Health literacy and antibiotic misuse among communities in Gondar City, Northwest Ethiopia: implications for antimicrobial resistance control

Background Antimicrobial resistance (AMR) is a growing global health threat largely driven by inappropriate antibiotic use. Evidence on the relationship between health literacy and AMR awareness at the community level in Ethiopia remains limited. Objectives This study aimed to assess the level of health literacy and examine its association with knowledge of antibiotics and awareness of antimicrobial resistance (AMR) among adults in Gondar City, Northwest Ethiopia. Methods A community-based cross-sectional study was conducted among 390 adults with prior antibiotic use in Gondar City from February 1 to April 1, 2025. Data were collected using a structured questionnaire adapted from the World Health Organization Antimicrobial Resistance Multi-Country Public Awareness Survey and the European Health Literacy Survey short questionnaire (HLS-EU-Q16). Descriptive statistics summarized participant characteristics and awareness levels, and logistic regression identified factors associated with AMR awareness. Results Among respondents, 48.7% had sufficient health literacy, while 23.1% and 28.2% had problematic and inadequate health literacy, respectively. Overall, 54.4% demonstrated adequate awareness of AMR. Regarding antibiotic practices, 52.8% obtained antibiotics from pharmacies and 49.7% discontinued treatment once symptoms improved. Participants aged 46–55 years (AOR = 2.34, 95% CI: 1.22–4.48), those with college or higher education (AOR = 2.61, 95% CI: 1.32–5.15), and individuals with monthly income >10,000 ETB (AOR = 4.82, 95% CI: 2.19–10.61) were more likely to have adequate awareness. Participants with sufficient health literacy were significantly more likely to demonstrate adequate AMR awareness (AOR = 6.12, 95% CI: 3.29–11.37). Conclusion AMR awareness remains limited among adults in Gondar City. Improving community health literacy may play a crucial role in promoting responsible antibiotic use and mitigating antimicrobial resistance in Ethiopia.