Knowledge, Attitudes, and Practices Regarding Antibiotic Use and Resistance Among University Students in Mogadishu: A Comparative Cross‐Sectional Study

ABSTRACT Background and Aim Antibiotic resistance is one of the greatest health threats in the world, particularly in Somalia, where the healthcare system is weak and information on antibiotic misuse is limited. University students are a crucial demographic, as they have the potential to influence future community behaviors through their knowledge, attitudes, and practices. Therefore, this study aimed to assess the knowledge, attitudes, and practices related to antibiotic use and resistance among students in Mogadishu, Somalia. Methods A comparative cross‐sectional study was conducted among 321 undergraduate students at Mogadishu University using a stratified random sampling method from November 29 to December 17, 2025. Data were collected using a structured self‐administered questionnaire, with a 60% cutoff for classification of scores. Analysis was performed using SPSS version 26, which included descriptive statistics, t‐tests after confirming normality using the Shapiro‐Wilk test ( p  > 0.05 for all domains), and Spearman correlation analyses, with significance set at p  < 0.05. Effect sizes (Cohen's d) and 95% confidence intervals were calculated for mean differences. Results Only 38.6% of all students had adequate knowledge, 24.9% held favorable attitudes, and 35.2% reported good practices. Health sciences students were significantly more likely than non‐health sciences students to have adequate knowledge (65.7% vs. 18.5%, p  < 0.001), favorable attitudes (47.4% vs. 8.2%, p  < 0.001), and good practices (57.7% vs. 18.5%, p  < 0.001). Female gender ( p  < 0.001 for all domains), upper academic year ( p  < 0.001 for knowledge; p  = 0.001 for attitude; p  = 0.004 for practice), and prior antibiotic training ( p  < 0.001 for knowledge; p  = 0.010 for attitude; p  = 0.005 for practice) were also significantly associated with higher KAP scores. Conclusion There is a concerning lack of KAP regarding antibiotic use, especially among non‐health sciences students, indicating an urgent need for comprehensive antibiotic stewardship training across all university disciplines to combat antibiotic resistance.