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Knowledge-Practice Gaps in Antimicrobial Prescribing among Nigerian Healthcare Providers: A Systematic Review and Meta-Analysis

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DOI: 10.21522/TIJAR.2014.13.03.Art034

Authors : Mawo Philip Benu, Michael Olabode Tomori, Sebit Mustafa Sebit

Abstract:

Antimicrobial resistance (AMR) remains a major public health challenge globally, with low- and middle-income countries such as Nigeria carrying a substantial burden because of irrational antibiotic use, weak antimicrobial stewardship (AMS) systems, and limited diagnostic capacity. This systematic review and meta-analysis synthesized evidence on AMR knowledge, AMS awareness, and antibiotic prescribing practices among healthcare workers in Nigeria. A comprehensive search of PubMed, Scopus, and Web of Science identified 136 records, of which 17 studies met the eligibility criteria for qualitative synthesis and 15 were included in quantitative meta-analysis. Quantitative synthesis was conducted using a random-effects model. The pooled proportion of healthcare workers demonstrating good AMR knowledge was 64.8% (95% CI: 58.1%–71.2%), while AMS awareness was lower at 49.3% (95% CI: 41.2%–57.5%). Poor or inappropriate antibiotic prescribing practices remained common, with a pooled prevalence of 61.7% (95% CI: 53.4%–69.6%), whereas empirical antibiotic prescribing reached 72.9% (95% CI: 65.1%–79.8%). Recent AMS training exposure was also limited at 38.6% (95% CI: 30.4%–47.5%). Narrative synthesis revealed persistent gaps in stewardship implementation, diagnostic limitations, weak institutional support, pharmaceutical influence, and inadequate continuous professional education across healthcare settings. The findings demonstrate that moderate awareness of AMR among Nigerian healthcare workers has not translated into rational antimicrobial prescribing practices. Strengthening institutional AMS programs, improving diagnostic infrastructure, expanding stewardship training, and implementing behavior-focused interventions are urgently needed to reduce irrational antimicrobial use and curb the growing burden of AMR in Nigeria.

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