AMINU (not his real name), a 7-year-old boy from Katsina State, was full of energy and often seen playing football barefoot in his village. One day, he started feeling sick with headaches and body pain. His mother suspected malaria and took him to a local chemist. Without proper tests, he was given antibiotics.
But Aminu didn’t get better. His parents took him from one clinic to another, each time receiving stronger antibiotics. By the time they reached a general hospital in Kano, his infection had become severe and resistant to nearly all available antibiotics. The doctors explained that the bacteria had become stronger and could no longer be killed by the drugs.
Aminu is one of many Nigerians affected by antimicrobial resistance (AMR), a growing crisis where infections become untreatable because germs no longer respond to the medicines meant to kill them.
What is AMR?
AMR happens when bacteria, viruses, fungi, or parasites evolve and stop responding to medicines meant to kill them. This makes infections harder and sometimes impossible to treat. Common illnesses can become deadly. People stay sick longer, face complications as common illnesses can become deadly.
Antimicrobials are drugs used to fight infections in people, animals, and even plants. They include:
- Antibiotics – for bacterial infections
- Antivirals – for viral infections
- Antifungals – for fungal infections
- Antiparasitics – for parasitic infections
How serious is the problem?
Globally, drug-resistant infections were linked to 4.95 million deaths in 2019, including 1.27 million directly caused by resistance.
Why AMR is a big problem in Nigeria
In Nigeria alone, 263,400 people died in 2019 from drug-resistant infections more than from malaria or heart disease. The country ranks 20th out of 204 nations in drug-resistance death rates. This means more Nigerians died from conditions related to drug resistance than of malaria, respiratory infections, or cardiovascular diseases
Why Is AMR happening?
According to the Nigeria Centre for Disease Control (NCDC), several connected factors fuel AMR:
1. Misuse and overuse of antibiotics
- People often buy antibiotics without prescriptions.
- Many use them for viral infections like colds, which antibiotics cannot treat.
The NCDC had issued a warning against the indiscriminate sale and display of antibiotics. The centre also called for strict enforcement of prescription regulations to curb the growing threat of Antimicrobial Resistance (AMR).
Globally, the consumption of antibiotics increased by almost half between 2000 and 2018. The rate of increase has been steepest in South Asia, where the proportion of people receiving antibiotics each day has more than doubled in the last 25 years.
The increase shows that antibiotics aren’t always used in the right way. Sometimes they are used unnecessarily – for example, for a viral infection like a cold or flu, on which antibiotics will have no effect. Other times they are misused: someone takes the wrong type, dose or course of drug. These inappropriate uses of antibiotics are huge contributors to the emergence of drug-resistant bacteria.
2. Incomplete treatment
- Some stop taking antibiotics once they feel better, allowing bacteria to survive and become stronger.
3. Poverty and inadequate access to drugs
- Many can’t afford full treatment or professional care.
- This leads to self-medication and use of fake or low-quality drugs.
In low-income countries like Nigeria where over 100 million people are multidimensionally poor, many cannot afford full medical treatments or consult qualified healthcare professionals. This leads to self-medication or reliance on substandard drugs, both of which increase the risk of resistance.
4. Poor sanitation and hygiene
- Dirty water and living conditions help infections spread, increasing antibiotic use and resistance.
5. Lack of awareness
- Many Nigerians don’t understand how dangerous AMR is.
- Without awareness, people are more likely to misuse antibiotics.
6. Uncontrolled sale and distribution of antibiotics
- Antibiotics are sold freely in some places, even by untrained staff.
- The NCDC has warned against this and called for strict rules on sales and prescriptions.
Speaking at a programme titled “Strengthening healthcare facility antimicrobial stewardship programme in Nigeria”, the World Health Organisation’s Country Representative, Walter Kazadi stressed the need for coordinated and collaborative efforts in addressing AMR.
Kazadi who was represented by Laxmikant Chavan from WHO, acknowledged the overuse and misuse of antibiotics in Nigeria, particularly in primary health care settings, and the need to scale up fight against AMR across the country’s 40,000 hospitals.
“Antimicrobial stewardship (AMS) is important because, in Nigeria, we have overuse and misuse of antibiotics; we know there is a lot of evidence on that, and that is actually fueling and spreading this AMR pathogen. We need to have many AMS in our hospitals, at least in 50 per cent of our 40,000 hospitals,” he noted.
What Nigeria is doing about It
Nigeria’s response to antimicrobial resistance, led by the Nigerian Centre for Disease Control (NCDC) in 2016 followed a situational analysis that investigated common antimicrobial-resistant pathogens recovered from hospitals, animal sources, and agricultural and environmental sources.
The NCDC also conducted systematic reviews to assess the prescribing patterns of antimicrobials in hospitals across the country. These efforts informed the development of the National Action Plan (NAP), designed with a 5-year focus in mind (2017–2022).
The National Action Plan (NAP) includes:
- Promoting responsible drug use in humans and animals.
- Improving hygiene and vaccination to prevent infections before they start.
- Training health workers and educating the public about AMR dangers.
- Tracking resistance trends through a nationwide surveillance system.
- Supporting research into new drugs, vaccines, and alternative treatments.
The NAP takes a “One Health” approach, involving human health, animals, agriculture, and the environment. Ministries, researchers, civil society, and global partners are working together to stop AMR from worsening.
Many health institutions face significant Infection prevention and control (IPC) gaps, such as poor hand hygiene, inadequate sterilisation of medical equipment, and limited vaccination coverage. NAP recommends strengthening IPC, which involves improving hygiene practices at all levels of care, ensuring adequate availability of water, sanitation, and hygiene (WASH) infrastructure, and promoting vaccination against preventable diseases like pneumococcal infections and typhoid. This pillar aims to curb the spread of infections and reduce reliance on antibiotics, particularly in resource-constrained settings.
The bottom line – AMR awareness and understanding
The NAP calls for targeted advocacy, education, and communication strategies to improve awareness of AMR among health professionals, farmers, policymakers, and the general public. Public understanding of AMR is limited in many communities, where antibiotics are often perceived as a quick fix for all infections.
To protect people like Aminu and prevent curable infections from becoming deadly, the NAP recommends:
- Enforcing prescription rules,
- Improve access to quality healthcare,
- Educate the public, and
- Strengthen hospital practices.
Nurudeen Akewushola is an investigative reporter and fact-checker with The ICIR. He believes courageous in-depth investigative reporting is the key to social justice, accountability and good governance in society. You can reach him via nyahaya@icirnigeria.org and @NurudeenAkewus1 on Twitter.