Prescription patterns and knowledge of rational antimicrobial use among primary healthcare workers in a humanitarian setting in Nigeria

Antimicrobial resistance (AMR) is a major global health threat, particularly in low- and middle-income countries such as Nigeria. Forced displacement may accelerate its spread. Due to a paucity of clinicians and nurses, task shifting had extended prescription rights to health extension workers. This study assessed antimicrobial prescription patterns and knowledge of AMR among primary healthcare workers in humanitarian settings. A cross-sectional survey was conducted among primary healthcare prescribers in 39 primary healthcare facilities in refugee-hosting communities using a structured digital questionnaire. The study was reviewed and approved by the Cross River State Health Research Ethics Committee and granted ethics number CRSMOH/HRP/REC/2024/488. Data were analysed with SPSS v29. Knowledge of AMR was assessed through 10 binary questions and categorized as poor (0–50%), moderate (51–70%), or good (71–100%). A total of 112 respondents participated, including 94(83.9%) females, with a mean age of 36.6 years (SD = 9.7). Participants comprised 50(44.6%) CHEWs, 34 (30.4%) nurses/midwives, 15 (13.4%) CHOs, and 13 (11.6%) JCHEWs. Only 36(32.1%) had AMR-related training in the past year. While 109(97.3%) correctly defined AMR and 102(91.1%) acknowledged its link to mortality, gaps remained. Thirty-four (30.4%) believed antibiotics treat viral infections, 19(17.0%) prescribed antibiotics for influenza, and 79(70.5%) co-prescribed them for malaria. Overall, 39 (34.8%) had poor knowledge, 39(34.8%) moderate, and 34(30.4%) good. Knowledge differed significantly by age (p= .017) and cadre (p= .018), with nurses/midwives and CHOs scoring higher. Commonly prescribed antibiotics were amoxicillin (12%), metronidazole (11%), ciprofloxacin (10%), and gentamicin (9%). Despite high awareness, irrational prescribing and knowledge gaps persist. Targeted training, revised standing orders, and strengthened antimicrobial stewardship at the PHC level are urgently needed to curb AMR in Nigeria.