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Community Knowledge and Practices Regarding Antibiotics use Across Five States in Nigeria

  • Danjuma Kamlen ADDA
  • Obed Tiwah JOHN
  • Prof. Barnabas Toge
  • Dr. Chinwe OCHU
  • Dr. Tochi OKWOR
  • Dr. Abiodun EGWUENU
  • Dr. Ridwan YAHAYA
  • Mohammed UMARU
  • Rijimra ANDE
  • Oscar Facknwie KAHWIR
  • 168-181
  • Oct 19, 2023
  • Microbiology

Community Knowledge and Practices Regarding Antibiotics use Across Five States in Nigeria

Danjuma Kamlen ADDA1, Obed Tiwah JOHN1*, Prof. Barnabas Toge1,3, Dr. Chinwe OCHU2, Dr. Tochi OKWOR2   Dr. Abiodun EGWUENU2, Dr. Ridwan YAHAYA2, Mohammed UMARU1, Rijimra ANDE1 Oscar Facknwie KAHWIR1

1Centre For Initiative and Development (CFID) Taraba

2Nigeria Centre for Disease Control (NCDC)

3Department of Pharmaceutical Science, University of Calabar, Nigeria

*Corresponding Author

DOI: https://doi.org/10.51584/IJRIAS.2023.8918

Received: 15 August 2023; Revised: 08 September 2023; Accepted: 15 September 2023; Published: 19 October 2023

ABSTRACT

The rational use of drugs is mandatory and properly captured by the World Health Organization (WHO). This study was aimed at assessing the knowledge and practices of community members regarding antibiotic use. This was a cross-sectional study conducted across six states in Nigeria. The study included 8,370 respondents drawn from Taraba, Benue State, Enugu State, Nasarawa State, Osun State, and Rivers States. The participants were stratified into such as; community members, in-school and out-of-school youths and patient groups. The study revealed significant gaps in understanding the behaviors related to antibiotics use and antimicrobial resistance.

Key findings indicated a lack of awareness about antimicrobials among a substantial proportion of participants, suggesting the need for educational campaigns and awareness. Misconceptions about the uses of antimicrobials were evident, with participants associating them with a range of diseases, sometimes inaccurately. The issue of partial compliance to antibiotic treatment was also note, with participants discontinuing treatments prematurely. Participants indicated some awareness of the concept of antimicrobial resistance, highlighting a potential starting point for education on this topic.

The study underscored the role of community pharmacies and patent store owners in antibiotic distribution, often without proper education on safety protocols. This emphasizes the importance of regulatory measures and training for responsible dispensing for proper patient care. To address these issues, recommendations include comprehensive public awareness campaigns, educational initiatives in schools and communities, healthcare provider training, and promoting adherence to treatment guidelines. Multisectoral collaboration, cultural sensitivity, and ongoing research and evaluation are also recommended to address the gaps identified and combat antimicrobial resistance effectively.

INTRODUCTION

Antimicrobial resistance is rising to dangerous high levels in all parts of the world including Nigeria (WHO, 2020). A driving force behind the rise in antibiotic resistance can best be understood in two ways: The supply side, owing to the practice of excessive prescription, uncontrolled or uneven access and, on the demand side, to the use of antibiotics (Bax et al., 1998; Costelloe et al., 2010; Céspedes et al., 2006; Omulo et al. 2015 and Combaco et al., 2022). Considering the demand side otherwise known as the users of antimicrobial, this group are usually influenced by several aspects, including: consumers’ lack of knowledge about appropriate antimicrobial use and its implications, as well as beliefs, expectations and personal experiences with antibiotics (Omulo et al. 2013; Aljadhey et al. 2015; Viberg et al. 2010; Cars & Nodperg, 2005; Bin Abdulhak 2005; Volpato et al. 2005; Butle et al. 1998; Franco et al. 2009; McNulty et al. 2009’ Awad et al. 2015; Napolitano et al. 2013).  Where antibiotics can be bought for human use without a prescription or without guidelines, the emergence and spread of resistance is emminent. Studies have documented various ways of using medicines irrationally some of which include: polypharmacy or the prescribing of too many medicines for a patient (Routledge et al., 2004); inadequate dosage, and sometimes medicines are prescribed for non-bacterial infections; failure to prescribe following established clinical procedures (Younis et al., 2009) such as, national treatment guidelines and hospital policies; inappropriate self-medication (Kaushal et al., 2012), often of prescription-only medicines; and incidences relating to various types of non-adherence to dosing regimens by patients (van Dulmen et al., 2007). These irrational use of medicines across communities have led to a growing number of infections that are becoming harder, and sometimes impossible, to treat as antimicrobials are rendered ineffective (WHO, 2020). Evidence suggests that about half of all patients who take these medicines for their ailments fail to take them correctly (Holloway and van Dijk, 2011)

