Knowledge and perceptions of community members on antimicrobial use and resistance in Cross River State, Nigeria

Nigeria faces a high burden of antimicrobial resistance (AMR), with an estimated 263,400 associated deaths in 2019. Despite this, public awareness and responsible antimicrobial practices remain suboptimal. This study assessed the knowledge and perceptions of community members in Cross River State (CRS), Nigeria, regarding antimicrobial use and resistance, to inform policy and intervention strategies. A cross-sectional study was conducted across seven local government areas in CRS from November 2023 to January 2024. An electronically administered questionnaire collected data on antibiotic use, knowledge of side effects, and AMR perceptions. Descriptive and inferential statistics were performed using SPSS version 23. Of the 483 respondents, 73.1% had used antibiotics, and 40.9% had done so 2–5 times in the past year. While 65.0% demonstrated good knowledge of AMR-recognizing appropriate antibiotic types and risks, misconceptions persisted. These included the perception that antibiotics are effective against colds (60.2%) and could be safely discontinued once one was feeling better (51.7%). A majority (58.8%) showed positive perceptions toward AMR prevention, though 71.0% endorsed saving or sharing leftover antibiotics. Employment status was significantly associated with both knowledge (p = 0.001) and perceptions (p < 0.001), while lower education levels were significantly linked to more negative perceptions (p < 0.001). Community members in CRS possess modest knowledge and trust healthcare providers, but misconceptions and informal antibiotic use practices exist. Targeted education and regulatory enforcement, integrated within a One Health framework, are essential for mitigating AMR and fostering sustainable behavior change in CRS and similar contexts.