Community Antibiotic Misuse and Low AMR Awareness in Enugu

Key Takeaways

• In Enugu State, Nigeria, 57.7% of surveyed residents reported antibiotic use within six months, and 48% of antibiotic users reported self-medication.
• Among antibiotic users, 49% stopped treatment when they felt better, 40% completed the course, and 8% stopped when affordable doses ran out.
• Antibiotics were obtained mainly outside formal prescribing channels, with chemist shops and nonprescription pharmacy sales outweighing prescription-based access.
• Awareness of antimicrobial resistance was low, and many respondents who had heard of AMR could not define it accurately.
• Qualitative findings linked misuse to trust in antibiotics, reliance on chemists, poverty, weak healthcare access, and participant narratives involving preventive cleansing and attempted pregnancy termination.

Antibiotic decisions in Enugu State, Nigeria, often happen outside clinics, where cost pressures, chemist shops, and informal beliefs about illnesses such as fever, cough, and malaria shape what people take. In this Nigerian setting, the authors argue that antibiotic-use behaviors relevant to AMR are shaped both by what people know about antibiotics and by how care is reached and paid for. Investigators examined those patterns with a statewide mixed-methods study of antibiotic access, beliefs, and treatment-seeking.

In a mixed-methods study of community antibiotic use and AMR awareness in Enugu State, Nigeria, investigators combined a descriptive baseline survey of 1,281 residents across all 17 Local Government Areas (LGAs) and urban and rural communities with 20 interviews and 4 focus group discussions (FGDs) involving 24 participants. Data were collected from July 18 to October 4, 2024, using systematic selection of five enumeration areas per LGA for the survey and purposive plus snowball recruitment for qualitative participants. The quantitative analysis was descriptive and was not intended for inferential testing or broad generalization.

Recent antibiotic use and self-medication were common, and access was centered largely outside formal prescribing. Among respondents who reported antibiotic use, 62% obtained antibiotics from chemist shops, 16% from pharmacy shops without prescriptions, and 15% through prescriptions. Antibiotics were commonly used for malaria, cough, fever, and related community-labeled illnesses that the authors described as often non-bacterial in origin. Overall, access was concentrated outside formal prescribing channels.

Awareness of AMR was limited: 15.7% of respondents had heard of it, and 20% of that group selected scientifically accurate definitions. The authors also described broader antibiotic knowledge gaps, including confusion between antibiotics and other medicines and uncertainty about which illnesses antibiotics are meant to treat. Interview and FGD accounts portrayed antibiotics as broadly effective medicines used across many ailments, reinforcing the survey pattern of low resistance awareness and low antibiotic literacy.

These findings were descriptive within this sample, many measures were self-reported, and the survey skewed toward older adults, which limits how far the pattern can be extended beyond the communities studied. The reported preventive-cleansing and attempted-pregnancy-termination uses came from participant narratives rather than prevalence estimates. The authors interpreted misuse as embedded in poverty, weak regulation, lack of insurance, and under-resourced facilities, but those themes were presented as context for the observed pattern rather than proof of causation.

The authors concluded that community antibiotic misuse in Enugu State reflected both limited antibiotic literacy and the realities of informal care networks and constrained healthcare access. In their interpretation, where people could obtain treatment and whom they trusted shaped antibiotic use as much as formal knowledge of antimicrobial resistance. Their closing view framed antibiotic use in this Nigerian setting as a community practice embedded in social and health-system conditions.

Clinician Questions

What behaviors qualified as antibiotic misuse among community respondents in Enugu State, Nigeria?

In the Enugu survey and interviews, misuse meant taking antibiotics without a prescription, using them for non-bacterial conditions such as malaria or viral illnesses, stopping early or taking incomplete doses, and using them for non-medical purposes.

What treatment-seeking pathway did community respondents in Enugu State describe before reaching hospitals?

Participant accounts commonly described self-medication first, then visits to chemist shops or pharmacies, with clinics and hospitals often used later or as a last resort. Herbal remedies and prayer also appeared in these accounts, which the authors presented as a participant-reported pathway shaped by cost, access, and trust rather than a formal referral sequence.

How was AMR awareness defined among community respondents in Enugu State?

AMR awareness was assessed first by whether respondents had heard of antimicrobial resistance or drug resistance and then, among those aware, by whether they could identify its meaning. The authors noted that respondents often confused AMR with fake drugs, allergic reactions, or other nontechnical concepts, which helps explain the low-awareness pattern.

How representative are the Enugu State antibiotic-use findings for other communities?

The study covered all 17 Local Government Areas and included urban and rural communities, but its quantitative component was descriptive and not designed for inferential testing or broad generalization. Many findings were self-reported, and the interviews and focus groups were used to add context rather than establish causation.