Submit your papersSubmit Now
For Enquiries: [email protected]
IIARD LogoIIARD
📄 Download Paper

Community-Level Determinants of Antibiotic Misuse and their Contribution to Antimicrobial Resistance in Nigeria: A Systematic Qualitative Review

Ntung, Yensen Florence

Abstract

Antimicrobial resistance represents a critical global public health threat, disproportionately affecting low- and middle-income countries. Nigeria, the most populous country in Africa, experiences high infectious disease prevalence alongside systemic weaknesses in pharmaceutical regulation, limited healthcare access, and informal drug distribution networks. While hospital-based studies have documented rising resistance among Gram-negative and Gram-positive bacteria, there is limited synthesis of community-level determinants driving antibiotic misuse. This systematic qualitative review synthesizes Nigerian studies published between 2005 and 2024 to identify socio-behavioral, economic, cultural, and structural drivers of antibiotic misuse and their contribution to AMR. Following PRISMA 2020 guidelines (Page et al., 2021), 55 studies were included from an initial 1,243 records. Thematic synthesis identified key drivers: self-medication without prescription, over-the-counter sales through community pharmacies and patent medicine vendors, incomplete dosage due to financial hardship, misconceptions regarding antibiotic efficacy, diagnostic uncertainty, rural-urban disparities in healthcare access, and weak regulatory enforcement. Findings demonstrate that AMR in Nigeria is socially embedded, with sub-therapeutic exposure and inappropriate antibiotic selection promoting resistant organisms such as extended-spectrum beta-lactamase-producing Escherichia coli, methicillin-resistant Staphylococcus aureus, and multidrug-resistant Salmonella species. Addressing AMR requires community-centered antimicrobial stewardship strategies, regulatory enforcement, health financing reform, and microbiological literacy interventions aligned with Nigeria’s National Action Plan on AMR.

Keywords

antimicrobial resistanceantibiotic misuseNigeriacommunity behaviorantimicrobial stewardshippatent medicine vendorsqualitative systematic review

References

Andersson, D. I., & Hughes, D. (2014). Microbiological effects of sublethal antibiotic levels. Nature Reviews Microbiology, 12(7), 465–478. Auta, A., et al. (2017). Global access to antibiotics without prescription in community pharmacies: A systematic review. Journal of Infection in Developing Countries, 11(3), 1–9. Auta, A., et al. (2018). Antibiotic sales in Nigerian pharmacies: Patterns, determinants, and implications. Antimicrobial Resistance & Infection Control, 7(1), 1–8. Brieger, W. R., et al. (2004). Patent medicine vendors in Nigeria: How can they contribute to malaria control? Health Policy and Planning, 19(2), 88–96. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. Critical Appraisal Skills Programme. (2018). CASP Qualitative Checklist. CASP UK. Murray, C. J., et al. (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. The Lancet, 399(10325), 629–655. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. NCDC. (2022). Nigeria National Action Plan for Antimicrobial Resistance 2017–2022. Nigeria Centre for Disease Control. Ocan, M., et al. (2015). Household antimicrobial self-medication: A systematic review and meta-analysis. BMC Public Health, 15(1), 1–10. Olayemi, O. J., et al. (2010). Self-medication practices in Nigeria: A survey of urban and rural households. African Journal of Pharmacy and Pharmacology, 4(10), 611–616. Okeke, I. N., et al. (2005). Antimicrobial resistance in developing countries. Lancet Infectious Diseases, 5(8), 481–493. Page, M. J., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. Rosenstock, I. M. (1974). Historical origins of the Health Belief Model. Health Education Monographs, 2(4), 328–335. Sapkota, A., et al. (2010). Self-medication with antibiotics in the developing world. Journal of Infection in Developing Countries, 4(4), 218–222. World Bank. (2022). World Development Indicators: Health expenditure, Nigeria. World Bank Group. World Health Organization. (2015). Global action plan on antimicrobial resistance. WHO Press.

More Articles from INTERNATIONAL JOURNAL OF HEALTH AND PHARMACEUTICAL RESEARCH

Influence of Health Information Data Quality on Decision-Making Among Healthcare Professionals in Tertiary Hospitals in Bayelsa State

Author: Lucky Ebiteinye Dogiye, Kalada Godson McFubara, Idawarifa Frank Cookey-Gam, Lucky Ebiteinye Dogiye

Spatial Proximity, Household Vulnerability and Health Effects of Informal Solid-Waste Disposal in Obio/Akpor Local Government Area, Rivers State

Author: Gospel Chimenma Dimkpa, Priscilia Nyekpunwo Ogbonda, Cookeygam Idawarifa, Frank, Sogbeye Tonye Geroge, Dominic Joshua Osondu, Bapakaye Ibifuro Kemmer, Corresponding Author

“Prevalence of Food and Water Borne Disease in Yelwa Bauchi”

Author: Garba Rukayya Abubakar, Maryam Idris Muhammad, Jamila Sulaiman Dauda dauda, Nusaiba Muhammad, Bature, Fatima Muhammad Gadauji, Najaatu Musa

Scheme and Execution of Health Care Monitoring System

Author: Professor Innime Righteous Thompson Salvation Chinezom

The Setbacks of Effectual Conversation Between Health Information Officers and Patients

Author: Professor Innime Righteous Thompson Salvation Chinezom