![](3D"DavwarNMJ64No4Page492_files/image002.png")
<=
/td>
![](3D"DavwarNMJ64No4Page492_files/image005.png")
Knowledge, Attitudes, and Practice of Doct=
ors
in Nigeria
Regarding Antimicrobial Resistance.=
*<=
/a>Pantong Davwar1, Nandom B=
itrus2,
David Nyam1, Kajo Ioramo1, Kefas Zawaya3, =
Orighomisan Agboghoroma1.
1 <=
span
lang=3DEN-US style=3D'font-family:"Times New Roman",serif;color:black;mso-t=
hemecolor:
text1'>Department of Internal Medicine, Jos University Teaching Hospi=
tal,
Plateau State Nigeria 2Department of Internal Medicine,
Federal Medical Centre, Nguru Yobe State, Niger=
ia 3
Department of Internal Medicine, Federal Teaching Hospital, Gombe,
Nigeria.
![](3D"DavwarNMJ64No4Page492_files/image007.png")
Background: Infectious d=
isease
treatment and prevention are threatened by antimicrobial resistance (AMR)
globally. The knowledge and attitudes of doctors regarding AMR and the
responsible use of antibiotics are critical to improving prescribing behaviours and mitigating the danger that AMR poses. =
This
study aims to assess the knowledge attitudes and practices of doctors in
Nigeria regarding AMR.
Methodology: This was an =
online
survey of doctors in Nigeria. A 31-item self-administered questionnaire was
distributed via an online forum for doctors. The questionnaire consisted of
knowledge, attitudes, and practices sections. Demographic and practice data
were also collected from respondents. Data were analyzed using IBM-SPSS and
were mainly descriptive. Bivariate correlation was used to determine the
relationship between knowledge attitudes and practices.
Results: Two hundred =
and
fifty -two doctors completed the survey.
There were 105 (42%) resident doctors who participated in the
study. Good knowledge and fair kno=
wledge
of AMR were shown by 95(41%) and 146(58%) doctors, respectively. There were few respondents with good
attitudes and practices: 40 (16%) and 16 (6%), respectively. A large proportion of respondents had f=
air
attitudes and practices -204(81%) and 185(73%) respectively. The relationship between practice, know=
ledge,
and attitude was negligible. (r<1, p>0.05).
Conclusion: Most doctors in this study showed fair=
to
good knowledge, attitudes, and practices regarding AMR. Efforts to reduce t=
he
incidence of AMR should leverage the perceptions and b=
ehaviours
of these healthcare workers.
Keywords: Antimicrobia=
l,
Resistance, Survey, Doctors, Nigeria.
*Corres=
pondence: Dr.
Pantong Davwar Depa=
rtment
of Medicine, Jos University Teaching Hospital, Jos, Nigeria.
E-mail: pdavwar@gmail.com
This is an open access journ=
al,
and articles are distributed under the terms of the Creative Commons
Attribution-Non-Commercial Share Alike 4.0 License, which allows others to
remix, tweak, and build upon the work non-commercially, as long as appropri=
ate
credit is given and the new creations are licensed under the identical term=
s.
How to Cite: Davwar
P, Bitrus N, Nyam D, Ioramo K, Zawaya
K, Agboghoroma O. Knowledge, Attitudes, and Pra=
ctice
of Doctors in Nigeria Regarding Antimicrobial Resistance. Niger Med J
2023;64(4): 492-502. Accepted: July 5, 2023. Published: September 21, 2023.=
![](3D"DavwarNMJ64No4Page492_files/image009.png")
=
=
Introduction
Antimicrobial
resistance (AMR) is a global problem, more so in lower and middle-income
countries where the effect is difficult to combat due to limited resources.=
AMR
has the potential to undermine the progress made in the management of infec=
tious
diseases as it reduces the effectiveness of available antibiotic therapy.
