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

Abstract

Antimicrobial resistance (AMR) is a major and growing public health challenge because inappropriate use of antibiotics accelerates the development and spread of resistant microorganisms, reducing the effectiveness of available treatments and increasing the risk of prolonged illness, complications, and healthcare costs. Antimicrobial resistance education refers to structured educational activities designed to improve individuals' knowledge and understanding of antimicrobial resistance, its causes, consequences, prevention, antibiotic stewardship, and responsible use of antibiotics. Appropriate antibiotic use refers to the use of antibiotics only when clinically indicated and in accordance with appropriate professional advice, prescribed dosage, frequency, duration, and other recommended treatment instructions. University students represent an important population for AMR interventions because they are active users of healthcare services, pharmacies, social media, online information, and peer networks and may influence medicine-use practices within their communities. In Nigeria, inappropriate antibiotic practices among young adults may include self-medication, obtaining antibiotics without appropriate consultation, using antibiotics for illnesses that do not require them, sharing antibiotics, using leftover medicines, and discontinuing treatment without professional advice. Targeted antimicrobial resistance education may improve students' understanding of antibiotic resistance and encourage responsible antibiotic-use practices. Against this background, this study investigates the effect of antimicrobial resistance education on appropriate antibiotic use among university students in Nigeria. The study is anchored on the Health Belief Model, Knowledge-Attitude-Practice Framework, and Theory of Planned Behavior. The Health Belief Model explains how perceptions of disease susceptibility, severity, benefits of appropriate preventive actions, perceived barriers, and cues to action may influence antibiotic-use behaviours. The Knowledge-Attitude-Practice Framework provides a basis for examining how educational interventions can improve knowledge and influence health-related practices. The Theory of Planned Behavior explains how knowledge, attitudes, subjective norms, and perceived behavioural control may influence individuals' intentions and behaviours concerning appropriate antibiotic use. Collectively, these theoretical perspectives provide a suitable framework for explaining how antimicrobial resistance education may influence antibiotic-use practices among university students in Nigeria. The study will adopt a quantitative quasi-experimental research design. University students will be selected from participating Nigerian universities and assessed before and after exposure to a structured antimicrobial resistance education programme. A multistage sampling technique will be employed to select universities, faculties or departments, and eligible students. Participants will be assessed at baseline and after the educational intervention using a structured questionnaire. Antimicrobial resistance education will cover topics such as the meaning and causes of antimicrobial resistance, inappropriate antibiotic use, appropriate indications for antibiotics, antibiotic self-medication, antibiotic prescription requirements, adherence to prescribed treatment, risks of sharing or using leftover antibiotics, consequences of antimicrobial resistance, antibiotic stewardship, and the importance of seeking appropriate professional advice. Appropriate antibiotic use will be assessed using indicators such as avoidance of antibiotic self-medication, appropriate consultation before antibiotic use, use of antibiotics only when indicated, adherence to prescribed dosage and frequency, adherence to prescribed duration, avoidance of sharing antibiotics, avoidance of using leftover antibiotics, appropriate response to illnesses that do not require antibiotics, and appropriate disposal or storage practices where relevant. Pre-intervention and post-intervention responses will be compared to determine changes in antibiotic-use practices. Descriptive statistics will be used to summarize participants' characteristics, baseline knowledge, and antibiotic-use practices. Inferential techniques, including paired-sample statistical tests, chi-square tests, correlation analysis, and regression analysis, will be used to determine the effect of antimicrobial resistance education on appropriate antibiotic use. Diagnostic tests will also be conducted to assess the reliability of the research instrument and the robustness of the findings. The study is expected to find that antimicrobial resistance education has a significant positive effect on appropriate antibiotic use among university students in Nigeria. Students exposed to structured AMR education are expected to demonstrate improved understanding of antimicrobial resistance and more appropriate antibiotic-use practices compared with their baseline responses. The educational intervention is expected to reduce practices such as self-medication, obtaining antibiotics without appropriate professional advice, using leftover antibiotics, sharing antibiotics, and using antibiotics for conditions that do not require antibiotic treatment. Students are also expected to demonstrate improved understanding of the importance of adhering to prescribed dosage, frequency, and duration and seeking appropriate healthcare advice before using antibiotics. However, education alone may not completely determine antibiotic-use practices because access to healthcare, cost of consultation, availability of antibiotics without prescription, pharmacy practices, previous treatment experiences, peer influence, and access to reliable health information may also affect antibiotic-use decisions. Therefore, antimicrobial resistance education should be implemented alongside broader antibiotic-stewardship and medicine-use interventions. The study is expected to contribute to the literature on antimicrobial resistance education, appropriate antibiotic use, antibiotic stewardship, health education, pharmacy practice, epidemiology, university health, and public health in Nigeria by providing empirical evidence on the effectiveness of targeted education in improving antibiotic-use behaviour among young adults. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, Pharmacy Council of Nigeria, universities, university health centres, pharmacists, healthcare professionals, public-health educators, development partners, and policymakers regarding strategies for reducing inappropriate antibiotic use. The study will also provide evidence-based recommendations for incorporating antimicrobial resistance education into university health programmes, strengthening student-focused AMR campaigns, improving access to credible antibiotic information, training healthcare providers in antibiotic-stewardship communication, promoting responsible medicine use, and establishing sustainable educational interventions to address antimicrobial resistance among young adults in Nigeria.

Keywords: Antimicrobial resistance education, appropriate antibiotic use, university students, Nigeria, antimicrobial resistance, antibiotic stewardship, antibiotic misuse, health education, self-medication, pharmacy practice, public health, responsible medicine use.