International Journal of Environmental Research and Public Health

Water, food, and energy are three of the most important resources for long-term survival and development. The term “nexus” is used to underline the need of controlling these primary components collectively rather than separately because they are interconnected and linked. With the purpose of better understanding nexus thinking and showcasing nexus analysis approaches and tools, this study explores the current state of the approach to the water–energy–food relationship, which has gotten a lot of attention in recent years. Water–energy, water–food, water–energy–food, water–energy, and climate are the four forms of nexus. This paper examines a variety of methodologies based on their principal objectives and provides a basic overview of a wide range of currently available methods and instruments for analyzing the water–energy–food (WEF) nexus. According to this study, the quantity of studies on the water–energy–food nexus has increased significantly, as the scientific community’s ability to analyze water, food, and energy interlinkages at a greater resolution. The integration and optimization of this multi-centric nexus is explored, with focus on four regions—Asia, Europe, America, and Africa—as a case study. The WEF nexus should be used in case studies to help illustrate its intricacies. Furthermore, this study builds a methodology and frameworks to find study linkages between water, energy, food, and other components, for a nexus analysis and discuss the major challenges and its solutions. This study also includes a scientometric analysis that looks at the countries and keyword mapping. Furthermore, the study is being planned, with an emphasis on quantitative analysis of the water–energy–food nexus which is helpful for the water security at local and global scale. This study aids in the coordination of research efforts to solve the difficult issues in nexus research and create sustainable and adaptable water, energy, and food systems. Full article

The purpose of this research is to empirically examine relationships between a multi-dimensional set of corporate social responsibility (CSR) initiatives, numerous dimensions of customer trust, and corporate image in an emerging economy. It also analyzes the mediating effect of customer trust on the relationship between CSR and corporate image. This study focuses on two of the most well-known hotel chains situated in Pakistan. Close-ended, self-administered questionnaires were circulated amongst a total of 300 hotel customers. The research data was analyzed using a partial least square-structural equation modeling (PLS-SEM) model. The results revealed that economic, legal, and ethical CSR significantly impacted corporate image, while philanthropic CSR did not affect the corporate image. However, economic, legal, and philanthropic CSRs were found to be in a significant relationship with customer trust, while ethical CSR was not in a significant relationship with customer trust. Finally, customer trust fully mediated the relationship between economic and legal CSR with corporate image, whereas it partially mediated the relationship between ethical and philanthropic CSR. This study is unique from earlier CSR research based on an assessment of the connection between CSR dimensions and corporate image to examine customers’ trust in an emerging economy, especially in times of crisis. Full article

The integrity of the talus is crucial for the physiologic function of the feet. The present study sought to summarize the available evidence on clinical outcomes and complications following conservative and surgical treatment of talar fractures. We systematically searched Medline via OVID to find relevant studies with a follow-up of at least six months. Hereafter, the success and complication rates were extracted and analyzed in a random effects proportion meta-analysis. Complications were defined as avascular bone necrosis (AVN) and posttraumatic osteoarthritis (OA). Additionally, a subgroup analysis was performed for fracture localization (talar neck fractures (TN) and combined talar body/neck fractures (TN/TB)) and severity of the fracture. The quality of the included studies was assessed utilizing the Coleman Methodology Score (CMS). A total of 29 retrospective studies, including 987 fractures with a mean follow-up of 49.9 months, were examined. Success rates were 62%, 60%, and 50% for pooled fractures, TN, and TN/TB, respectively. The overall complication rate for AVN was 25%. The rate was higher for TN (43%) than TN/TB (25%). Talar fractures revealed a 43% posttraumatic osteoarthritis (OA) rate in our meta-analysis. Success rates showed an association with fracture severity, and were generally low in complex multi-fragmentary fractures. The mean CMS was 34.3 (range: 19–47), indicating a moderate methodological quality of the studies. The present systematic review on clinical outcomes of patients undergoing conservative or surgical treatment for talar fractures reveals a lack of reliable prospective evidence. Talar fractures are associated with relatively poor postoperative outcomes, high rates of AVN, and posttraumatic osteoarthritis. Poor outcomes revealed a positive association with fracture severity. Prospective studies investigating predictors for treatment success and/or failure are urgently needed to improve the overall quality of life and function of patients undergoing surgical treatment due to talar fractures. Full article

