveillance and training frameworks is essential to transform attitudinal readiness into sustained behavioural change.\u003c/p\u003e","manuscriptTitle":"Antimicrobial Resistance Knowledge, Attitudes and Practices among Fulani Women Vendors in Informal Dairy Markets of Sabon‑gari and Zaria, Nigeria: A One Health Perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-29 08:29:21","doi":"10.21203/rs.3.rs-9545172/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"daed7acc-5b4a-481e-972a-e814dcd141f4","owner":[],"postedDate":"April 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":67112711,"name":"Animal Science"},{"id":67112712,"name":"Food Science \u0026 Technology"},{"id":67112713,"name":"Bioinformatics"}],"tags":[],"updatedAt":"2026-04-29T08:29:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-29 08:29:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9545172","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9545172","identity":"rs-9545172","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}