Management of Antimicrobial Resistance in Nigerian Secondary Healthcare Facilities: Policy Gaps and Practical Solutions

Antimicrobial resistance (AMR) represents one of the most urgent threats to healthcare delivery in Nigeria, yet structured management frameworks within secondary healthcare facilities remain poorly developed. This study examines AMR management practices at 10 secondary health facilities across three geopolitical zones including Enugu (South East), Kaduna (North West), and Ondo (South West) States, focusing on stewardship programme implementation, diagnostic capacity, and prescribing patterns. A mixed-methods approach combines facility audits, structured interviews with 30 clinical and laboratory staff, and retrospective analysis of antibiotic prescription records. Findings reveal that fewer than 30 percent of facilities have formal antimicrobial stewardship programmes and only 40 percent routinely perform antibiotic susceptibility testing before prescription. Empirical prescribing guided by clinical judgement alone is the dominant practice, with broad-spectrum agents accounting for 62 percent of all antibiotic prescriptions audited. Over-the-counter antibiotic dispensing by facility pharmacies was documented in 35 percent of encounters reviewed. The study identifies staff knowledge gaps, equipment deficits, and absence of local antibiograms as the primary stewardship obstacles. A facility-level AMR management framework adapted to the resource constraints of Nigerian secondary hospitals is proposed, incorporating antibiogram development, prescriber education modules, and pharmacy gatekeeping protocols. Professional recommendations target State Ministries of Health for mandatory stewardship policy adoption. Keywords: antimicrobial resistance, stewardship, secondary healthcare, Nigeria, prescribing practice