Antibiotic Non-Adherence and Associated Factors Among Household Members in Kolfe Keraniyo and Nifas Silk Lafto Subcities, Addis Ababa, Ethiopia: A Community-Based Cross-Sectional Study, Addis Ababa, Ethiopia, 2025

Background: Antimicrobial resistance, fueled in part by antibiotic non-adherence, is a critical global public health threat. Understanding the scale and drivers of non-adherence at the community level is essential for crafting effective interventions, particularly in low-and middle-income countries like Ethiopia. Objective: This study aimed to assess the prevalence of antibiotic non-adherence and identify its associated factors among household members in Kolfe Keraniyo and Nifas Silk Lafto subcities of Addis Ababa, Ethiopia. Methods: A community-based cross-sectional study was conducted from July to August 2025. A total of 507 households were selected using a multi-stage sampling technique. Data were collected through face-to-face interviews using a structured questionnaire that included the 8-item Morisky Medication Adherence Scale (MMAS-8). Bivariate and multivariable logistic regression analyses were employed to identify factors associated with antibiotic non-adherence. Results: The prevalence of antibiotic non-adherence was 79.5% (95% CI: 75.7-82.9). The most common reason for non-adherence was forgetting to take the medication (39.6%). In the multivariable analysis, lower educational status (AOR=0.003, 95% CI: 0.00-0.023 for college and above vs. illiterate), poor knowledge about antibiotics (AOR=2.43, 95% CI: 1.12-5.30), poor attitude towards antibiotic use (AOR=2.38, 95% CI: 1.20-4.72), experiencing medication discomfort (AOR=2.50, 95% CI: 1.27-4.92), and not receiving prescription information from a drug dispenser (AOR=2.59, 95% CI: 1.29-5.23) were statistically significant factors associated with antibiotic non-adherence. Conclusion and Recommendations: The study revealed an alarmingly high prevalence of antibiotic non-adherence in the community. Public health interventions should prioritize patient education, improve healthcare provider-patient communication, and strengthen antibiotic stewardship programs, with a special focus on individuals with lower educational attainment.