Although there are few surveillance reports from Africa, the available data
indicate a high prevalence of AMR in countries with these reports.ADDIN CSL_CITAT=
ION
{"citationItems":[{"id":"ITEM-1","itemDa=
ta":{"DOI":"10.1007/s13312-014-0374-3","ISBN&=
quot;:"9789241564748","ISSN":"0042-9686",&quo=
t;PMID":"6603914","abstract":"The
development of antimicrobial drugs, and particularly of antibiotics, has pl=
ayed
a considerable role in substantially reducing the morbidity and mortality r=
ates
of many infectious diseases. However, the fact that bacteria can develop
resistance to antibiotics has produced a situation where antimicrobial agen=
ts
are losing their effectiveness because of the spread and persistence of
drug-resistant organisms. To combat this, more and more antibiotics with
increased therapeutic and prophylactic action will need to be developed.This
article is concerned with antibiotic resistance in bacteria which are
pathogenic to man and animals. The historical background is given, as well =
as
some information on the present situation and trends of antibiotic resistan=
ce
to certain bacteria in different parts of the world. Considerable concern is
raised over the use of antibiotics in man and animals. It is stated that
antibiotic resistance in human pathogens is widely attributed to the
\"misuse\" of antibiotics for treatment and prophylaxis in man an=
d to
the administration of antibiotics to animals for a variety of purposes (gro=
wth
promotion, prophylaxis, or therapy), leading to the accumulation of resista=
nt
bacteria in their flora. Factors favouring the development of resistance are
discussed.","author":[{"dropping-particle":"&=
quot;,"family":"WHO","given":"",&qu=
ot;non-dropping-particle":"","parse-names":false,&=
quot;suffix":""}],"container-title":"World
Health
Organization","id":"ITEM-1","issue":&quo=
t;3","issued":{"date-parts":[["2014"]]},=
"page":"12-28","title":"Antimicrobial
resistance. Global report on
surveillance","type":"article-journal","volum=
e":"61"},"uris":["http://www.mendeley.com/doc=
uments/?uuid=3D256fcf3a-67de-3a4d-aa68-16f7d5adda9d"]}],"mendeley=
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quot;:0},"schema":"https://github.com/citation-style-languag=
e/schema/raw/master/csl-citation.json"}1 One report
estimates that western sub-Saharan Africa had the highest AMR-attributable
death rate in 2019.2
The
World Health Organization (WHO) instituted a global action plan (GAP) again=
st
AMR that was taken up by several countries including Nigeria.3 One objecti=
ve of
this plan is the optimization of antibiotic usage by the implementation of
antimicrobial stewardship(AMS) programmes. Some
components of AMS include surveillance of AMR, education of health workers =
and
the populace on the effects of AMR and promotion of be=
havioural
changes to antibiotic prescribing and dispensing. Adherence to therapeutic
guidelines and delayed antibiotic prescription are some behavioural
changes that may curb AMR.
In
Nigeria, the timeline for setting these actions into motion, including
collecting surveillance data and creating awareness of AMR among healthcare
workers across all cadres, is 2022.4 Despite thi=
s,
awareness of AMR and the implementation of AMS
remains low. A survey of all healthcare workers in Nigeria showed th=
at
less than half of respondents had a good knowledge of AMR and a majority st=
ill
prescribed antibiotics for viral infections.5 In another =
survey
of in-hospital antibiotic prescriptions, less than 10% of prescriptions were
guideline-compliant.6 In Nigerian
hospitals, physicians are responsible for the management of diseases and
antibiotic prescription and so play a pivotal role in the implementation of
AMS. Also, leveraging on the mandatory continuing medical education, physic=
ians
are better positioned to be informed about AMR and AMS. However, awareness =
and
changes in behaviour regarding AMR and AMS among
doctors remain uncertain. Assessing their awareness and practices through
surveys may prove helpful in delineating areas of concern and improvement in
the rollout of AMR-related activities.
The
objective of our study is to assess the knowledge, attitude, and practices =
of
Nigerian doctors regarding antimicrobial resistance and antibiotic
prescription.
Methods
This
study was a descriptive cross-sectional study carried out among doctors
practicing in Nigeria. All doctors working and residing in Nigeria were
eligible to participate in this survey. We used the Nigerian Medical
Association Telegraph® social media forum to reach eligible participants. D=
ata
collection was by use of a 31-item self-administered electronic questionnai=
re.
(Appendix I) modified from questionnaires used in an earlier study among
healthcare workers in Nigeria.5 This included 6 questions on demography
including age, sex, duration of practice, specialty, level of care, and ran=
k in
the hospital. The questionnaire was further divided into four sections on
knowledge attitude and practice, the barriers to reducing AMR and sources of
information on AMR, and antibiotic prescription.
The
total score for knowledge was calculated as the sum of scores for each answ=
er
in that section with a maximum score of 20. The score for each right answer=
was
one. The total score for attitude was the sum of the scores for each item in
the attitude scale which comprised of 5-point Likert response scales as wel=
l as
dichotomous responses. The maximum possible score in the attitude section w=
as
5. The total score in the practice section was the sum of the scores for ea=
ch
item in that section which included both “yes/no” and a 5-point Likert scale
response format ranging from 1 (strongly disagree) to 5 (strongly agree). T=
he
maximum score on the practice section was 18.