The central tenet of Place Attachment theory states that an individual has an inborn predisposition to form strong bonds with places as well as with people. Our qualitative study applies this theory to understand how, despite loss and adversity, refugees are able to reconstruct a sense of identity, community, and “home”. Participants included 15 forcibly displaced people from different countries of origin. Semistructured interviews explored factors that facilitate participants’ integration in a new context and the impact of this context on their sense of identity. Data were analysed using Consensual Qualitative Research Methodology to identify recurrent themes and their frequencies within interview transcripts. Within the relational dimensions of place attachment, affiliation, and seeking help from others, the study explores the factors that facilitate the integration of refugees in a new context and the impact of this context on their sense of identity, identifying recurrent themes and their frequencies within interview transcripts. The most frequent resulting themes were (a) a sense of identity and (b) expectations toward the resettlement country. Additional, though less frequent, themes included: (c) sense of belonging, (d) community integration, (e) trust, (f) opportunity seizing, (g) being a point of reference for others, (h) sense of community, (i) positive memories, (j) refusal. These results begin to describe the ways by which Place Attachment, toward both birth and resettlement countries, contributes to a restructured identity and sense of “feeling at home” for refugees. Full article

Hamstring Strain Injuries (HSIs) are the most common type of lesion in professional footballers and the leading cause of absence days from sports. However, recent studies have shown that high-level football teams apparently do not apply any HSI prevention protocol. The aim of the study was to determine the effect of preventive strategies and protocols in reducing the incidence of hamstring muscle injuries in professional and semi-professional football teams. A literature search of PubMed/MEDLINE, ISI/Web of Science and Scopus databases was conducted with the keywords “hamstring* and (injury* or strain) and prevent* and (soccer or football)”. Quality and bias assessment was completed through the Kennelly modified scale. The Injury Incidence Rate (IIR) and the Incidence Rate Ratio (IRR) were assessed in the statistical analysis. In the meta-analysis, data were extracted, pooled and analysed with “Comprehensive Meta-Analysis Version 3.3.070” software. In total, 8 of the 1017 original search studies met the inclusion criteria of this review. The total exposure of the studies was 170,221.8 h, while the number of HSIs recorded was 165 in the intervention groups and 224 in the control groups. The average score of the quality assessment was 23.6/34. The meta-analysis of six of the eight included studies provided strong evidence that interventions are effective in reducing hamstring injuries. The IRR of the effect size was 0.443, with p-value = 0.001. The studies analysed applied different preventive strategies: the Nordic hamstring exercise, the FIFA 11+ programme and exercises for core stability or balance training. All these interventions proved to have a successful effect on prevention of hamstring injuries. Full article

As cities grow in size and number of inhabitants, continuous monitoring of the environmental impact of sound sources becomes essential for the assessment of the urban acoustic environments. This requires the use of management systems that should be fed with large amounts of data captured by acoustic sensors, mostly remote nodes that belong to a wireless acoustic sensor network. These systems help city managers to conduct data-driven analysis and propose action plans in different areas of the city, for instance, to reduce citizens’ exposure to noise. In this paper, unsupervised learning techniques are applied to discover different behavior patterns, both time and space, of sound pressure levels captured by acoustic sensors and to cluster them allowing the identification of various urban acoustic environments. In this approach, the categorization of urban acoustic environments is based on a clustering algorithm using yearly acoustic indexes, such as $L_{\mathrm{day}}$, $L_{\mathrm{evening}}$, $L_{\mathrm{night}}$ and standard deviation of $L_{\mathrm{den}}$. Data collected over three years by a network of acoustic sensors deployed in the city of Barcelona, Spain, are used to train several clustering methods. Comparison between methods concludes that the k-means algorithm has the best performance for these data. After an analysis of several solutions, an optimal clustering of four groups of nodes is chosen. Geographical analysis of the clusters shows insights about the relation between nodes and areas of the city, detecting clusters that are close to urban roads, residential areas and leisure areas mostly. Moreover, temporal analysis of the clusters gives information about their stability. Using one-year size of the sliding window, changes in the membership of nodes in the clusters regarding tendency of the acoustic environments are discovered. In contrast, using one-month windowing, changes due to seasonality and special events, such as COVID-19 lockdown, are recognized. Finally, the sensor clusters obtained by the algorithm are compared with the areas defined in the strategic noise map, previously created by the Barcelona city council. The developed k-means model identified most of the locations found on the overcoming map and also discovered a new area. Full article

