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Effect of Antimicrobial Resistance Education on Responsible Antibiotic Use among University Students in Nigeria

Abstract

Antimicrobial resistance is an increasing public health challenge that threatens the effective treatment of bacterial infections and contributes to prolonged illness, increased healthcare costs, treatment failure, and preventable deaths. Inappropriate antibiotic use is one of the important factors contributing to the development and spread of antimicrobial resistance. University students may be exposed to inappropriate antibiotic-use practices, including self-medication, obtaining antibiotics without appropriate professional consultation, sharing antibiotics with others, using leftover medicines, discontinuing treatment when symptoms improve, and using antibiotics for conditions for which they are not indicated. Antimicrobial resistance education provides students with information about antimicrobial resistance, appropriate antibiotic use, antibiotic stewardship, the dangers of self-medication, antimicrobial resistance prevention, and the importance of using antibiotics only when appropriately prescribed. Responsible antibiotic use involves obtaining antibiotics through appropriate healthcare channels, using antibiotics only when indicated, following prescribed dosage and duration, avoiding unnecessary antibiotic use, not sharing antibiotics, and completing treatment as directed by a qualified healthcare professional. In Nigeria, misconceptions about antibiotics, easy access to medicines, self-medication, inadequate knowledge, and inappropriate perceptions about antibiotic effectiveness may contribute to misuse among young adults. Effective antimicrobial resistance education may improve knowledge and encourage responsible antibiotic-use practices among university students. Against this background, this study investigates the effect of antimicrobial resistance education on responsible antibiotic use among university students in Nigeria. The study is anchored on the Health Belief Model, Theory of Planned Behavior, and Knowledge-Attitude-Practice framework. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding students' decisions regarding antibiotic use. The Theory of Planned Behavior explains how attitudes, subjective norms, and perceived behavioural control influence intentions and subsequent antibiotic-use behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from antimicrobial resistance education may influence responsible antibiotic-use practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how antimicrobial resistance education may influence responsible antibiotic use among university students in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from undergraduate students in selected universities in Nigeria using a structured self-administered questionnaire. A multistage sampling technique will be employed to select universities, faculties or departments, and eligible students. Where feasible, selected student groups or academic units will be assigned to intervention and comparison groups. Students in the intervention group will receive structured antimicrobial resistance education covering the meaning and causes of antimicrobial resistance, appropriate antibiotic use, antibiotic stewardship, common misconceptions about antibiotics, dangers of self-medication, risks of sharing or using leftover antibiotics, adherence to prescribed dosage and duration, appropriate healthcare-seeking, and strategies for preventing antimicrobial resistance. Responsible antibiotic use will be assessed using indicators such as obtaining antibiotics through appropriate healthcare channels, avoiding self-medication, using antibiotics only when prescribed or otherwise appropriately indicated, adhering to prescribed dosage and duration, avoiding sharing antibiotics, avoiding the use of leftover antibiotics, and seeking professional advice when uncertain about antibiotic use. Descriptive statistics will be used to summarize students' sociodemographic characteristics, antimicrobial resistance knowledge, exposure to education, and antibiotic-use practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple regression analysis, will be used to determine the effect of antimicrobial resistance education on responsible antibiotic use. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that antimicrobial resistance education has a significant positive effect on responsible antibiotic use among university students in Nigeria. Students exposed to structured antimicrobial resistance education are expected to demonstrate improved knowledge of antimicrobial resistance and greater adherence to responsible antibiotic-use practices. Education may reduce misconceptions about antibiotics, discourage self-medication, reduce the use of leftover or shared antibiotics, improve adherence to prescribed treatment regimens, and encourage students to seek appropriate professional healthcare when experiencing symptoms of infection. However, education alone may not eliminate inappropriate antibiotic use because students may continue to face barriers such as easy access to antibiotics without appropriate consultation, healthcare costs, limited access to healthcare services, peer influence, previous experiences with antibiotics, and misconceptions about the need for antibiotics for common illnesses. Consequently, antimicrobial resistance education is expected to be most effective when supported by antimicrobial stewardship programmes, responsible medicine dispensing practices, accessible healthcare services, and institutional policies promoting appropriate antibiotic use. The study is expected to contribute to the literature on antimicrobial resistance, antibiotic stewardship, health education, infectious disease prevention, rational medicine use, and public health in Nigeria by providing empirical evidence on the effect of antimicrobial resistance education on responsible antibiotic use among university students. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention (NCDC), universities, university health centres, pharmacists, medical practitioners, public health professionals, antimicrobial stewardship programmes, development partners, and policymakers regarding strategies for improving antibiotic-use behaviour among young adults. The study will also provide evidence-based recommendations for integrating antimicrobial resistance education into university health programmes, strengthening antibiotic stewardship initiatives, improving access to appropriate healthcare services, promoting responsible antibiotic dispensing, addressing misconceptions about antibiotics, and reducing inappropriate antibiotic use among university students across Nigeria.

Keywords: Antimicrobial resistance education, responsible antibiotic use, university students, antibiotic stewardship, antibiotic misuse, self-medication, antimicrobial resistance, rational antibiotic use, health education, infectious disease prevention, public health, Nigeria.