Regulatory barriers to antimicrobial resistance control in Nigeria: implications for stewardship and surveillance

Nigeria carries a disproportionate antimicrobial resistance (AMR) burden: national sentinel surveillance documents ESBL-producing Enterobacteriaceae in 60–80% of clinical isolates, MRSA prevalence exceeding 80%, and carbapenem-resistant Enterobacteriaceae at 20–30%. These are a reflection of a governance environment in which formal stewardship obligations are absent from statute and national AMR surveillance remains voluntary. This study identifies and critically analyses the legal and regulatory barriers to AMR control in Nigeria, and advances a structured, evidence-anchored reform framework grounded in One Health principles. An interdisciplinary design combined legal doctrinal analysis with a semi-systematic literature review. PubMed, Scopus, and African Journals Online (AJOL) were searched for publications from 2000 to 2024. Of 252 records identified, 57 met the inclusion criteria (34 peer-reviewed studies, 14 legal instruments or policy documents, and 9 international regulatory frameworks). Nigerian legislation was assessed using the Baldwin, Cave and Lodge regulatory compliance framework and benchmarked against the United Kingdom and South Africa. Five principal regulatory barriers were identified: unenforced prescription-only requirements that facilitate non-prescription antibiotic access; the absence of AMS legislation that removes accountability for irrational prescribing; inadequate veterinary antibiotic governance that sustains zoonotic resistance transmission; the absence of a statutory surveillance mandate that prevents detection of emerging resistance trends; and jurisdictional fragmentation that precludes coordinated stewardship responses. South Africa’s SAASP model demonstrates that structured stewardship governance is achievable under African resource constraints, producing 59.5% institutional compliance against Nigeria’s 13.5%. The TRACE Reform Framework is proposed as a practical roadmap for regulatory strengthening. Strengthening regulatory enforcement and integrating legal frameworks into national AMR strategies are essential for improving antibiotic stewardship and surveillance in Nigeria.