For the
categorization of total scores in all sections, the total scores were conve=
rted
to percentages. A score of ≥ 80% in each section was categorized as g=
ood,
50-79.9 % as fair, and less than 50% as poor.
Data
was stored in Microsoft Excel and analyzed using IBM- SPSS version 22.
Continuous variables were summarized using mean and standard deviation and
differences were analyzed using student’s t-test. Categorical variables wer=
e summarized
as proportions and differences were assessed using Chi-square tests. The association between knowledge, atti=
tude,
and practice was determined by bivariate correlation. A p-value of < 0.05
was considered statistically significant.
Ethical
approval was provided by the research and ethics committee of the Jos
University Teaching Hospital, Jos Nigeria. All data were treated as
confidential and anonymized.
Results
There
were 252 respondents who completed the survey. The mean (SD) age of
respondents was 38(8) years, and the mean (SD) duration of medical practice=
was
11(8) years. Other demographic characteristics are shown in Table 1. =
The
subject of AMR in their medical practice was regarded as highly relevant by=
208
(82%) respondents and moderately and rarely relevant by 37(15%) and 7 (3%)
respondents, respectively.
Table 1: Demographic
characteristics of respondents
|
Varia=
ble |
n |
% |
|
Sex&n=
bsp; Female Male &n=
bsp; Prefer not to
say |
57 193 2 |
22.6 77.6 0.8 |
|
Rank&=
nbsp; Consul=
tant Reside=
nt Medical
Officer House
officer Other&=
nbsp; |
72 104 55 15 6 |
28.6 41.3 21.8 5.6 2.4 |
|
Place=
of
medical practice Primar=
y Second=
ary Tertia=
ry Privat=
e |
5 42 196 9 |
2.0 16.7 77.8 3.6 |
|
Durat=
ion
of practice 0-9 ye=
ars ≥=
;10
years |
113 139 |
44.8 55.2 |
|
Frequ=
ency
of antibiotic prescribing Low&nb=
sp;(<
once /week) Modera=
te (1-5
times/week) High
(≥ once /day) |
13 67 172 |
5.2 26.6 68.2 |
|
Depar=
tments Intern=
al
Medicine Surger=
y Paedia=
trics Obstet=
rics
and Gynaecology Family
medicine Commun=
ity
Medicine Dentis=
try Pathol=
ogy Others=
|
88 29 14 11 33 12 5 17 43 |
34.9 11.5 5.5 4.4 13.1 4.8 2.0 6.7 17.1 |
|
Knowl=
edge
Score Good Fair Poor |
104 146 2 |
41 58 1 |
Knowledge
Regarding
knowledge of AMR, the mean score was 74 (11%) with only 2 (1%) respondents
scoring less than 50% in total. One
hundred and seventy-eight (71%) of respondents thought that antibiotic
resistance occurred when the body becomes resistant to antibiotics, and the=
y no
longer worked as well. 248 (98.4%) and 246(97.6%) respondents agreed that m=
any
infections were becoming increasingly resistant to antibiotics and that AMR
makes it increasingly difficult to treat infections, respectively. The number of respondents who agreed t=
hat
the prescription of antibiotics with overly broad-spectrum coverage contrib=
uted
to AMR and that AMR was only a problem for those who took antibiotics regul=
arly
were 215 (85%) and 18(7%), respectively.
Two hundred and thirty-nine respondents agreed that antibiotic-resis=
tant
bacteria could be transferred from person to person and 249(99%) agreed that
resistant infections could make procedures such as surgery, organ transplan=
ts,
and cancer treatment much more dangerous.
Figure 1 shows the response of participants to the question on secto=
rs
that should be targeted to curb AMR. Figure 2 shows the doctors’ response to
the knowledge question on actions that could reduce the spread of AMR.
There was no statistical difference between the mean knowledge score for th=
ose
who had practiced medicine for 10 years or more and those who had practiced=
for
less than 10 years (70±11% vs. 68±11%, t=3D-1.94, p=3D0.053). There was als=
o no
difference in the mean scores for knowledge for those who had received form=
al
teachings on AMR and those who had not (70±11% vs. 69±11%, t=3D0.18, p=3D0.=
91).
There was no significant difference in mean scores for knowledge between le=
vels
of health centres.