An extensive literature review on rational use of medicines in Nigeria shows that significant proportion of rational use medicines were carried out in hospital settings (77.0%) neglecting other settings such as community pharmacies, Patent and proprietary medicine vendors and patients across communities (Alfa & Adigwe, 2014).

Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill (WHO, 2021).

It is against this backdrop that this study aimed at accessing knowledge and practices of community members regarding antibiotic use across six States in Nigeria to better understand the existing evidence in this area, as well as critically review them with a view to identifying fresh perspectives to addressing RUM in Nigeria.

MATERIALS/METHODS

This was a Community based Antimicrobial Stewardship interventional studies conducted across six states in Nigeria (Taraba, Enugu, Rivers, Nasarawa, Osun and Benue). A total of 8,370 community members/in-school youths were interviewed to collect data with respect to KAP. The questionnaire was structured and scripted into ODK in a way to obtained data with respect to; Section 1 – Demographic characteristics, Section 2 – Knowledge on RUD practice, Section 3 – Attitude towards the practice of RUD, Section 4 – Community practice, Section 5 – Barriers to RUD in community settings. Descriptive statistics was used to summaries the data and organize them into groups according to the sections of the questionnaires. It was also designed using point like response format consisting of yes and no and a few open ended questions. Simple percentages were used.

Prior to the commencement of the survey, training was conducted followed by the field work. Survey on Knowledge, Attitudes and Practices of rational use/dispensing of Antimicrobials among community members/in-school youths on 30th of June, 2022 to 2st of July, 2022 in all the target states.