Background: The present study compared the effects of performing the lateral squat exercise in three different formats from eccentric overload training on concentric/eccentric peak/mean power and inter-limb asymmetries in young soccer players. Methods: Forty-five young male (U-17) soccer players were distributed into three groups. Two groups performed the same training volume with both legs, beginning with the weaker leg (SVW, n = 15) or with the stronger leg (SVS, n = 15). The third group executed double volume with the weaker leg and also commenced with such leg (DVW, n = 15) in the lateral squat during a 10-week period. Pre- and post-intervention metrics included concentric and eccentric peak/mean power during the lateral squat test and their corresponding asymmetries. Results: All groups improved all power variables. Concentric mean and peak power asymmetry were substantially reduced in the SVW (ES: 0.89), DVW (ES: 0.43), and in SVW (ES: 1.60). Eccentric mean and peak power asymmetry were also substantially decreased in SVW (ES: 0.81) and in DVW (ES: 0.68). Between-group analyses showed substantially better performance in concentric and eccentric variables with stronger and weaker legs in SVW and DVW groups compared with SVS. Conclusions: Those groups which started with the weaker leg showed greater both power enhancements and reductions on inter-limb asymmetries. Full article

Setting off a global pandemic, coronavirus disease 2019 (COVID-19) has been marked by a heterogeneous clinical presentation that runs the gamut from asymptomatic to severe and fatal. Although less lethal in children than adults, COVID-19 has nonetheless afflicted the pediatric population. This systematic review used clinical information from published literature to assess the spectrum of COVID-19 presentation in children, with special emphasis on characteristics associated with multisystem inflammatory syndrome (MIS-C). An electronic literature search for English and Chinese language articles in COVIDSeer, MEDLINE, and PubMed from 1 January 2020 through 1 March 2021 returned 579 records, of which 54 were included for full evaluation. Out of the total 4811 patients, 543 (11.29%) exhibited MIS-C. The most common symptoms across all children were fever and sore throat. Children presenting with MIS-C were less likely to exhibit sore throat and respiratory symptoms (i.e., cough, shortness of breath) compared to children without MIS-C. Inflammatory (e.g., rash, fever, and weakness) and gastrointestinal (e.g., nausea/vomiting and diarrhea) symptoms were present to a greater extent in children with both COVID-19 and MIS-C, suggesting that children testing positive for COVID-19 and exhibiting such symptoms should be evaluated for MIS-C. Full article

This study assessed spatial and temporal variations of water quality to identify and quantify possible pollution sources affecting the Yeongsan River using multivariate statistical techniques (MSTs) and water quality index (WQI) values. A 15 year dataset of 11 water quality variables was used, covering 16 monitoring sites. The nutrient regime, organic matter, suspended solids, ionic contents, algal growth, and total coliform bacteria (TCB) were affected by the summer monsoon and the construction of weirs. Regression analysis showed that the algal growth was more highly regulated by total phosphorus (TP; R² = 0.37) than total nitrogen (TN, R² = 0.25) and TN/TP (R² = 0.01) ratios in the river after weir construction and indicated that the river is a P-limited system. After constructing the weirs, the mean TN/TP ratio in the river was about 40, meaning it is a P-limited system. Cluster analysis was used to classify the sampling sites into highly, moderately, and less polluted sites based on water quality features. Stepwise discriminant analysis showed that pH, dissolved oxygen (DO), TN, biological oxygen demand (BOD), chemical oxygen demand (COD), chlorophyll-a (CHL-a), and TCB are the spatially discriminating parameters, while pH, water temperature, DO, electrical conductivity, total suspended solids, and COD are the most significant for discriminating among the three seasons. The Pearson network analysis showed that nutrients flow with organic matter in the river, while CHL-a showed the highest correlation with COD (r = 0.85), followed by TP (r = 0.49) and TN (r = 0.49). Average WQI values ranged from 55 to 141, indicating poor to unsuitable water quality in the river. The Mann–Kendall test showed increasing trends in COD and CHL-a but decreasing trends for TP, TN, and BOD due to impoundment effects. The principal component analysis combined with factor analysis and positive matrix factorization (PMF) showed that two sewage treatment plants, agricultural activities, and livestock farming adversely impacted river water quality. The PMF model returned greater R² values for BOD (0.92), COD (0.87), TP (0.93), TN (0.91), CHL-a (0.93), and TCB (0.83), indicating reliable apportionment results. Our results suggest that MSTs and WQI can be effectively used for the simple interpretation of large-scale datasets to determine pollution sources and their spatiotemporal variations. The outcomes of our study may aid policymakers in managing the Yeongsan River. Full article