![3D"Chart,](3D"DavwarNMJ64No4Page492_files/image011.png")
Figure 1:<=
span
lang=3DEN-US style=3D'font-size:12.0pt;line-height:115%;font-family:"Times =
New Roman",serif'>
Responses to the questions on sectors to be targeted to curb antimicrobial
resistance in percentages
![](3D"DavwarNMJ64No4Page492_files/image013.png")
Figure 2: Doctors ’response to ac=
tions
that could reduce the spread of AMR in hospitals in percentages.
Attitude
The
mean (SD) percentage score for attitudes regarding AMR was 69% (10%). Good =
and
fair attitudes towards AMR were shown by 40(16%) and 204 (81%) respondents,
respectively. One hundred and ninety- five (77.4%) respondents believed that
their prescribing behaviour influenced AMR in t=
heir
region, and 169 (67.1%) would not prescribe antibiotics without a laboratory
diagnosis; however, 54(21.4%) and 55(21.8%) doctors would prescribe antibio=
tics
to be on the safe side and when further diagnostic tests were expensive,
respectively. The attitudes of participants towards the prescription of
antibiotics for common symptoms such as fever, sore throat, and body aches =
are
shown in Table 2. There was a negligible association between attitudes and
practice (r=3D0.09, p=3D0.18) or knowledge and practice (r=3D0.09, p=3D0.17=
).
|
Condi=
tion |
Stron=
gly
Agree |
Agree=
|
Neith=
er
agree nor disagree |
Disag=
ree |
Stron=
gly
disagree |
|
Lower
abdominal pain |
11(4.4) |
69(27.4) |
108(42.9) |
46(18.3) |
18(7.1) |
|
Ureth=
ral
discharge |
110(43.7) |
120(47.6) |
17(6.7) |
5(2.0) |
0(0) |
|
Tooth=
ache |
13(5.2) |
69(27.4) |
99(39.3) |
54(21.4) |
17(16.7) |
|
Diarr=
hoea |
11(4.4) |
63(25.0) |
100(39.7) |
61(24.2) |
17(6.7) |
|
Cold =
and
flu |
2(0.8) |
18(7.1) |
101(40.1) |
88(34.9) |
43(17.1) |
|
Body
aches |
2(0.8) |
5(2.0) |
82(32.5) |
97(38.5) |
66(26.2) |
|
Fever=
|
20(7.9) |
63(25.0) |
112(44.4) |
45(17.9) |
12(4.8) |
|
Skin =
rash |
8(3.2) |
35(13.9) |
107(42.5) |
79(31.3) |
23(9.1) |
|
Sore
throat |
38(15.1) |
123(48.8) |
65(25.8) |
19(7.5) |
7(2.8) |
|
Heada=
che |
2(0.8) |
5(2.0) |
107(42.5) |
80(31.7) |
58(23.0) |
Table
2: Showing the choice of antibioti=
cs for
different conditions among participants
Practice
Practice
was fair for 185(73%) respondents and good for 16(6%) respondents Although =
152
(60.3%) respondents said they did not practice delayed antibiotics prescrip=
tion,
48(18.8%) respondents rarely or never waited for laboratory evidence before=
the
antibiotic prescription. Three (1.2%) respondents reported that they
always waited for a laboratory diagnosis of infection before prescribing
antibiotics. There were 191 respondents who used clinical practice guidelin=
es
for prescribing antimicrobials. Of these, 118(61.8%) respondents reported t=
he
use of WHO guidelines, and 118(61.8%) respondents reported the use of local=
or
hospital guidelines (multiple responses). One hundred and fifty-seven (62.3=
%)
respondents reported that there were no restrictions to antimicrobials
available for use at their centre and 158(62.7%=
) had
rarely or never reported antimicrobial resistance in their department or
hospital. Teachings on AMR had occurred on one or more occasions for
144(57.1%) respondents in the past year. The relationship between years of
practice (x=3D0.99, p=3D0.32), exposure to lectures on AMR (x=3D2.32, p=3D0=
.13) and
delayed antimicrobial prescription was not statistically significant. The
association between the use of guidelines (x=3D5.37, p=3D0.07), duration of
practice, and frequency of AMR teaching sessions (x=3D1.87, p=3D0.39) was a=
lso not
statistically significant.
Barriers
and sources of information
Figure
3 shows the doctors’ response to what they considered barriers to the contr=
ol
of AMR. Twelve (4.8%) respondents added that the prescription of
antibiotics by unlicensed practitioners was also a barrier to reducing
AMR.