RESULTS

RUD Analysis for Taraba Taraba Benue Enugu Nassarawa Osun Rivers
Sex Freq % Freq % Freq % Freq % Freq % Freq %
Male 729 55 704 50 499 49 735 44 631 57 983 53
Female 590 45 706 50 527 51 937 56 474 43 855 47
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
Edcational leveL                          
No formal education 171 13 53 4 80 8 207 12 75 7 179 10
Primary 58 4 13 1 41 4 55 3 15 1 17 1
Junior Secondary 178 13 56 4 50 5 68 4 18 2 67 4
Senior Secondary 580 44 374 27 374 36 224 13 254 23 326 18
Tertiary 225 17 493 35 247 24 768 46 345 31 703 38
University 106 8 421 30 234 23 350 21 398 36 546 30
1318 100 1410 100 1026 100 1672 100 1105 100 1838 100
Target group
Community members 595 45 838 59 386 38 811 49 522 47 677 37
In-school-Youth 466 35 193 14 45 4 303 18 343 31 267 15
Out-of Schoo-Youths 198 15 350 25 218 21 507 30 198 18 371 20
Patient Group 60 5 29 2 377 37 51 3 42 4 523 28
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
Average monthly income of respondents 0
<20,000 991 75 634 45 423 41 836 50 451 41 601 33
20,000-50,000 249 19 492 35 403 39 677 40 470 43 939 51
51,000-80,000 51 4 186 13 182 18 120 7 118 11 205 11
>80,000 28 2 98 7 18 2 39 2 66 6 93 5
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
01. Have you ever heard of a type of medicine called an antimicrobial medicine? Response Frequency Percentage
Yes 710 54 235 17 191 19 226 14 344 31 109 6
No 609 46 1175 83 835 81 1446 86 761 69 1729 94
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
02b. I am going to mention some antimicrobial(s) (medicines) and I want you to let me know if you have heard of them.
ANTIBACTERIALS
a. Have you ever heard of Penicillin? Yes 730 55 1176 83 942 92 1058 63 946 86 1611 88
No 589 45 233 17 74 7 614 37 154 14 227 12
1319 100 1409 100 1016 99 1672 100 1100 100 1838 100
b. Have you ever heard of Tetracycline?
Yes 892 68 849 60 719 70 951 57 884 80 1549 84
No 427 32 561 40 307 30 721 43 221 20 289 16
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
c. Have you ever heard of Amoxicillin?
Yes 718 54 808 57 763 74 1211 72 910 82 1558 85
No 601 46 602 43 263 26 461 28 195 18 280 15
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
ANTIMALARIALS
d. Have you ever heard of Chloroquine?
Yes 1207 92 1268 90 952 93 1370 82 1023 93 1602 87
No 112 8 142 10 74 7 302 18 82 7 236 13
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
e. Have you ever heard of Sulfadoxine-Pyrimethamine or SP?
Yes 191 14 339 24 213 21 214 13 265 24 587 32
No 1128 86 1071 76 813 79 1458 87 840 76 1251 68
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
f. Have you heard of Artemisinin Combination Therapy or ACT?
Yes 590 45 639 45 624 61 842 50 457 41 814 44
No 729 55 771 55 402 39 830 50 648 59 1024 56
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
ANTIVIRALS
g. Have you heard of AZT or ARVs?
Yes 216 16 479 34 275 27 528 32 277 25 580 32
No 1103 84 931 66 751 73 1144 68 828 75 1258 68
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
ANTIFUNGALS