Objective: This study intended to construct a scale measuring the catharsis effect on medical professionals or students through illness narratives (ECS-IN). Methods: After a systematic literature review and panel discussion, the researchers conducted a pilot study with a sample of seven hundred and eighty-two randomly selected healthcare students and providers in Taiwan to examine psychometric properties using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for item derivation and factor extraction. The researchers also tested the validities and reliabilities of the ECS-IN scale to confirm its feasibility. Results: the EFA yielded 29 items and three factors: “emotional identification as self-healing” (12 items; 55.500% of variance explained), “emotional release for compensation” (10 items; 7.465% of variance explained), and “emotional adjustment for intellectual growth” (7 items; 4.839% of variance explained). The CFA yielded an 18-item, three-factor model with satisfactory fit to the data, where the χ²/df ratio = 1.090, Tucker–Lewis index (TLI) = 0.996, comparative fit index (CFI) = 0.997, and root mean square of approximation (RMSEA) = 0.020. The convergent validity and discriminant validities also demonstrated the feasibility of the ECS-IN scale. For the first version of the ECS-IN scale (29 items), the Cronbach’s alphas for the three factors and the overall scale were in the range between 0.912 and 0.971; for the reduced version of the scale (18 items), the Cronbach’s alphas and composite reliabilities were in the range of 0.888–0.946 and 0.890–0.968. Conclusion: The findings proved that the ECS-IN could be a reliable and valid instrument to assess participants’ emotional catharsis through illness narratives. Full article

Physical risk assessments allow us to understand work-related critical issues, thus representing a useful tool in risk management strategies. In particular, our study focuses on the identification of already known and emerging physical risks related to necropsy and morgue activities, as well as crime scene investigations. The aim of our study is, therefore, to identify objective elements in order to quantify exposure to such risk factors among healthcare professionals and working personnel. For the research of potentially at-risk activities, data from the Morgue of Policlinico Umberto I Hospital in Rome were used. The scientific literature has been reviewed in order to assess the risks associated with morgue activity. Measurements were performed on previously scheduled days, in collaboration with the activities of different research units. The identified areas of risk were: microclimate; exposure to noise and vibrations; postural and biomechanical aspects of necropsy activities. The obtained results make it possible to detect interindividual variability in exposure to many of the aforementioned risk factors. In particular, the assessment of microclimate did not show significant results. On the contrary, exposure to vibrations and biomechanical aspects of load handling have shown potential risk profiles. For this reason, both profiles have been identified as possible action targets for risk management strategies. Full article

A proper estimation of anti-epidemic measures related to the influence of the COVID-19 outbreak on air quality has to deal with filtering out the weather influence on pollution concentrations. The goal of this study was to estimate the effect of anti-epidemic measures at three pollution monitoring stations in the Ostrava region. Meteorological data were clustered into groups with a similar weather pattern, and pollution data were divided into subsets according to weather patterns. Then each subset was evaluated separately. Our estimates showed a 4.1–5.7% decrease in NO_x concentrations attributed to lower traffic intensity during the lockdown. The decrease of PM_2.5 varied more significantly between monitoring stations. The highest decrease (4.7%) was detected at the traffic monitoring station, while there was no decrease detected at the rural monitoring station, which focuses mainly on domestic heating pollution. The key result of the study was the development of an analytical method that is able to take into account the effect of meteorological conditions. The method is much simpler and easy to replicate as an alternative to other published methods. Full article

