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

Abstract

Antimicrobial resistance (AMR) is a major public health challenge in Nigeria and globally, with inappropriate and excessive use of antibiotics contributing significantly to the emergence and spread of resistant microorganisms. University students are an important population for antimicrobial resistance prevention because they may obtain antibiotics without appropriate prescriptions, self-medicate, discontinue treatment when symptoms improve, share antibiotics with others, or use antibiotics for illnesses that do not require antibacterial treatment. Antimicrobial resistance education provides students with information about antimicrobial resistance, causes and consequences of antibiotic resistance, appropriate indications for antibiotic use, prescription requirements, adherence to prescribed treatment, dangers of self-medication and sharing antibiotics, and the importance of completing treatment as directed by qualified healthcare professionals. Responsible antibiotic use refers to behaviours that promote the appropriate and safe use of antibiotics, including using antibiotics only when indicated and prescribed, taking the correct dose and duration, following healthcare professionals' instructions, avoiding sharing or using leftover antibiotics, and seeking appropriate professional advice when experiencing symptoms of illness. In Nigeria, factors such as self-medication, easy access to antibiotics, misinformation, inadequate knowledge, financial constraints, and misconceptions about antibiotics may contribute to inappropriate antibiotic use. Effective antimicrobial resistance education may improve students' knowledge and encourage responsible antibiotic-use practices. Against this background, this study investigates the impact of antimicrobial resistance education on responsible antibiotic use among university students in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and Knowledge-Attitude-Practice framework. The Health Belief Model explains health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding students' decisions regarding appropriate antibiotic use. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping health 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 anonymous self-administered questionnaire. A multistage sampling technique will be employed to select states, universities, faculties or departments, academic levels, and eligible students. Where feasible, selected student groups 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 AMR, consequences of antibiotic resistance, appropriate indications for antibiotic use, prescription requirements, adherence to prescribed dosage and duration, risks of self-medication, dangers of sharing antibiotics, appropriate disposal of leftover antibiotics, antibiotic use for viral infections, and the importance of seeking professional healthcare advice. Responsible antibiotic use will be assessed using indicators such as obtaining antibiotics through appropriate professional prescription, avoiding self-medication, following prescribed dosage and duration, avoiding sharing antibiotics, avoiding use of leftover antibiotics, and seeking professional advice before antibiotic use. Descriptive statistics will be used to summarize students' sociodemographic characteristics, AMR knowledge, exposure to education, and antibiotic-use practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact 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 impact on responsible antibiotic use among university students in Nigeria. Students exposed to structured AMR education are expected to demonstrate improved understanding of antibiotic resistance and greater adoption of responsible antibiotic-use practices. Education may reduce self-medication, discourage the use of antibiotics without appropriate professional advice, improve adherence to prescribed treatment, reduce antibiotic sharing, discourage the use of leftover antibiotics, and improve students' understanding that antibiotics are not appropriate for most viral infections. However, education alone may not guarantee sustained responsible antibiotic use because students may continue to face barriers such as the availability of antibiotics without prescriptions, cost of healthcare services, previous experiences with self-medication, peer influence, misinformation, and limited access to convenient healthcare services. Consequently, antimicrobial resistance education is expected to be most effective when supported by antimicrobial stewardship programmes, appropriate regulation of antibiotic sales, accessible healthcare services, professional counselling, and continuous public health communication. The study is expected to contribute to the literature on antimicrobial resistance, antibiotic stewardship, health education, infectious disease prevention, university health, and public health in Nigeria by providing empirical evidence on the impact 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), National Primary Health Care Development Agency (NPHCDA), Pharmacists Council of Nigeria, Medical and Dental Council of Nigeria, National Universities Commission, university health services, healthcare professionals, pharmacists, public health practitioners, development partners, and policymakers regarding strategies for promoting responsible antibiotic use. The study will also provide evidence-based recommendations for strengthening university-based antimicrobial resistance education, improving antimicrobial stewardship, promoting appropriate antibiotic prescribing and dispensing, reducing non-prescription antibiotic use, strengthening regulation of antibiotic sales, and encouraging responsible antibiotic-use practices among university students across Nigeria.

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