h. Have you ever heard of Fluconazole? Yes 284 22 914 65 491 48 656 39 375 34 945 51
No 1035 78 496 35 535 52 1016 61 730 66 893 49
1319 100 1410 100 1026 100 1672 100 1105 100 1838 100
i. Have you ever heard of Ketoconazole? Yes 228 17 671 48 410 40 554 33 290 26 862 47
No 1091 83 739 52 616 60 1118 67 815 74 876 48
1319 100 1410 100 1026 100 1672 100 1105 100 1738 95
ANTIPROTOZOALS
j. Have you ever heard of Metronidazole?
Yes 694 53 501 36 538 52 760 45 597 54 843 46
No 625 47 909 64 388 38 912 55 508 46 995 54
1319 100 1410 100 926 90 1672 100 1105 100 1838 100
03a. What diseases (illnesses) are these antimicrobials (medicines), which we just discussed, used to treat? Response Frequency %
a. STI/STD 229 17 809 57 444 43 1127 67 263 24 1025 56
b. PNEUMONIA 164 12 160 11 330 32 465 28 140 13 192 10
c. BLOODY DIARRHEA OR DYSENTERY 195 15 144 10 156 15 310 19 313 28 80 4
d. HIV/AIDS 207 16 288 20 91 9 561 34 201 18 169 9
e. TB 73 6 233 17 102 10 349 21 150 14 149 8
f. MALARIA 1099 83 1097 78 770 75 1337 80 822 74 1235 67
g. Cold 0 189 13 363 35 839 50 281 25 343 19
h.1 DIARRHEA 476 36 100 7 371 36 641 38 402 36 257 14
i. others 213 16 1 0 11 1 68 4 39 4 16 1
h.2 Do you mean bloody diarhea or watery diarhea?
Bloody diarhea 110 23 69 69 77 21 82 13 53 13 35 14
Watery diarhea 366 77 31 31 293 79 556 87 340 85 221 86
05. Do you believe that some of these antimicrobials (medicines) we discussed are useful in treating a cold?
Yes 425 32 392 28 621 61 207 12 229 21 752 41
No 894 68 542 38 405 39 1465 88 574 52 1086 59
1319 100 934 66 1026 100 1672 100 803 73 1838 100
07. Do you believe that some of these antimicrobials (medicines) we discussed are useful in treating watery diarrhea?
Yes 938 71 616 44 633 62 946 57 540 49 1018 55
No 381 29 791 56 393 38 726 43 566 51 820 45
1319 100 1407 100 1026 100 1672 100 1106 100 1838 100
08. Have you ever been sick and had to visit a health professional such as a doctor, nurse, or pharmacist?
Yes 1092 83 1321 94 739 72 1470 88 963 87 1418 77
No 227 17 89 6 287 28 202 12 139 13 420 23
1319 100 1410 100 1026 100 1672 100 1102 100 1838 100
09. When you have visited a health professional, such as a doctor, nurse, or pharmacist, have you ever asked for any of these antimicrobials (medicines)?
Yes 628 48 932 66 650 63 1076 64 771 70 1170 64
No 691 52 478 34 376 37 596 36 335 30 668 36
1319 100 1410 100 1026 100 1672 100 1106 100 1838 100
010. Have you ever taken any of these medicines that we have been discussing. I am referring to the antibiotics, antimalarials, or antivirals (antimicrobials), which are used to fight infections?
Yes 1100 83 1238 88 892 87 1466 88 822 74 1481 81
No 219 17 165 12 134 13 206 12 284 26 357 19
1319 100 1403 100 1026 100 1672 100 1106 100 1838 100
011. Did you ever stop taking these antimicrobials (medicines) before completing the full course?
Yes 843 64 930 66 512 50 903 62 517 47 502 27
No 476 36 480 34 514 50 561 38 589 53 1336 73
1319 100 1410 100 1026 100 1464 100 1106 100 1838 100
012. Why did you stop taking the antimicrobial (medicine)?
a. Don’t have enough money to buy the entire course 53 6 100 11 232 45 371 41 41 8 83 5
