Understanding the Lived Experience of Adverse Drug Reactions among Patients in Rural Communities of North Central Nigeria: A Phenomenological Inquiry with Implications for Pharmacovigilance

Background: Pharmacovigilance systems rely predominantly on formal healthcare channels for adverse drug reaction (ADR) detection, systematically excluding the experiences of rural populations who often encounter ADRs without professional support. In North Central Nigeria, where healthcare access is limited, understanding the lived experience of ADRs offers insights that conventional surveillance cannot capture. This phenomenological inquiry investigates ADR experiences among rural community dwellers in North Central Nigeria and derives implications for pharmacovigilance system design. Methods: A descriptive phenomenological design was employed using in-depth interviews with 45 purposively selected adults from rural communities in Benue, Nasarawa, and Niger states who reported experiencing significant reactions to prescribed or self-purchased medicines. Interviews were audio-recorded, transcribed verbatim, and analysed using Colaizzi's seven-step procedure. Community health workers served as cultural liaisons and co-investigators. Results: Five thematic clusters emerged describing ADR experiences: unexpected bodily disruption and fear, attribution to spiritual causes in the absence of professional interpretation, self-management using complementary remedies, silence and internalisation to avoid stigma, and erosion of trust in biomedicine following ADR events. Barriers to reporting included absence of perceived reporting channels and fear of discontinuation of beneficial medication. Conclusion: Rural ADR experiences in North Central Nigeria are characterised by fear, misattribution, and systemic invisibility. Community-based pharmacovigilance models incorporating traditional health workers and mobile reporting tools are needed to achieve more equitable ADR surveillance. Keywords: adverse drug reactions, pharmacovigilance, phenomenology, rural communities, North Central Nigeria