Since 2024, Nigeria has intensified its efforts to combat Antimicrobial Resistance (AMR) through strategic plans and support from the Fleming Fund, a UKaid-backed initiative implemented by organizations like Management Sciences for Health (MSH). Their focus includes enhancing surveillance systems, generating high-quality AMR data, and informing policymakers while raising public awareness. Musa Umar Bologi discusses the dangers of AMR and the challenges of addressing this health threat in Nigeria.
Have you ever taken a full course of antibiotics as prescribed, yet still didn’t feel better?
This can be puzzling, leading some to suspect fake or adulterated medication. However, the culprit might be antimicrobial resistance (AMR), a pressing global health issue. It is remarkable how these tiny microorganisms can outsmart human efforts.
AMR occurs when microorganisms develop resistance to drugs that once effectively treated infections. This resistance primarily arises from the misuse and overuse of antibiotics in both human and veterinary medicine. Researchers have confirmed that numerous pathogens have developed resistance to standard synthetic antibiotics.
AMR is like a battlefield where microbes adapt to and counterattack standard antibiotic strategies. Through repeated exposure, these microorganisms become familiar with the antibiotics’ mechanisms, enabling them to build effective defenses.
According to the World Health Organization (WHO) AMR complicates infection treatment, threatens food security, and hinders development.
AMR prevalence in Nigeria
“In Nigeria now, research has indicated that almost 80% of bacteria known as Escherichia coli is resistant to more than one drug,” said Dr. Nafiu Lawal, a Clinical Veterinary Microbiologist at Usmanu Danfodio University, Sokoto, AMR is a major public health challenge in Nigeria, threatening both human and animal health.
Lawal, who has been actively involved in the research and advocacy to curb this menace, further warned that 70% of Salmonella isolates (a type of bacteria) from human and veterinary cases are also resistant to multiple antibiotics.
“It’s like a multiple drug resistance pathogen. Let’s say, for example, Amoxicillin, Penicillin, Gentamicin, and Streptomycin—these are all different types of drugs used for treating infections in both humans and animals, he explained.
“If Salmonella is no longer susceptible to the harmful effect of these drugs, it means the treatment will fail, and the patient’s condition could worsen.”
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Lawal warned that antimicrobial resistance has reached alarming levels, with no bacterial isolates in his lab showing full susceptibility to common antibiotics.
“This underscores the gravity of the threat,’ he said. “Inaction could send us back to the pre-antibiotic era, where minor infections become deadly.”
Facing the reality
Beyond health implications, AMR imposes a substantial economic burden, according to Dr. Sati Ngulukun, Director of Bacteriology, Parasitology and Virology at the National Veterinary Research Institute (NVRI), Vom, Plateau State.
“AMR is a global health threat, and Nigeria is no exception. It causes significant mortality and morbidity,” he said. “It is also an economic threat because when people are sick and can’t be treated with antibiotics, they can’t work, resulting in lost productivity and income, which can ultimately affect the country’s economy.”
Resistant infections prolong hospital stays, driving up healthcare costs. Patients may face months of hospitalization and mounting medical bills, instead of recovering within a week. This strains our healthcare system, occupying beds and limiting capacity for new patients.
Furthermore, this situation is exacerbated when first-line antibiotics fail, forcing patients to seek pricier alternatives, which can be unaffordable for many Nigerians.
As Lawal aptly put it, “The cost of treatment will rise because the readily available and affordable drugs are no longer useful, and the few effective alternatives are expensive—if they are even available.”
Breaking the chain
According to experts, good hygiene practices are crucial in halting the transmission AMR. When we maintain cleanliness, we break the chain of infection, reducing the spread of resistant pathogens. This is especially important in environments where humans, animals, and food intersect, as resistant bacteria can jump between species and contaminate food and water sources. By prioritizing hygiene, we can significantly slow the spread of AMR and protect public health.
Understanding the role of poor hygiene in the spread of AMR, Lawal explained how resistant pathogens move from animals to humans through contaminated food and the environment.
“Farmers in Nigeria often use animal dung as manure, if the dung contains AMR pathogens, these can contaminate vegetables,” he said. “People then buy these vegetables from the market, sometimes without washing them properly, and unknowingly expose themselves to resistant bacteria,” he explained.
This cycle, he said, demonstrates how AMR is not limited to hospitals but is also an environmental issue.
“The pathogens move from animals to humans through food and water. If someone eats contaminated vegetables, they could get infected with bacteria that are resistant to multiple drugs,” he warned.
Uniting against AMR
Experts have advocated shared responsibility that requires active participation from healthcare providers, pharmacists, and patients. In line with this, healthcare providers must take a crucial step: avoiding antibiotic prescriptions without conducting necessary tests.
This approach, according to experts, ensures that proper diagnosis and laboratory tests guide treatment, thereby guaranteeing the right antibiotic is used.