b. WASN’T GIVEN ENOUGH 25 3 32 3 137 27 81 9 24 5 41 2
c. RAN OUT 23 3 40 4 127 25 107 12 24 5 59 3
d. WAS TOLD TO STOP BY  A HEALTH PROFESSIONAL 20 2 56 6 187 37 52 6 44 9 28 2
e. CONDITION DID NOT IMPROVE 47 6 79 8 229 45 120 13 38 7 55 3
f. CONDITION IMPROVED 366 43 331 36 173 34 377 42 337 65 176 10
g. THERE WERE SIDE EFFECTS/MEDICINE MADE HIM/HER SICK 40 5 106 11 162 32 91 10 37 7 68 4
h. DON’T LIKE TO TAKE MEDICINES 133 16 163 18 75 15 76 8 169 33 91 5
i. i. DIDN’T THINK IT WAS WORKING 26 3 49 5 34 7 51 6 32 6 23 1
x. OTHER 21 2 6 1 0 0 20 2 12 2 2 0
z. DON’T KNOW 29 3 8 1 3 1 28 3 6 1 4 0
013. Some of these medicines that used to work in the past for fighting infections are no longer working. This problem is called drug resistance (antimicrobial resistance). Have you ever heard of this problem where medicines no longer work?
Yes 776 59 854 61 600 58 1077 64 244 22 1383 75
No 543 41 549 39 426 42 595 36 862 78 455 25
1319 100 1403 100 1026 100 1672 100 1106 100 1838 100
014. Where did you hear about this problem of medicines no longer working (antimicrobial resistance)?
a. HEALTH WORKER/CLINIC 18 2 273 32 172 29 648 60 82 34 659 48
b. ON THE RADIO 21 3 68 8 116 19 49 5 9 4 100 7
c. ON THE TV 10 1 55 6 24 4 47 4 7 3 133 10
d. IN A NEWSPAPER OR MAGAZINE 6 1 28 3 29 5 13 1 3 1 99 7
e. COMMUNITY/FRIEND/RELATIVE 74 10 317 37 221 37 231 21 80 33 238 17
x. OTHEROTHER 16 2 55 6 18 3 47 4 39 16 59 4
z. DON’T REMEMBER 631 81 58 7 17 3 39 4 24 10 97 7
015. Can you name some of these antimicrobials (medicines) that used to work in the past for fighting infections that are no longer working?  (medicines for which antimicrobial resistance or drug resistance has occurred?)2
a. PENICILLIN 29 4 20 2 17 3 20 2 18 7 137 10
b. TETRACYCLINE 43 6 13 2 16 3 15 1 32 13 30 2
c. AMOXICILLIN 51 7 17 2 14 2 17 2 17 7 44 3
d. CHLOROQUINE 84 11 26 3 40 7 28 3 18 7 65 5
e. SULFADOXIME-PYRIMETHAMINE/SP 6 1 6 1 8 1 6 1 6 2 35 3
f. ARTEMISININ COMB. THERAPY/ACT 18 2 2 0 11 2 3 0 5 2 9 1
g. ZIDOVUDINE/AZT/ARVs 1 0 6 1 8 1 2 0 2 1 0 0
h. FLUCONAZOLE 1 0 8 1 5 1 5 0 7 3 13 1
i. KETOCONAZOLE 2 0 7 1 4 1 3 0 3 1 18 1
j. METRONIDAZOLE 21 3 2 0 2 0 3 0 11 5 11 1
k.  IBUPROFEN 16 2 4 0 4 1 7 1 15 6 9 1
l. PARACETAMOL 40 5 13 2 6 1 26 2 20 8 21 2
y. OTHER 5 1 2 0 1 0 10 1 9 4 2 0
z. DON’T KNOW 459 59 175 20 32 5 181 17 209 86 37 3
16. Can you name some diseases or infections for which some of these antimicrobials (medicines) no longer work? In other words, antimicrobial resistance or drug resistance has occurred?
a. STI/STD 139 18 574 67 334 56 847 79 90 37 982 71
b. PNEUMONIA 140 18 108 13 290 48 248 23 61 25 199 14
c. BLOODY DIARRHEA OR DYSENTERY 93 12 113 13 157 26 207 19 105 43 152 11
d. HIV/AIDS 159 20 0 0 155 26 230 21 86 35 144 10
e. TB 84 11 155 18 145 24 135 13 61 25 82 6
f. MALARIA 619 80 683 80 600 100 1020 95 221 91 1112 80
g. WATERY DIARRHEA 113 15 188 22 303 51 422 39 91 37 526 38
y. Others 219 28 0 0 0 0 60 6 0 0 125 9
z. DON’T KNOW 454 59 463 54 125 21 485 45 582 239 54 4