We conducted environmental surveillance of antimicrobial resistance (AMR) bacteria in the Msimbazi river basin in Tanzania to determine the occurrence of extended-spectrum β-lactamase (ESBL)-producing, carbapenem resistant Enterobacteriaceae (CRE) and quinolone resistant Escherichia coli and Klebsiella spp. A total of 213 Enterobacteriaceae isolates were recovered from 219 samples. Out of the recovered isolates, 45.5% (n = 97) were Klebsiella pneumoniae and 29.6% (n = 63) were Escherichia coli. K. pneumoniae isolates were more resistant in effluent (27.9%) compared to the E. coli (26.6%). The E. coli had a higher resistance in river water, sediment and crop soil than the K. pneumoniae (35 versus 25%), respectively. Higher resistance in K. pneumoniae was found in nalidixic acid (54.6%) and ciprofloxacin (33.3%) while the E. coli isolates were highly resistant to ciprofloxacin (39.7%) and trimethoprim/sulfamethoxazole (38%). Resistance increased from 28.3% in Kisarawe, where the river originates, to 59.9% in Jangwani (the middle section) and 66.7% in Upanga West, where the river enters the Indian Ocean. Out of 160 E. coli and K. pneumoniae isolates, 53.2% (n = 85) were resistant to more than three classes of the antibiotic tested, occurrence being higher among ESBL producers, quinolone resistant and carbapenem resistant strains. There is an urgent need to curb environmental contamination with antimicrobial agents in the Msimbazi Basin. Full article

A renewed interest in the study of character and virtue has recently emerged in the fields of Education and Psychology. The latest research has confirmed the association between virtuous consistent behaviours and academic positive outcomes. However, the motivational dimension of character (the intentions underlying the patterns of observed behaviours) has received little attention. This research aims to extend the knowledge on this topic by examining the predictive relationships between the behavioural and motivational dimensions of character, with reference to academic engagement, career self-doubt and performance of Spanish university students. A total of 183 undergraduates aged 18–30 (142 of whom were women) from the north of Spain completed specific parts of self-report questionnaires, including the Values in Action VIA-72, a Spanish translated and validated version of the Moral Self-Relevance Measure MSR, and the Utrecht Work Engagement Student Scale UWES-S9. The collected data were analysed using Structural Equation Modelling. The behavioural dimension of character (character strength factors of caring, self-control and inquisitiveness) showed positive associations with academic engagement and performance. The motivational dimension of character (phronesis motivation), was negatively related to career self-doubt. For the first time, the present study has provided support for the contribution of both dimensions of character to undergraduate academic outcomes. Full article

Athletes have higher thoracic and lumbar curvature in standing than the reference values of the non-athletic population. The sagittal integral morphotype method (SIM) assessment has not previously been applied to competitive amateur athletes (CAA). The propose of the present study was to determine the SIM of CAA treated at a sports-medicine center and to identify spinal misalignments associated with recurrent low back pain (LBP). An observational analysis was developed to describe the SIM in 94 CAA. The thoracic and lumbar curvatures of the CAA were measured in standing, sitting, and trunk forward flexion. Association analysis (Pearson’s chi-square and Cramér’s V tests) was then performed to identify the SIM misalignments associated with LBP. Effect size was analyzed based on Hedges’ g. The most common thoracic SIMs in CAA were total hyperkyphosis (male = 59.02%; female = 42.42%) and static hyperkyphosis (male = 11.48%; female = 6.06%). Hyperlordotic attitude (female = 30.30%; male = 4.92%), static-functional hyperkyphosis (male = 16.39%; female = 3.03%), and structured hyperlordosis (female = 21.21%; male = 1.64%) were the most common lumbar SIMs. Hyperlordotic attitude, static functional lumbar hyperkyphosis, and structured hyperlordosis were associated with LBP in male and female athletes. Full article

Stigma is a negative feeling affecting many patients with various health conditions, especially the contagious ones such as COVID-19. The Explanatory Model Interview Catalogue (EMIC) is one of the valid and reliable stigma-measuring tools; however, it has not been translated and validated in Arabic. Therefore, the aim of this study was to translate and validate the EMIC in Arabic among a sample of Arabic-speaking adults who recently recovered from COVID-19 in Saudi Arabia. The 12 items of the EMIC scale were forward- and backward-translated and reviewed by all authors to check the face and content validity prior to approving the final version of the Arabic 12-item EMIC. A total of 174 participants aged ≥18 years who contracted COVID-19 and recovered as of 29 July 2020 were interviewed. The Cronbach’s alpha of the Arabic version of the 12-item EMIC was 0.79, indicating an acceptable level of internal consistency. Using principal component analysis with varimax rotation, two factors explained more than 60% of the variance of the translated EMIC scale. The mean EMIC score was 5.91, implying a low level of stigma among participants. Married participants (β = 2.93; 95%CI 0.88 to 4.98, p = 0.005) and those with a family history of mental illness (β = 2.38; 95%CI 0.29 to 4.46, p = 0.025) were more likely to have higher EMIC scores in comparison to their counterparts who were unmarried and had no family history of mental illness. On the contrary, older adults were less likely to have high EMIC scores (β = −0.11; 95%CI −0.21 to −0.01, p = 0.03). Future studies with larger samples of patients with COVID-19 and various health conditions should be conducted to examine the validity and reliability of the Arabic version of the EMIC among different patient populations and to unveil the factors that may play a role in patients’ feelings of stigmatization in this part of the world. Full article