“Pharmaceutical companies and professionals also play a vital role in the battle against AMR,” said Lawal, a strong advocate for collective responsibility. “Pharmacists should never dispense antibiotics without a valid prescription. If a customer requests antibiotics for symptoms like headaches or fever without consulting a doctor, the pharmacist must insist on a prescription to prevent self-medication and misuse.”
At the individual level, strict adherence to prescribed antibiotic regimens, combined with proper personal hygiene, is highly recommended by experts to ensure effective treatment and prevent antimicrobial resistance.
“AMR affects everyone, regardless of location or socioeconomic class,” said Ngulukun. “As individuals, we have a responsibility to take preventive measures, such as frequent handwashing and avoiding over-the-counter purchase of drugs without a doctor’s prescription.”
Building on Nguluku’s explanation, Lawal emphasized the importance of adherence to prescribed treatment, noting that “If a doctor prescribes two tablets three times daily for five days, the patient must follow the schedule strictly.
“Skipping doses or stopping treatment early allows bacteria to survive and develop resistance.
“Unnecessary antibiotic use kills not only harmful bacteria but also beneficial microbes that aid digestion. This can weaken the body’s natural defenses, making individuals more susceptible to infections.”
However, Nguluku emphasized the role of the National Agency for Food and Drug Administration and Control (NAFDAC) in ensuring drug quality. However, he acknowledged challenges such as porous borders and limited staff, which allow fake and substandard medicines to enter the market.
“There are many counterfeit medicines in circulation, often smuggled in illegally. These substandard drugs contribute to resistance,” he said, urging consumers to only purchase antibiotics with a proper prescription.
He also warned that sellers of fake medicines are not immune to the dangers of AMR.
“If they fall ill and use substandard drugs, their lives could be at risk. Everyone must do their part,” he added.
“AMR is a threat to everyone. It takes a united effort to combat it. By making responsible choices, we protect ourselves and our communities.”
The One Health Approach
In 2024, the Federal Government launched the second National Action Plan (NAP2) on Antimicrobial Resistance (AMR), covering 2024-2028. Building on the progress of the first NAP (2017-2023), NAP2 aims to further address AMR.
The NAP2 adopts a comprehensive, multisectoral “One Health” approach, recognizing the interconnectedness of human, animal, and environmental health in combating AMR. This plan focuses on enhancing governance, awareness, surveillance, infection prevention, and responsible antimicrobial use, and identifies key implementing agencies, including the Ministries of Health, Environment, Agriculture, Livestock, and the Centre for Disease Control.
The key aspects of NAP2 encompass a detailed operational plan with estimated costs and timelines, a comprehensive Monitoring and Evaluation framework, and a One Health Approach that fosters collaboration across sectors. Additionally, NAP2 outlines Strategic Objectives for governance, awareness, and surveillance, while focusing on reducing antimicrobial overuse and misuse. It also aims to strengthen surveillance and diagnostic capabilities and improve public awareness through effective communication and education.
Nguluku highlighted the significance of NAP2, noting that its “One Health Approach” is a highly effective strategy against AMR, but stressed that adequate funding is essential for its success.
“One of the good things with the plan is that it is costed,” Nguluku said. “For every activity, there is a cost attached. As it is today, each ministry looks at the NAP2 and picks those activities that affect it and includes them in their annual budget.
“However, the government needs to fund the NAP2 more effectively by having a budget line for it. So, we call on the National Assembly to support this by making provision and approving the budget line that will be proposed by the Ministries.”
Beyond the budgetary provision, Lawal emphasized that the key ministries and all Nigerians must work together to curb AMR.
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Lawal said, “The NAP2 document outlines roles for every sector, making it a collective responsibility beyond government alone. As key ministries do their part, it’s equally important for all citizens to play theirs.
“Indeed, collective action and collaboration are crucial in addressing complex health challenges like AMR.”
Dr. Mary Alex-Wele, Consultant Clinical Microbiologist, Senior Lecturer, and Head of the Department of Medical Microbiology and Parasitology at the University of Port Harcourt Teaching Hospital, stressed the urgent need for stronger policies, increased research funding, and widespread public awareness.
“Without immediate and sustained intervention, we are heading toward a post-antibiotic era where common infections become untreatable, reversing decades of medical progress,” she warned.
Emphasizing the need for a coordinated response, the infectious disease expert also championed the “One Health” approach—an integrated framework that links human health, food production, environmental sustainability, and animal health to combat AMR effectively.
Also, Lawal and Nguluku, echoing the position of the other experts, called for stronger policies, public awareness, and strict antibiotic regulations to combat AMR effectively.
“If we do not take immediate action, the consequences will be devastating,” Lawal said.
“Everyone must play a role—healthcare professionals, farmers, policymakers, and the general public. We must act now to preserve the effectiveness of antibiotics for future generations,” Nguluku added.