17. What can cause some of these medicines [ANTIMICROBIALS]   that used to work in the past to stop working? [IN OTHER  WORDS, FOR ANTIMICROBIAL RESISTANCE OR DRUG RESISTANCE TO OCCUR?
a. POOR QUALITY ANTIMICROBIAL 431 56 559 40 416 69 845 78 247 22 894 65
b. WHEN ONE STOPS TAKING IT BEFORE COMPLETING THE FULL COURSE 527 68 455 32 3374 562 818 76 311 28 922 67
c. INSUFFICIENT AMOUNT OF ANTIMICROBIAL 204 26 182 13 260 43 205 19 143 13 279 20
d. WHEN ONE USES ANTIMICROBIALS THAT  ARE PRESCRIBED FOR SOMEONE ELSE 227 29 403 29 327 55 354 33 248 22 316 23
e. WHEN ONE USES THE WRONG  ANTIMICROBIAL 264 34 446 32 197 33 448 42 274 25 204 15
x. OTHER 76 10 39 3 6 1 71 7 28 3 49 4
z. DON’T KNOW 408 53 359 25 113 19 515 48 346 31 135 10
2137 275 2443 173 4693 782 3256 302 1597 145 2799 202
18. Today or yesterday, during the day or night, did you take any medicines?  (NOTE: MAKE IT CLEAR TO RESPONDENT THAT YOU ARE SPEAKING OF PRESCRIPTION OR OVER-THE-COUNTER MEDICINES,  NOT HERBAL OR TRADITIONAL MEDICINES.)
Yes 280 21 264 19 232 23 143 9 170 15 422 23
No 1039 79 1136 81 794 77 1529 91 935 85 1416 77
1319 100 1400 99 1026 100 1672 100 1105 100 1838 100
019. Can you show me the medicines themselves, the packaging, or bottles for the medicines that you are taking?’
Yes 280 36 74 28 9 4 29 20 60 35 32 8
No 1039 134 190 72 223 96 114 80 110 65 390 92
1319 170 264 100 232 100 143 100 170 100 422 100
20. Medicine 1
Eligible 38 76 70 95 8 89 25 86 31 70 17 77
Not eligible 12 24 4 5 1 11 4 14 13 30 5 23
Medicine 2
Eligible 15 83 27 93 1 100 4 80 17 55 7 58
Not eligible 3 17 2 7 0 0 1 20 14 45 5 42
Medicine 3
Eligible 8 100 14 93 0 2 100 2 12 3 100
Not eligible 0 0 1 7 0 0 0 15 88 0 0
021a. Who recommended or prescribed that you take that medicine 1 above
1. HEALTH PROFESSIONAL AT HEALTH FACILITY/MOBILE OUTREACH UNIT 12 19 25 34 1 11 10 34 8 1 8 36
2. COMMUNITY HEALTH WORKER 8 13 11 15 1 11 2 7 4 0 0 0
3. COMMUNITY HEALTH 3 5 1 1 1 11 1 3 0 0 0 0
4. GENERAL STORE WORKER 4 6 6 8 0 0 1 3 14 1 2 9
5. DRUG STORE WORKER 12 19 8 11 2 22 3 10 0 0 6 27
7. TRAD. HEALER 2 3 0 0 0 0 1 3 1 0 0 0
8. FRIEND/NEIGHBOR 4 6 4 5 1 11 4 14 3 0 2 9
9. RELATIVE 3 5 1 1 0 0 1 3 1 0 3 14
9.5 Respondnet him/herself 13 21 13 18 3 33 5 17 11 1 1 5
9.6 Others 1 2 0 0 0 0 0 0 0 0 0 0
62 100 69 93 9 100 28 97 42 4 22 100
22. Where did you buy the drudgs
Health professional, Clinic, drug store, Pharm/chemist 38 76 60 81 9 100 24 83 28 74 20 91
Fiends, hawkers, 4 8 14 19 0 0 5 17 10 26 2 9
23. Do community pharmacists/patent store owners provide you with education after purchase of medicines Yes No
Yes 422 32 678 48 163 16 612 37 295 27 1091 59
No 897 68 732 52 863 84 1053 63 811 73 747 41
1319 100 1410 100 1026 100 1665 100 1106 100 1838 100
24. Do you receive any safety netting protocol after buying medicines from community pharmacist/patent store owner (providing information for patient and follow up after contact with patient
Yes 422 32 678 48 163 16 612 37 295 27 1091 59
No 897 68 732 52 863 84 1053 63 811 73 747 41
1319 100 1410 100 1026 100 1665 100 1106 100 1838 100

