Background
Antimicrobial resistance (AMR) is a major global public health threat, driven in part by inappropriate antibiotic use in primary care. In Nigeria, primary healthcare (PHC) providers, particularly Community Health Extension Workers (CHEWs), make many frontline prescribing decisions, yet little is known about their experiences and perspectives regarding antimicrobial stewardship (AMS). This study explored knowledge of AMR, antibiotic prescribing practices, barriers to appropriate prescribing, and opportunities for strengthening AMS among PHC providers in Cross River State, Nigeria.
Methods
A qualitative phenomenological study was conducted between July and August 2024 using key informant interviews with frontline healthcare workers from purposively selected PHC facilities across Cross River State. Eleven local government areas were included. Participants were selected based on their direct involvement in antibiotic prescribing, dispensing, laboratory services, or facility leadership. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis supported by NVivo software. Coding was conducted iteratively, and findings were organised into themes and subthemes reflecting participants’ experiences and perceptions.
Results
Twenty-nine healthcare workers participated. Six major themes emerged: knowledge of AMR; prescribing practices and decision-making; training and guidelines; barriers to appropriate prescribing; interventions for improvement; and policy and system-level recommendations. Participants generally understood AMR because of antibiotic misuse, overuse, incomplete treatment courses, self-medication, and widespread antibiotic access through patent medicine vendors. Although prescribing was largely guided by standing orders and standard treatment protocols, routine practice was constrained by limited diagnostic capacity, medicine stock-outs, workforce shortages, patient expectations, and financial barriers. Formal AMR and AMS training was infrequent, with many participants relying primarily on standing orders and personal experience. Suggested improvements included regular AMS training, strengthened supervision, reliable availability of essential medicines, improved laboratory services, community education on antibiotic use, stricter regulation of antibiotic sales, updating prescribing guidelines, and deployment of additional skilled personnel to PHC facilities.
Conclusions
PHC providers in Cross River State recognise the importance of responsible antibiotic use but face significant system-level barriers that limit effective AMS. Strengthening training, diagnostics, medicine supply systems, regulatory enforcement, and community engagement could improve prescribing practices and support national efforts to mitigate AMR in Nigeria.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)