Sefako Makgatho Health Sciences University (SMU) is advancing research into antimicrobial resistance through the doctoral work of Dr Nishana Ramdas, who graduated with a PhD in Pharmacy at the university’s 2026 Spring Graduation Ceremony. Her doctoral research addresses a critical public health challenge by examining the behavioural factors that influence antibiotic use among patients in South Africa’s primary healthcare system.
Titled Development and Validation of a Community Anti-Microbial Use Scale (CAMUS) for Use at Primary Health Care Level in South Africa, the research developed and validated a tool to help identify misconceptions, social influences and behavioural patterns associated with inappropriate antibiotic use.
Antimicrobial resistance (AMR) occurs when microorganisms develop the ability to resist medicines designed to treat infections. Inappropriate antibiotic use contributes to this growing global threat, making responsible medicine use and effective antimicrobial stewardship essential to protecting public health.
Dr Ramdas’s research involved a sequential mixed-methods approach, including a scoping review, instrument development, pilot testing and psychometric validation. The study surveyed 1,283 adult patients across 25 public healthcare facilities in Gauteng and Limpopo.
The findings revealed significant misconceptions about antibiotics. More than three-quarters of participants (76.5%) believed antibiotics could cure colds and flu, while 22.8% reported obtaining antibiotics without a prescription. Among those reporting non-prescribed use, community pharmacies were the primary source, accounting for 81.7%.
The research also found that non-prescribed antibiotic use was significantly associated with inadequate health literacy, misconceptions about antibiotics and permissive social and behavioural norms. Non-prescribed use was more prevalent in high-density peri-urban township settlements (36.3%) than in rural areas (16%).
These findings highlight that inappropriate antibiotic use extends beyond gaps in knowledge and is also influenced by social practices, health literacy and community expectations.
The 30-item CAMUS instrument measures five domains: understanding of antibiotics; social and behavioural norms; non-prescribed use and community practices; understanding of antimicrobial resistance; and attitudes and beliefs influencing patient demand for antibiotics. The validated tool offers a structured approach to identifying factors that may inform targeted, patient-centred antimicrobial stewardship interventions.
Dr Ramdas’s achievement builds on an extensive career in pharmacy, public health and pharmaceutical services. She continues to support the National Department of Health (NDoH) in the coordination and implementation of the national Central Chronic Medicine Dispensing and Distribution (CCMDD) programme, which aims to improve access to chronic medicines for patients in South Africa. Her professional experience also includes pharmaceutical systems strengthening and healthcare workforce training.
In addition to her ongoing work supporting the national CCMDD programme, Dr Ramdas was appointed as an extraordinary lecturer in the Department of Pharmacology at the University of Pretoria in 2026. She also contributes to postgraduate research co-supervision, curriculum development and university teaching.
Her doctoral research has contributed to five first-author publications in international peer-reviewed scientific journals, covering community antibiotic use, behavioural influences and the development and validation of CAMUS. These contributions support evidence-based approaches to strengthening antimicrobial stewardship and improving appropriate antibiotic use.
The study recommends moving beyond awareness campaigns towards community-based interventions that address health literacy and social influences. It also highlights opportunities to improve communication between healthcare professionals and patients, strengthen oversight of access to non-prescribed antibiotics, and integrate CAMUS into national surveillance strategies.
Through Dr Ramdas’s doctoral achievement, SMU reinforces its commitment to innovative research, professional training and evidence-based solutions to public health challenges. The work shows how research in South Africa’s health sciences sector can inform interventions to improve patient care and address antimicrobial resistance.
By Tumelo Moila
