By Olanma (Solace) Okezie-Okafor, Sydani Institute for Research and Innovation

Introduction

Antimicrobials refer to a wide range of treatments and medicines that target bacteria (antibacterial), fungi (antifungal), viruses (antiviral), and parasites (antiparasitic), with certain antimicrobials being specific to the microbes they affect. For centuries, the discovery and development of antimicrobials have been key in reducing mortality rates due to infectious diseases.

Antimicrobial resistance, commonly referred to as AMR, is the phenomenon that occurs when organisms—specifically infectious agents—evolve to develop immunity or resistance to drugs that previously affected them.¹ The occurrence of AMR has recorded a sharp increase in recent years and has become a major public health concern worldwide, as it often results in prolonged ailments, increased healthcare costs, and 1.27 million direct deaths globally in 2019.²

Global Burden of AMR

In 2019, studies demonstrated an association between bacterial antimicrobial resistance and 4.95 million deaths, of which 1.27 million were directly attributed to bacterial AMR. Projections estimate there will be about 10 million deaths per year by 2050 if there is no intervention. ³ AMR as a public health concern has been championed on a global scale by the World Health Organization (WHO), which has led efforts to bring about global health security through initiatives like the Global Action Plan on AMR (2015) and annual World AMR Awareness Week campaigns. However, despite these initiatives, low- and middle-income countries (LMICs) such as Nigeria, bear a disproportionate impact of the AMR burden. LMICs experience an amplified prevalence of AMR due to factors such as their fragile health systems that hinder proper surveillance, high poverty which fuel self-medication, and elevated infection rates that often lead doctors to empirically prescribe broad spectrum antibiotics, all of which create ideal conditions for resistance development and spread.

EVIDENCE OF AMR SPREAD IN NIGERIA

Nigeria is confronted with AMR across the human health, agriculture and environmental sectors. In human health, the Nigeria Centre for Disease Control (NCDC) reported a 2024 typhoid outbreak with 50% fluoroquinolone resistance, underscoring the crisis and hospital surveillance reveals high MDR rates: 70-90% for third-generation cephalosporins in gram-negative infections. A 2025 review highlighted Nigeria’s healthcare system’s struggles, including high rates of multidrug-resistant (MDR) bacteria like Escherichia coli and Klebsiella pneumoniae in hospitals. ⁴ Studies report up to 80% resistance to common antibiotics like ciprofloxacin in urinary tract infections, fueling prolonged hospital stays and mortality. This matters because ciprofloxacin is a common first-line treatment for various infections in Nigeria due to its effectiveness as a broad-spectrum drug and affordability for the public. 6

A Cureus study noted rampant over-the-counter antibiotic sales without prescriptions, meaning everyday Nigerians can purchase antibiotics such as ciprofloxacin for viral colds or mild diarrhea, all of which directly contributes to community-acquired resistance, and makes common infections untreatable when they are genuinely needed.

In agriculture, poultry farmers in northwestern Nigeria show low AMR awareness, with 60% unaware of resistance risks from routine antibiotic use as growth promoters. ⁵

Hospital wastewater, across Nigeria act as reservoirs for antibiotic resistant bacteria (ARBs) and antibiotic-resistant genes (ARG’s) with systematic review of existing research documenting high prevalence of ARG’s in untreated effluents that are discharged into public water ways. This environmental transmission facilitates the dissemination of AMR in the environment. 7

NIGERIA’S CURRENT INITIATIVES

Nigeria has made strides through multi-sectoral efforts aligned with WHO’s Global Action Plan, these include:

The 2017 National Action Plan (NAP) on AMR: NAP coordinates surveillance via the NCDC’s National Reference Laboratory, which tracks resistance in priority pathogens like methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem resistant Enterobacterales.

Regulatory Measures: The National Agency for Food and Drug Administration and Control (NAFDAC) enforcement of prescription-only antibiotic sales in 2022 and bans on livestock growth promoter. ²

Awareness and Stewardship: WHO-supported campaigns target healthcare workers and farmers. Hospital antimicrobial stewardship programs (ASP) like in Lagos University Teaching Hospital (LUTH) reduced usage by 30% in their pilot program. This program was conducted from 2015-2018 and achieved results through pharmacist-led audits using the Global Point Prevalence System (PPS) methodology, feedback on ward-level prescription usage and guidelines prioritizing narrow-spectrum agents when needed. 8

Surveillance and Research: the Nigeria Antimicrobial Resistance Surveillance Network (NARMS), a national laboratory-based surveillance system works to track antimicrobial resistance patterns across human health in coordination with NCDC.

