A Survey of rational antibiotic use and public knowledge of antibiotic resistance among rural communities of North Central region of Nigeria

Antimicrobial resistance (AMR) is a growing global public health threat that undermines the effective treatment of infectious diseases and increases morbidity, mortality, and healthcare costs. Low- and middle-income countries bear a disproportionate share of the AMR burden, with limited surveillance data and gaps in antimicrobial stewardship practices. Nigeria is among the countries with significant AMR-related mortality, yet facility-level data on antibiotic consumption and prescribing patterns remain limited. This study assessed antibiotic utilization patterns and antimicrobial stewardship practices in secondary healthcare facilities in North Central Nigeria. Using a mixed-method cross-sectional design, the study evaluated antibiotic consumption among hospitalized patients and outpatients, prescribing practices, and the utilization of antimicrobial susceptibility testing (AST) in clinical decision-making. Data were collected between December 2023 and December 2024 across seven secondary healthcare facilities using multiple complementary approaches, including patient folder audits, point prevalence surveys of antimicrobial prescribing, review of microbiology laboratory records for culture and susceptibility testing, and interviews with healthcare workers. The study identified important stewardship gaps, including high levels of empirical antibiotic prescribing, suboptimal utilization of WHO-recommended Access antibiotics, limited use of diagnostic testing to guide treatment, and the absence of facility-level antibiograms. These findings highlight critical opportunities to strengthen antimicrobial stewardship through improved diagnostic capacity, data-driven prescribing, and implementation of stewardship programs in secondary healthcare facilities. This work contributes evidence to inform antimicrobial stewardship policy and interventions aimed at optimizing antibiotic use and slowing the emergence of antimicrobial resistance in Nigeria.