RESULTS DESCRIPTION

A total of 8,370 respondents were interviewed, out of which 1,319, 1410, 1026, 1672, 1105, and 1838 were drawn from Taraba, Benue State, Enugu State, Nasarawa State, Osun State, and Rivers States, respectively.

The target populations were stratified into Community members, In-school youths, out-of-school youths, and patient groups, and participants across target proportions were Taraba (595, 466, 198, and 60), Benue (838, 193, 350, 29), Enugu (386, 45, 298, 377), Nasarawa (811, 303, 507, 51), Osun (522, 343, 198, 42), and Rivers (677, 267, 371, 523).

Most of the sampled populations had Secondary, tertiary, or non-formal education and had an average monthly income of less than N20,000. Taraba: 75%; Benue: 45%; and Nasarawa: 50%.

Results show that most participants have never heard about the term antimicrobials: Taraba (50%), Benue (83%), Enugu (81%), Nasarawa (86%), Osun (69%), and Rivers (94%).

Results also show that these antimicrobials were used in diseases like Malaria, Diarrhea (mostly watery), HIV/AIDS, and dysentery, among others.

A small number of participants were of the opinion that antimicrobials are used in treating watery diarrhea, for example, Taraba (71%, Enugu (62% and Nasarawa (57%).

The majority of the participants responded that they have taken one form of antimicrobial or another. However, many reported that they have ever stopped taking the full course of these antimicrobials because their conditions suddenly improved or that they do not like taking the medications again: Taraba (64%), Benue (66%), Enugu (50%), and Nasarawa (52%).

Many respondents claimed that they had heard of a condition where medicines no longer work but that they had forgotten the exact channel where they got such information. Participants, however, mentioned Artemisinin Comb., Paracetamol, and Metronidazol as some of these antimicrobials that no longer work.

On the recommendation of medicines that participants take, most of them reported that their antimicrobials are being recommended by patent store owners in their communities and that the patent store owners do not provide them with education or safety net protocols.

DISCUSSION OF RESULTS

The aim of the study was to assess the knowledge and practices of community members in six states across Nigeria regarding antibiotic use. The study employed a cross-sectional design and collected data from a substantial number of respondents across different states and target populations, including community members, in-school and out-of-school youths, and patient groups. The study primarily focused on gaining insights into the existing evidence concerning antibiotic use and resistance in Nigeria and aimed to identify potential new perspectives for addressing the issues related to Rational Use of Medicines (RUM).

The study sample consisted of 8,370 respondents drawn from Taraba, Benue State, Enugu State, Nasarawa State, Osun State, and Rivers States. The target populations were further categorized into different groups, and participants were divided across these categories in each state. The majority of the sampled population had secondary, tertiary, or non-formal education and earned an average monthly income of less than N20,000 in several states.

The results of the study revealed several important findings:

Awareness and Knowledge: A significant proportion of participants across all states had never heard about the term “antimicrobials.” This lack of awareness is a cause for concern, as it reflects a gap in knowledge about the proper use of antibiotics and their potential risks.

Perceived Uses of Antimicrobials: The study found that participants associated antimicrobial use with a range of diseases including Malaria, Diarrhea (particularly watery diarrhea), HIV/AIDS, and dysentery. This perception indicates that there might be misconceptions about the appropriate use of antibiotics, leading to their overuse or misuse.

Understanding of Antimicrobial Function: A small percentage of participants believed that antimicrobials were used in treating watery diarrhea, which could indicate a lack of accurate knowledge about the role of antibiotics in specific conditions.

Adherence to Treatment: A significant portion of participants reported that they had taken antimicrobials at some point, but many had discontinued the full course of treatment prematurely. Reasons cited for discontinuation included improvement in their condition or a dislike for taking medications. This partial adherence to treatment can contribute to the development of antimicrobial resistance.

Awareness of Antimicrobial Resistance: Participants indicated awareness of a condition where medicines no longer work, suggesting some level of familiarity with the concept of antimicrobial resistance. However, they struggled to recall the source of such information.

Sources of Recommendations: A noteworthy finding was that most participants reported obtaining antimicrobials from patent store owners in their communities. These store owners often did not provide education or safety protocols, potentially leading to inappropriate antibiotic use.