Background: One of the consequences of COVID-19 has been the cancelation of collegiate sporting events. We explore the impact of sports on COVID-19 transmission on a college campus. Methods: Using a compartmental model representing the university, we model the impact of influxes of 10,000 visitors attending events and ancillary activities (dining out, visiting family, shopping, etc.) on 20,000 students. We vary the extent visitors interact with the campus, the number of infectious visitors, and the extent to which the campus has controlled COVID-19 absent events. We also conduct a global sensitivity analysis. Results: Events caused an increase in the number of cases ranging from a 25% increase when the campus already had an uncontrolled COVID-19 outbreak and visitors had a low prevalence of COVID-19 and mixed lightly with the campus community to an 822% increase where the campus had controlled their COVID-19 outbreak and visitors had both a high prevalence of COVID-19 and mixed heavily with the campus community. The model was insensitive to parameter uncertainty, save for the duration a symptomatic individual was infectious. Conclusion: Sporting events represent a threat to the health of the campus community. This is the case even in circumstances where COVID-19 seems controlled both on-campus and among the general population. Full article

This paper examines the spatial and temporal trends in county-level COVID-19 cases and fatalities in the United States during the first year of the pandemic (January 2020–January 2021). Statistical and geospatial analyses highlight greater impacts in the Great Plains, Southwestern and Southern regions based on cases and fatalities per 100,000 population. Significant case and fatality spatial clusters were most prevalent between November 2020 and January 2021. Distinct urban–rural differences in COVID-19 experiences uncovered higher rural cases and fatalities per 100,000 population and fewer government mitigation actions enacted in rural counties. High levels of social vulnerability and the absence of mitigation policies were significantly associated with higher fatalities, while existing community resilience had more influential spatial explanatory power. Using differences in percentage unemployment changes between 2019 and 2020 as a proxy for pre-emergent recovery revealed urban counties were hit harder in the early months of the pandemic, corresponding with imposed government mitigation policies. This longitudinal, place-based study confirms some early urban–rural patterns initially observed in the pandemic, as well as the disparate COVID-19 experiences among socially vulnerable populations. The results are critical in identifying geographic disparities in COVID-19 exposures and outcomes and providing the evidentiary basis for targeting pandemic recovery. Full article

Misuse and overuse of antibiotics are potential causes of the increasing prevalence of antibiotic resistance (ABR). Having information about the knowledge, attitude, and practices concerning antibiotics use by the public might help control ABR growth. Therefore, this cross-sectional study aimed to investigate the levels and associated factors of knowledge, attitude, and practice (KAP) of antibiotics use among the public. A questionnaire was designed and validated, which consisted of a total of 51 questions with four sections: demographics (6), knowledge (20), attitude (12), and practice (13) to measure KAP. Univariate analysis (using Mann–Whitney U and Kruskal–Wallis analysis) was applied to assess the differences in the mean scores of KAP. Linear regression analysis was performed to identify factors associated with KAP. Finally, using Spearman analysis we have examined the correlation between responses to the KAP. The sample size of this study was 575, with a 99.96% response rate. Regarding knowledge, 73.12% of respondents stated that antibiotics could be used to treat viral infections, and 63.35% of respondents answered that antibiotics could reduce fever. Concerning attitude, 50% of respondents had considered stopping taking antibiotics as soon as symptoms had disappeared. In analyzing practice, we found 40% of respondents obtained antibiotics from a pharmacy without a prescription from a physician, a nurse, or a midwife. Statistical analysis revealed that KAP about antibiotic use was significantly associated with gender, area of residence, level of education, and monthly income (p < 0.05). Our findings concluded that men, respondents with low income, those with low-level education, and those living in rural areas are more prone to excessive use of antibiotics without knowing the adverse effects of improper use and how it can contribute to high ABR. So it is urgently necessary to strengthen policies on antibiotics use, including drug provision, distribution, and sales. In addition, people with low KAP should be a priority consideration in education outreach initiatives. Full article