Empowering Women, Elevating Health: A Community-Centered One Health Approach to Combat AMR in Malaysia

By Dr. Liyana Azmi and Team

Editor: Anti Rismayanti, SEAOHUN Regional Program Manager

Under the SEAOHUN One Health Research and Training (OHRT) Awards Program, our team embarked on a transformative journey to address one of the world’s most pressing health challenges—antimicrobial resistance (AMR). Our project, "Empowerment of Housewives as Antimicrobial Resistance Guardians through Community-Based Participatory Research," was rooted in a simple but powerful premise: empowering women—particularly housewives—can ignite meaningful, sustainable change in community health practices. Set in the coastal district of Kuala Nerus in Terengganu, Malaysia, the initiative used a participatory approach to translate One Health concepts into accessible, culturally resonant knowledge that resonates with those who make daily health decisions at home.

Implementation Experience: When Science Meets Culture

From the outset, we knew that data alone wouldn’t shift behaviors—we needed trust, context, and collaboration. The project began with a baseline assessment using KAP (Knowledge, Attitudes, and Practices) surveys distributed among housewives. Results highlighted widespread misconceptions about antibiotic use, including the belief that antibiotics could treat viral infections and that sharing prescriptions within families was harmless.

To bridge these gaps, we co-developed a training module with the community, informed by focus group discussions and feedback from mosque leaders and local women’s societies. Our AMR Awareness Day, complemented by medical check-ups and interactive booths, became more than an educational event—it became a celebration of community, inclusion, and shared responsibility.

Significantly, we conducted these engagements with a deep sensitivity to local customs. No music was played in mosque-based events, and prayer times were carefully respected. Students and team members fluent in the Terengganu dialect acted as cultural liaisons, ensuring every message landed with empathy and clarity.

A Living Laboratory for One Health Learning

This project didn’t just benefit the community—it served as a living classroom for medical students and young professionals. Through training workshops and real-life outreach, students developed not only a clearer understanding of AMR but also vital soft skills. They learned to adapt their messaging, communicate with older adults, and deliver content in a relatable, culturally appropriate manner.

For instance, one student who had represented Malaysia at the World Health Assembly in Geneva expressed how this grassroots experience offered insights that global forums could not—namely, the complex human dynamics behind health behaviors. Post-training evaluations revealed a boost in student confidence, communication skills, and critical thinking—all essential competencies for One Health champions.

Strengthening Education and Institutional Synergies

As educators, we found ourselves reinvigorated by this field experience. The modules we co-created with the community are now being integrated into coursework, enhancing our One Health curriculum with real-world relevance. Meanwhile, partnerships with institutions like Universiti Malaysia Terengganu and Majlis Belia Malaysia have expanded our reach, offering valuable interdisciplinary perspectives on health, environment, and gender.

Notably, the mosque’s existing TikTok platform emerged as an unconventional but promising channel for public health education. Recognizing that many women relied on TikTok for health information, we are now exploring ways to co-create videos in collaboration with students and the mosque community—transforming social media into a tool for responsible antibiotic messaging.

Navigating Challenges with Flexibility and Trust

The journey wasn’t without obstacles. Seasonal monsoon rains delayed some sessions, and limited project disbursements early on required team members to front initial costs. But we adapted. When flooding disrupted plans, indoor venues and flexible timelines kept us on track. When questionnaire response rates lagged, we engaged a well-respected female leader to distribute surveys—and participation soared.

The key lesson? Relationships matter. Our existing rapport with the community, especially the chief mosque leader and local women’s groups, was the backbone of our success. Trust enabled open conversations, especially around sensitive topics like medication use, privacy, and family health practices.

Lasting Impact and Future Directions

While the project has officially concluded, its momentum continues. Educational posters remain in community mosques, serving as constant visual reminders about AMR. More importantly, the women who participated have become informal ambassadors, spreading knowledge within their networks.

Looking ahead, we plan to formalize our partnerships, develop more digital content tailored for community platforms, and secure new funding to replicate the model in other regions. We also aim to expand our outreach to include youth and male caregivers, ensuring that AMR stewardship becomes a shared family responsibility.

At an international level, the recognition of our project by the ICID 2024 Ubuntu Community Village signals that this localized initiative holds global relevance. We hope to present our learnings on that platform, inspiring other countries to invest in community-led, culturally grounded One Health efforts.

Reflections and Lessons for the Field

Our work reinforces a core principle of One Health: sustainable change starts with the people most embedded in daily care systems. Empowering women—who cook the meals, care for the sick, and influence family decisions—has a ripple effect that no policy alone can achieve. We also learned that success isn’t just about what we teach; it’s about how we listen. By creating safe, small-group environments like our focus group discussions, women felt heard, respected, and valued. This emotional safety translated into openness, trust, and behavior change.

Finally, the experience has emphasized the need for continuous engagement. Health behavior change doesn’t happen overnight. We envision periodic check-ins, refresher workshops, and a growing network of trained local advocates who can sustain the work long after funding cycles end.

Conclusion

This project has reaffirmed our belief that the best public health strategies begin with community voices. Through the SEAOHUN OHRT Awards Program, we didn't just implement an intervention—we built a movement grounded in empathy, cultural respect, and collective learning. The true reward has been watching housewives transform into guardians of their families’ health and seeing students evolve into holistic, culturally conscious public health leaders.

With continued support, collaboration, and creativity, this model holds the potential to reshape how we address AMR—not just in Terengganu, but across Southeast Asia and beyond.

Team Leader: Dr. Liyana Azmi – Universiti Sains Islam Malaysia

Team Members:

• Associate Professor Dr. Nuruliza Roslan – Islamic Science Institute, USIM

• Mr. Ahmad Yussof Zainal Abidin – Islamic Science Institute, USIM

• Associate Professor Dr. Siti Nor Khadijah Addis – Universiti Malaysia Terengganu

• Associate Professor Dr. Nurul Azmawati Mohamed – Faculty of Medicine and Health Sciences

• Ustaz Muhammad Muzzammil Bin Mokhetar – Director, Ummah Relief Project