Comparing these results with other studies is crucial to place the findings in a broader context. Other studies in Nigeria and globally have also reported similar issues with inadequate awareness of antimicrobial resistance, misconceptions about antibiotic use, and improper adherence to treatment courses. The cross-sectional nature of this study limits its ability to establish causal relationships or capture changes over time. However, the findings align with broader concerns about the growing problem of antimicrobial resistance and highlight the need for targeted educational interventions, policy measures, and community engagement to address these issues effectively.

CONCLUSION

The survey study revealed deficit in knowledge and practice of community members/students. There is also inadequate knowledge on the importance of drugs prescriptions couple with poor safety netting practice from the pharmaceutical care. Hence, an urgent need of action to conduct community sensitization, radio programs and patients education so as to reduce spread of AMR among community members

RECOMMENDATION

Based on the findings of the study, we recommend the following in order to address the gaps in knowledge and practices regarding antibiotic use in the community:

  1. Public Awareness Campaigns: Develop and implement comprehensive public awareness campaigns about antibiotics, their appropriate use, and the risks of antimicrobial resistance. These campaigns should be culturally sensitive and accessible to all segments of the population.
  2. Educational Initiatives: Launch educational programs in schools, communities, and healthcare facilities to raise awareness about antibiotics, their proper use, and the consequences of misuse. Tailor these programs to address misconceptions and provide clear information on conditions that require antibiotics.
  3. Antimicrobial Resistance Education: Develop focused education modules about antimicrobial resistance, explaining the concept, causes, and implications. Highlight the role of individuals in preventing its spread and the importance of completing full courses of antibiotics.
  4. Healthcare Provider Training: Provide training to patent store owners and other healthcare providers who distribute antibiotics. Equip them with knowledge about appropriate antibiotic use, the importance of adhering to treatment guidelines, and safety protocols.
  5. Promote Adherence to Treatment: Create patient-centered strategies to promote adherence to antibiotic treatment, such as reminders and education about the dangers of discontinuing treatment prematurely.
  6. Regulation and Oversight: Implement regulations to ensure that antibiotics are dispensed only with a valid prescription, limiting the ability of non-medical professionals to distribute these medications. This can help control inappropriate use.
  7. Multisectoral Collaboration: Foster collaboration between healthcare authorities, educational institutions, community leaders, and relevant stakeholders to coordinate efforts in addressing antibiotic misuse and antimicrobial resistance.
  8. Cultural Sensitivity: Tailor interventions to respect cultural beliefs and practices while promoting accurate antibiotic knowledge. Engage local leaders and influencers to support and disseminate information effectively.
  9. Data-Driven Strategies: Continuously monitor and analyze antibiotic usage patterns, awareness levels, and adherence rates. Use this data to refine interventions and strategies over time.
  10. Behavioral Change Interventions: Design behavior change interventions that focus on shifting attitudes and practices related to antibiotic use. Utilize evidence-based techniques to encourage responsible antibiotic behavior.
  11. Health Literacy Enhancement: Improve general health literacy among communities to empower individuals to make informed decisions about their health and medication use.
  12. Research and Evaluation: Conduct further research to assess the impact of interventions on knowledge, practices, and antimicrobial resistance rates. Use the findings to refine strategies and ensure their effectiveness.

CONFLICTS OF INTEREST

Conflicts of interest: All authors – none to declare.

FUNDING

Financial support for this study was provided by Pfizer Independent Quality Improvement grant to Centre For Initiative and Development (CFID) NGO in Nigeria. Pfizer had no role in the study design or data collection, analysis, or interpretation. The authors have access to all study data and have final responsibility for the writing and decision to submit for publication.

ACKNOWLEDGMENT

We acknowledge that the CAMS Project is supported by an independent Quality Improvement grant from Pfizer Plc. The authors acknowledge all recruited CSOs, Communities and states of interest where the project is been implemente.

Ethics approval and consent to participate

Ethics approval was received from the National Health Research Ethics Committee with NHREC Protocol Number: NHREC/01/01/2007-01/11/2021. Informed consent was obtained from each participants prior to the observation of any consultations. Consent was also obtained from Ministries of Health and Education in all the six target states,

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