International Partnerships: funding from organizations like Fleming Fund and UK Aid have supported lab upgrades for improved diagnostics. ⁴ ⁵

Despite all this progress, there are still gaps that exist. ASP implementation makes up only about 23% in Nigeria, as opposed to 76% in countries like South Africa. NAFDAC staff coverage is still too little to fully monitor pharmaceutical health facilities across the country. Community pharmacists still sell over-the-counter antibiotics without prescription. 2 4 6

POLICY RECOMMENDATIONS TO BRIDGE IMPLEMENTATION GAPS

To strengthen these efforts, Nigeria needs targeted, feasible steps.

National ASP Mandate (scale LUTH model): There is need to scale the stewardship of antibiotics nationwide and mandate ASPs. Starting off with the 20 federal teaching hospitals in Nigeria with pharmacist-led audits targeting 20% antibiotic reduction using LUTH’s proven Global-PPS methodology. Recruit and train pharmacists nationwide to ensure smooth running of the antimicrobial stewardship program audits.

NAFDAC Enforcement and Access Reforms: There is also a need to enforce prescription laws in rural communities, NAFDAC can deploy mobile enforcement teams to high-risk pharmacy clusters as well as provide subsidies through the National Health Insurance Scheme (NHIS) for narrow-spectrum drugs in low-income areas.

One Health Farmer Training: scale AMR education to farmers in communities nationwide implementing radio jingles in native languages, market demonstrations, SMS alerts etc. to increase awareness of the effects improper antibiotic use in agriculture can cause in the environment and subsequently in human beings. NAFDAC also needs to strengthen efforts in surveillance to ensure at least 80% implementation of the formal ban on using antibiotics as growth promoters in agriculture by 2028 pending the policy revenue coming up in 2030

Statutory Budget Commitment: Allocate 1% of the health budget (₦23.8 billion assuming the 2025 allocated national health budget of ₦2.38 trillion as a baseline) annually to fund NAP2 surveillance, wastewater monitoring, and execution of AMR campaigns that are culturally aligned to communicate to individual target audiences across schools, markets and faith spaces. Leverage social media platforms and influencers for increased reach.

CONCLUSION

According to the WHO, Nigeria is at risk of a projected 4% drop in GDP by 2030 because of the economic toll of AMR. 10 Without addressing AMR, achieving global health targets will become increasingly difficult and double treatment costs, for an LMIC like Nigeria, this is not ideal. To win the war against AMR, we must scale up and execute what already works: LUTH’S success in ASP, NAP2 surveillance, NAFDAC laws. Nigeria has a solid foundation, but execution of the 2026 budget will determine our healthcare future.

REFERENCES

1. World Health Organization. Antimicrobial resistance [Internet]. Geneva: WHO; 2024 [cited 2026 Jan 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
2. Olagunju OJ, Ben E, Olagunju O, Majolagbe OG, Osanyinlusi OO, Adewoye T, et al. Poorly regulated antibiotic use in Nigeria: a critical public health concern and its impact on medical practice. Cureus. 2025;17(6): e85212.
3. Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-55.
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6. Olanrewaju Olamide Popoola, Damilola Samson Adepitan, Adebowale Sylvester Adeyemi, Opeyemi Fortunate Oladeru, Sodiq Inaolaji Yusuff, A national survey of the antibiotic use, self-medication practices, and knowledge of antibiotic resistance among graduates of tertiary institutions in Nigeria,Scientific African, Volume 23,2024, e01978, ISSN 2468-2276. https://doi.org/10.1016/j.sciaf.2023.e01978.
7. Hotor, P., Kotey, F. C. N., & Donkor, E. S. (2025). Antibiotic resistance in hospital wastewater in West Africa: a systematic review and meta-analysis. BMC public health, 25(1), 1364. https://doi.org/10.1186/s12889-025-22513-w
8. Ola-Bello OI, Osuagwu CS, Versporten A, Ines P, Goossens H, Akintan PE, et al. Impact of Antimicrobial Stewardship Intervention on Antibiotic Prescribing Practices in the Paediatric Unit of a Tertiary Hospital: Using Global-Point Prevalence Survey as a Tool. Ann Health Res 2025;3(1):12-20 doi:10.30442/ahr.1101-02-266.
9. Health sector gets N2.48trn in 2025 budget. Business Day News. 2024. https://businessday.ng/news/article/health-sector-gets-n2-48trn-in-2025-budget/
10. Chavan L. AMR to reduce Nigeria’s GDP by 4% if unchecked. Health Reporters. 2024 https://healthreporters.info/amr-to-reduce-nigerias-gdp-by-4-if-unchecked/