Empowering communities against AMR: Evaluating the one health-based antibiotic-wise village (SAJAKA) in Bali, Indonesia

Antimicrobial resistance (AMR) is a critical global health issue, especially in low-resource settings. A One Health-based community engagement approach, such as the Antibiotic-Wise Village (SAJAKA) model, offers a potential solution. This study assessed SAJAKA’s implementation in four Bali villages, evaluating its impact on knowledge and antibiotic use behavior. The intervention included workshops, school programs, poultry feed/water analysis, and medical audits. Using a pre-test/post-test design, 769 participants including household mothers, schoolchildren, farmers, healthcare workers were surveyed. Results showed significant knowledge improvements, particularly among farmers (30.69%) and household mothers (26.65%). Behaviorally, household antibiotic storage declined (3.39%), and addition antibiotics in poultry feed were eliminated. However, irrational prescribing by healthcare workers persisted. Water tests revealed faecal contamination but no resistant E. coli to third-generation cephalosporins was detected. Of the four villages, Buwit achieved ‘Antibiotic-Wise Village’ status (score = 7). The SAJAKA model successfully boosted AMR awareness and promoted responsible antibiotic use. To expand impact, healthcare workers engagement and sustained community efforts are crucial for AMR containment.