Theoretical Framework for Integrating One Health Principles into Veterinary Surgical Antimicrobial Stewardship in Nigerian Referral Hospitals

The rise of antimicrobial-resistant pathogens in Nigerian veterinary surgical settings presents a complex public health challenge that extends beyond clinical practice boundaries into ecosystem and human health domains. This doctoral study develops and proposes a theoretical framework for integrating One Health principles into antimicrobial stewardship programs within veterinary surgical departments at referral hospitals in Nigeria. Using a grounded theory methodological approach, data were collected from 62 key informant interviews with veterinary surgeons, clinical microbiologists, public health officials, and livestock policy makers across 12 states spanning all six geopolitical zones between 2021 and 2024. Thematic analysis of interview transcripts and systematic review of 84 peer-reviewed studies published between 2019 and 2024 informed framework development. The resulting One Health Veterinary Stewardship Framework comprises five interconnected domains: clinical prescribing rationalization, surgical infection surveillance, cross-sector communication protocols, institutional policy architecture, and ecosystem resistance monitoring. The framework identifies feedback loops between companion animal, livestock, and human antimicrobial resistance patterns that require integrated monitoring. Pilot institutional testing at three referral hospitals confirmed the framework's contextual relevance and preliminary feasibility. This theoretical contribution advances the Nigerian veterinary surgery literature by providing the first indigenously developed, evidence-grounded stewardship framework adaptable to the resource realities and epidemiological contexts of Nigerian referral hospitals. Keywords: One Health, antimicrobial stewardship, veterinary surgery, theoretical framework, antimicrobial resistance.