![3D"Chart
Description](3D"DavwarNMJ64No4Page492_files/image014.png")
Figure 3:
Response to question on barriers to reduction of AMR in percentages. A
multiple-response question.
Doctors’
responses to the source of information on antimicrobial resistance and
antibiotic prescription are shown in Figure 3. Seventy (28%) respondents sa=
id
that digital information sites were a source of information
![](3D"DavwarNMJ64No4Page492_files/image016.png")
Figure 4:
Sources of information on antimicrobial resistance and antibiotic prescript=
ion
in percentages.
In
this online survey among medical doctors practising
in Nigeria, knowledge, attitudes, and practices were fair to good regarding=
AMR
and there was no relationship between knowledge and attitudes with practice=
. In
general, attitudes toward an antibiotic prescription for common ailments we=
re
appropriate with most respondents unwilling to prescribe antibiotics unless
indicated; however, less than half of respondents reported that they practi=
ced
delayed antimicrobial prescription. The
majority of our respondents agreed that the subject of AMR was highly relev=
ant
to their practice, and this consisted of a large proportion of doctors who
frequently prescribed antibiotics. Our
findings are similar to the findings of studies of healthcare workers in ot=
her
parts of the world.5,=
7
In surveys in US and Peru, 65% and=
22%of
physicians who prescribed antibiotics,
strongly agreed that antibiotic resistance was a problem in their
practice. 8,9
The contrast between our study result and those from the US and Peru may be
related to the systematic restrictions placed on antibiotic prescriptions in
those countries.
The
mean score for knowledge of AMR was fair with almost all participants scori=
ng
more than 50%. Participants consisted of doctors in the tertiary health
Regarding
attitudes, more than three-quarters of respondents believed that their
prescribing behaviour affected AMR and more than
two-thirds of the respondents believed that a laboratory diagnosis should be
made before antibiotics could be prescribed. Their attitude toward prescrib=
ing
drugs for common symptoms was good. Less
than a tenth of respondents agreed that antibiotics should be prescribed fo=
r a
common cold and about a quarter agreed that antibiotics should be prescribed
for diarrhoea. A different response was observe=
d in
Cambodia where 86% and 36 % of respondents would prescribe antibiotics for a
cold and diarrhoea, respectively.16
However, more than half of the respondents agreed that antibiotics should be
prescribed for a sore throat. This is similar to findings from another stud=
y in
Nigeria.5 Perhaps this is related to the percep=
tion
that a sore throat is a symptom of bacterial pharyngitis. This perception is especially importan=
t in
the care of pediatric-aged patients as bacterial pharyngitis may result in
rheumatic heart disease or glomerulonephritis over time. Paediatricians in
this study made up a small percentage of respondents and therefore, cannot
explain this finding.
Delayed
antibiotic prescription, the practice of deferring antibiotic prescription =
for
an infection until it is necessary, and a proven strategy for reducing
antibiotic use, especially with respiratory tract infections,17
were practiced by 4 out of 10 doctors in this study. Among general
practitioners in Germany, less than a third of doctors practised
delayed antibiotic prescriptions for respiratory infections.18
Our observation also differed from what was seen among healthcare workers in
Nigeria where about two-thirds of respondents often or very often practiced
delayed antibiotic prescription.5 Differences in our sample composition a=
nd
individual experiences with patients with infections may explain this contr=
ast
in our observations. Also, our question was framed differently -we asked if
delayed antibiotic prescribing was practiced or not, and in their study
frequency of practice was asked. Factors such as the logistics of getting a
prescription filled after the patient has left the hospital and the patient=
's
demand for treatment of symptoms may have also contributed to the reluctanc=
e to
pursue this practice by respondents in our study.
The
majority of doctors in our study engaged in good practices regarding antibi=
otic
prescription although institutional guidance on AMR and antibiotic prescrip=
tion
seemed lacking. About four out of five respondents waited for a laboratory
diagnosis before antibiotics were prescribed and prescriptions were often m=
ade
using clinical practice guidelines. Local practice guidelines were used by =
more
than half of the respondents. More than half of respondents reported no
restrictions to the use of antibiotics at their centre=
and about the same number did not report AMR. This highlights the inadequac=
ies
in antimicrobial stewardship programs in Nigeria as described by Fadare et al in their study on antimicrobial stewards=
hip programmes in tertiary hospitals in Nigeria.ADDIN CSL_CITAT=
ION
{"citationItems":[{"id":"ITEM-1","itemDa=
ta":{"DOI":"10.1016/J.JGAR.2018.11.025","ISSN=
":"2213-7165","PMID":"30557686","ab=
stract":"Objectives:
The problem of antimicrobial resistance (AMR) is increasing worldwide, with
health-related and economic consequences. This is a concern in Africa,
including Nigeria, the most populous country in Africa, with its high rates=
of
infectious diseases. Approaches to reducing AMR include instigating
antimicrobial stewardship programmes (ASPs) in hospitals. Currently, no
information is available regarding the extent of ASPs in Nigerian hospitals.
