Antimicrobial resistance in Nigeria’s healthcare system: a comprehensive narrative review and policy implications
James Esther, B Ogbonna, Onwuchuluba Ebele Eugenia, Ogbonna Chigozie Ann, Nwaodu Mercy Adamma, Ibeneme Georgian Chiaka, Folaranmi Omowumi, Sunday Odunke Nduka, Folaranmi Nkeiruka, Umeh Ifeoma Blessing
Abstract
Antimicrobial resistance (AMR) is a critical challenge to public health within the healthcare system globally and in Nigeria. It is one of the leading causes of morbidity, mortality, and emergency room visits in the 21st century. This review summarizes the current body of evidence regarding the prevalence, determinants, and interventions for AMR in Nigeria. We conducted a narrative review of the literature to generate information for patient care and policy. We utilized PubMed and Google Scholar, in addition to official reports from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), the Ministry of Health of Nigeria, and published articles from recorganized health research institutes which gave rise to a total of eight sources. This was carried out by two reviewers independently. Data were summarized using tables and descriptive statistics. The review found high AMR rates in Nigeria, with 67.8% MRSA resistance in tertiary hospitals and 28.6% Carbapenem resistance in Enterobacterales. Major drivers include widespread antibiotic misuse (72.4% of pharmacies sell without prescriptions), poor health infrastructure (only 23.4% of secondary facilities have microbiology labs), low public awareness (23.8%), and heavy antibiotic use in agriculture (87.4% of poultry farms). AMR costs 2.4% of Nigeria’s GDP, with resistant infections costing 287% more to treat. Despite launching a National Action Plan in 2017, only 45% of the activities were implemented by 2021 due to funding constraints and competing health priorities. AMR is widespread in Nigeria due to poor public awareness, irrational antibiotic use, and improper disposal in both human and agricultural sectors. This has led to high treatment costs and health risks. Addressing AMR requires strengthened regulations, better healthcare infrastructure, improved surveillance, public education, and reforms in agricultural practices.