Physician perspectives on antimicrobial resistance and stewardship in Nigeria’s private healthcare sector: a cross-sectional survey study

Imagine a world where the medicines we rely on to fight infections stop working. This is not a distant threat but a growing reality known as antimicrobial resistance. It happens when bacteria, viruses, fungi, and parasites change over time and no longer respond to the drugs designed to kill them. When this occurs, common infections become harder to treat, leading to longer illnesses, higher medical costs, and a greater risk of death. While this is a global crisis, it hits some places harder than others. In many low- and middle-income countries, the challenge is compounded by limited access to laboratory tests that can identify exactly which germ is causing an illness, and by health systems where the rules for prescribing these powerful drugs are not always strictly followed.

In Nigeria, the private healthcare sector plays a massive role, providing more than sixty percent of all medical care. Yet, this sector has often been overlooked in efforts to fix the problem of drug resistance. Unlike public hospitals, which are more closely monitored, private clinics and hospitals operate with less oversight, and doctors there face unique pressures. To understand how to improve the situation, researchers needed to know what these private doctors actually think, how they decide which medicines to give, and what stops them from following the best practices. They wanted to see if these doctors were aware of the problem and if they were willing to change how they work.

A team of researchers from universities in Canada and Nigeria set out to answer these questions by talking directly to doctors in the private sector. They focused on two major regions: the Federal Capital Territory, where the capital city Abuja is located, and Lagos State, a bustling economic hub. The researchers reached out to 172 licensed physicians working in private clinics and hospitals across these areas. They sent a digital survey that asked about the doctors' knowledge of drug resistance, their past training, how they choose medicines for their patients, and what they believe would help them prescribe more wisely. The survey was designed to be quick, taking about fifteen to twenty minutes, and the researchers offered a small payment to cover the cost of mobile data, ensuring that doctors could participate without financial burden.

The response was strong. Out of the 172 doctors invited, 153 completed the survey, representing a very high participation rate. The group was diverse, with doctors of various ages and experience levels, though most were men in their thirties working in for-profit clinics. The results painted a picture of a workforce that is aware of the problem but often lacks the tools to solve it. Most of the doctors knew what antimicrobial resistance was and could define it correctly. Nearly all of them agreed that it is a serious problem in Nigeria and a growing threat globally. They also recognized that it makes treating infections much more difficult.

Despite this awareness, there was a significant gap in formal training. About half of the doctors said they had never received any specific education on how to use antimicrobial medicines properly. When asked why they hadn't attended such training, the most common reason was simply that they did not know these opportunities existed. They did not say they were uninterested or that the cost was too high; they just lacked information. This finding is crucial because it suggests that the barrier is not a lack of desire to learn, but a lack of access to the right information.

When it came to their daily work, the doctors described a complex reality. Most said they relied on clinical signs and lab test results to decide which medicine to prescribe. However, nearly half admitted that they sometimes prescribed antibiotics even when they were unsure of the diagnosis, usually to be safe and avoid missing a serious infection. A small number said they prescribed based on what the patient asked for, but the vast majority disagreed that patient pressure was the main driver of their decisions. Instead, they cited the severity of the illness and the type of infection as their primary guides. Yet, they also noted that practical constraints, such as the cost of the medicine to the patient and whether the drug was actually available in the local market, heavily influenced their choices.

One of the most revealing findings concerned how these doctors interact with the medicines they prescribe. In many private settings, doctors do not just write a prescription for a patient to take to a pharmacy; they often dispense the medicine directly from their own clinic. The survey found that nearly one-third of the doctors admitted to doing this occasionally, and a few did it very often. This practice bypasses the formal prescription system and makes it harder to track what medicines are being used, which is a major hurdle for controlling resistance.

The doctors were also very clear about what stands in the way of better practices. The most frequently cited barrier was the lack of diagnostic capacity. Without reliable and quick laboratory tests to identify the specific germ causing an infection, doctors feel forced to guess which medicine might work. Other major hurdles included a lack of regulatory oversight, meaning rules are not always enforced, and financial pressures that make it difficult to prioritize the best treatment over the cheapest one.

Despite these challenges, the mood among the doctors was surprisingly optimistic and eager for change. An overwhelming majority expressed a strong willingness to participate in training programs on antimicrobial stewardship. They were confident that such programs would improve how medicines are used. They did not want to be policed or punished; instead, they wanted to learn. When asked who should lead these efforts, they pointed to trusted professional groups like the Nigerian Medical Association and the Pharmacy Council of Nigeria, rather than law enforcement agencies. They also supported the idea of doctors from different clinics working together to share what works best.

The study concludes that the private healthcare sector in Nigeria is ready to engage in the fight against drug resistance, but it needs support. The doctors are not ignoring the problem; they are aware of it and want to do better. However, they are operating in a system where diagnostic tools are scarce, regulations are weak, and financial pressures are high. To fix this, the researchers suggest that solutions must be practical and tailored to the local context. This means providing accessible education that fits into the doctors' busy schedules, improving the availability of diagnostic tests, and creating a supportive environment where professional organizations lead the way. By addressing these structural issues and listening to the doctors who are on the front lines, it may be possible to slow the spread of resistance and ensure that these life-saving medicines continue to work for future generations.