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Impact of Antimicrobial Resistance Awareness on Antibiotic Use Practices among University Students in Nigeria

Abstract

Antimicrobial resistance (AMR) is an increasing public health challenge that threatens the effectiveness of antibiotics used to prevent and treat bacterial infections. Antimicrobial resistance occurs when microorganisms develop the ability to survive exposure to medicines that would normally inhibit or eliminate them, making infections more difficult to treat and increasing the risk of complications, prolonged illness, healthcare costs, and mortality. Awareness of AMR among university students is particularly important because young adults may engage in antibiotic-use practices such as self-medication, obtaining antibiotics without prescriptions, discontinuing treatment when symptoms improve, sharing antibiotics, or using previously prescribed medicines. Appropriate antibiotic use requires individuals to understand when antibiotics are necessary, the importance of professional medical advice, adherence to prescribed dosage and duration, and the risks associated with inappropriate antibiotic use. In Nigeria, inappropriate antibiotic use remains a public health concern due to factors including over-the-counter access to antibiotics, self-medication, limited antimicrobial stewardship awareness, inadequate access to healthcare services, and misconceptions regarding the treatment of viral and bacterial infections. University students may be particularly exposed to these challenges because of their independence in healthcare decision-making, academic pressures, financial constraints, peer influence, and access to medicines through informal channels. Although awareness of AMR has received increasing attention globally, awareness does not necessarily translate into appropriate antibiotic-use practices. Against this background, this study investigates the impact of antimicrobial resistance awareness on antibiotic-use practices among university students in Nigeria. The study is anchored on the Health Belief Model (HBM), Theory of Planned Behavior (TPB), and Knowledge-Attitude-Practice (KAP) framework. The Health Belief Model suggests that individuals' health-related behaviors are influenced by their perceived susceptibility to health threats, perceived severity of those threats, perceived benefits of appropriate actions, and perceived barriers to adopting recommended behaviors. The Theory of Planned Behavior proposes that behavioral intentions and actual practices are influenced by attitudes, subjective norms, and perceived behavioral control. The Knowledge-Attitude-Practice framework provides a basis for examining how knowledge and awareness of AMR may influence attitudes and ultimately affect antibiotic-use practices. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how awareness of antimicrobial resistance may influence antibiotic-use practices among university students in Nigeria. The study adopts a quantitative cross-sectional research design. Primary data will be collected from undergraduate and postgraduate students enrolled in selected universities in Nigeria using a structured self-administered questionnaire. A multistage sampling technique will be employed to select universities, faculties, departments, and students to ensure adequate representation of the study population. Antimicrobial resistance awareness will be measured using students' knowledge of AMR causes, transmission, consequences, prevention, antimicrobial stewardship, antibiotic resistance development, and appropriate antibiotic use. Antibiotic-use practices will be assessed using indicators such as obtaining antibiotics with or without prescriptions, self-medication, adherence to prescribed dosage and treatment duration, discontinuation of antibiotics when symptoms improve, sharing antibiotics with others, use of leftover antibiotics, consultation with healthcare professionals before antibiotic use, and use of antibiotics for conditions such as common cold and other illnesses for which antibiotics may not be appropriate. Descriptive statistics will be used to summarize respondents' demographic characteristics and levels of AMR awareness and antibiotic-use practices. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be employed to determine the impact of antimicrobial resistance awareness on antibiotic-use practices. Appropriate diagnostic tests will also be conducted to assess multicollinearity, model specification, goodness of fit, and the robustness of the estimated relationships. The study anticipates that antimicrobial resistance awareness will have a significant positive impact on appropriate antibiotic-use practices among university students in Nigeria. Students with higher awareness of AMR are expected to demonstrate better understanding of the consequences of antibiotic misuse, the importance of completing prescribed treatment, the dangers of self-medication, and the need to obtain antibiotics through appropriate healthcare channels. Increased awareness may therefore reduce inappropriate practices such as purchasing antibiotics without prescriptions, sharing antibiotics, using leftover medicines, and stopping treatment prematurely. However, awareness alone may not be sufficient to guarantee appropriate antibiotic use. Students may continue to engage in inappropriate practices because of financial constraints, limited access to healthcare professionals, convenience, previous experiences with antibiotics, peer influence, availability of medicines through informal sources, and perceptions that antibiotics provide quick relief. Consequently, the effectiveness of AMR awareness in improving antibiotic-use practices is expected to depend partly on students' ability to access appropriate healthcare and obtain reliable professional guidance regarding antibiotic treatment. This study is expected to make significant contributions to the literature on antimicrobial resistance, health education, health behavior, and public health in Nigeria by providing empirical evidence on the relationship between AMR awareness and antibiotic-use practices among university students. The findings will provide useful information for the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention (NCDC), National Primary Health Care Development Agency (NPHCDA), universities, healthcare professionals, pharmacists, public health practitioners, antimicrobial stewardship programmes, and policymakers regarding the role of awareness in promoting responsible antibiotic use among young adults. The study will also provide evidence-based recommendations for strengthening AMR education in universities, incorporating antimicrobial stewardship into student health programmes, improving access to reliable health information, promoting responsible antibiotic dispensing, discouraging self-medication, and strengthening public health interventions aimed at reducing inappropriate antibiotic use and the development and spread of antimicrobial resistance in Nigeria.

Keywords: Antimicrobial resistance, AMR awareness, antibiotic use, antibiotic-use practices, university students, antimicrobial stewardship, self-medication, health behavior, public health, Nigeria.