Consequently, the objective was to address this starting in tertiary hospit=
als.
Methods: This was a cross-sectional, questionnaire-based study among tertia=
ry
healthcare facilities. Tertiary hospitals were chosen initially since if th=
ere
are concerns in these training hospitals, such concerns will likely to be
exacerbated in other hospitals. Results: Completed questionnaires were rece=
ived
from 17 of 25 tertiary healthcare facilities across five of the six
geopolitical regions of Nigeria. Ten (59%), four (24%), two (12%) and one (=
6%)
respondents were in internal medicine, infectious diseases, medical
microbiology and clinical pharmacology, respectively. Only six healthcare
facilities (35%) had a formal organisational structure and a team responsib=
le
for ASP. Facility-specific treatment recommendations, based on local AMR
patterns, were available in only four facilities (24%). Policies on approval
for prescribing specified antimicrobials and formal procedures for reviewing
their appropriateness after 48 h were present in only two facilities (12%).=
A cumulative
antimicrobial susceptibility report for the previous year was available in =
only
two facilities (12%), and only one facility routinely monitored antimicrobi=
al
use. Conclusion: Significant inadequacies in the availability of ASPs were
observed. This needs to be urgently addressed to reduce AMR rates in
Nigeria.","author":[{"dropping-particle":"&qu=
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In their study, only one out of 17 hospitals routinely monitored antimicrob=
ial
use. Similarly, in another study among physicians in tertiary hospitals,
antibiotic stewardship programmes were absent i=
n all
of the hospitals included. 11 In addition to the absence of antibiotic
stewardship programs in hospitals, a culture of reporting AMR seems to be
lacking- less than a fifth of our respondents ‘always’ or ‘often’ reported =
the
occurrence of AMR.
Limited
knowledge about AMR and antimicrobials, unrestricted access to antibiotics,=
and
limited access to laboratory services for diagnosis were considered the most
important barriers to reducing AMR. For our respondents, clinical practice
guidelines were the most common source of information about AMR and antibio=
tic
prescription. This is similar to findings in other countries.=
12,=
10,=
20,=
10,=
21
Other common sources of information included talks and lectures, scientific
journals, textbooks, and direct communication with colleagues. Internet fora
and digital platforms were not common sources of information for most respo=
ndents.
There
is a need to strengthen AMR information among doctors since a large portion=
of
the responsibility of prescribing antibiotics safely lies with them. They a=
re
also well-positioned to disseminate AMR information to other members of the
healthcare workforce. Already, from our study, doctors show a willingness to
propagate information - four in five doctors teach the rest of the medical =
team
about AMR. This may provide an efficient and effective means of transmitting
information to other cadres of the health team.
Antibiotic stewardship programmes should=
be
instituted and encouraged in hospitals with provisions made for easy access=
to
prescription guidelines adapted to local experience. Measures of infection
prevention and control such as hand washing should also be supported in
hospitals.
A
limitation of our study is the response from 20% of registered doctors henc=
e,
our study may not be reflective of all doctors in Nigeria. Although the stu=
dy utilized
a digital platform intended to be accessible by all doctors practising
in Nigeria, not all doctors are active on the platform. One strength of the study is that forms=
were
distributed electronically allowing for a wider coverage than in paper form=
at.
Using self-administered questionnaires reduced self-representation bias. The
survey was available to doctors from all over the country irrespective of t=
he centre of practice and explored more practical aspect=
s of
antibiotic prescribing.
In
conclusion, our study showed gaps in knowledge of AMR among doctors in Nige=
ria,
good attitudes, and a willingness to improve antibiotic prescribing and red=
uce
AMR. Improving the information on =
AMR
available to Nigerian doctors remains an important strategy for combatting =
AMR.
Supporting infection prevention and control measures as well as instituting
antibiotic stewardship and prescription measures in health centres
are also integral to reducing AMR.
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