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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

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