Antimicrobial Resistance Preparedness among Clinical Medical Students in Abuja, Nigeria: Knowledge, Attitudes and Practice Gaps
Abstract
Background: Antimicrobial resistance (AMR) is a major public health challenge, and medical students require both conceptual knowledge and practical prescribing judgement to support future antimicrobial stewardship. This study assessed the knowledge, attitudes, perceptions, and self-reported antimicrobial-use practices of clinical medical students at the University of Abuja Teaching Hospital, Nigeria.
Methods: A cross-sectional, questionnaire-based survey was conducted among fourth, fifth, and sixth year clinical medical students at the College of Health Sciences, University of Abuja Teaching Hospital, Gwagwalada. The questionnaire assessed demographic characteristics, knowledge of antimicrobial use and resistance, attitudes toward AMR, and self-reported antimicrobial-use practices. Data were summarized using descriptive statistics, including frequencies, percentages, and proportions. Inferential analyses (chi-square tests) were conducted to examine associations between year of study and key practice indicators.
Results: Of 148 students invited, 108 returned usable questionnaires, giving a response rate of 73.0%. Respondents were aged 19–53 years, with most being male (76.9%). Knowledge of key consequences of inappropriate antimicrobial use was generally high, including recognition of bacterial resistance (89.8%), reduced future effectiveness (90.7%), ineffective treatment (87.0%), additional medical cost (85.2%), and prolonged illness (79.6%). Attitudes showed strong recognition of AMR as a serious issue globally (88.7%) and nationally (80.0%), although awareness of AMR as a problem within the teaching hospital was lower (62.1%). Self-reported practices were mixed: most respondents reported completing a full course (71.7%) and checking expiry dates (80.5%), but fewer reported consistently consulting a doctor before starting antimicrobials (38.9%), and some reported using antimicrobials for cough or sore throat (29.6%). Chi-square analysis revealed significant differences in antimicrobial use practices across year levels (p<0.05), with senior students showing slightly more appropriate practices.
Conclusion: The findings suggest that clinical medical students at the University of Abuja have substantial AMR awareness but important gaps in practical antimicrobial-use behaviour. Undergraduate training should place stronger emphasis on rational antimicrobial use, clinical decision-making, prescribing behaviour, and antimicrobial stewardship.
Keywords
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Introduction
Inappropriate antimicrobial use and insufficient knowledge of antimicrobial resistance (AMR) are major contributors to the growing burden of resistant infections. Antimicrobial resistance occurs when microorganisms adapt to antimicrobial exposure in human medicine, veterinary care, agriculture, and other settings, reducing the effectiveness of treatment. Its public health impact is substantial, with an estimated 700,000 deaths annually attributed to resistant infections worldwide.[1,2] In response to this threat, the World Health Organization designated the theme of World Health Day 2011 as "Combat Antimicrobial Resistance: No Action Today, No Cure Tomorrow."[3]
Future doctors must be able to select antimicrobials appropriately and communicate clearly with patients and other healthcare workers about their use. The WHO has emphasized the importance of undergraduate training in prudent antimicrobial prescribing, and medical students are an important group because they will become future prescribers and clinical leaders.[4] In Nigerian medical training, students are introduced to pathogenic microorganisms, infectious diseases, antimicrobial mechanisms of action, and mechanisms of resistance, but antimicrobial use and resistance are usually embedded within Pharmacology and Microbiology rather than taught as a distinct subject area.[5] A key concern is that students may acquire theoretical knowledge of AMR without developing the practical judgement needed for rational antimicrobial use in clinical settings.
Understanding clinical medical students' knowledge, attitudes, perceptions, and self-reported practices may therefore support more effective undergraduate training and inform curriculum improvements, prescribing guidelines, and interventions aimed at reducing inappropriate antimicrobial use among future doctors.[6] This study therefore aims to assess the knowledge, attitudes, and self-reported antimicrobial practices of clinical medical students at the University of Abuja.
Conclusion
This survey of clinical medical students at the University of Abuja suggests that students have substantial knowledge of antimicrobials and antimicrobial resistance. However, the findings also indicate important gaps in practical antimicrobial-use behaviour, including inconsistent consultation before antimicrobial use and continued use of antimicrobials for symptoms commonly associated with viral infections. The survey highlights the need to strengthen the translation of antimicrobial knowledge into rational clinical decision-making in a Nigerian hospital training environment.
To reduce antimicrobial misuse and its consequences, undergraduate medical training should include additional coursework and practical learning on rational antimicrobial use, prescribing behaviour, local resistance patterns, and antimicrobial stewardship, rather than relying solely on knowledge acquired during preclinical and early clinical training. Specific recommendations include:
- Introducing case-based prescribing exercises in clinical rotations
- Discussing local antimicrobial resistance patterns and their implications for prescribing
- Incorporating supervised antimicrobial stewardship activities
- Assessing rational antimicrobial use explicitly in examinations
- Providing educational materials on local resistance patterns
Future research should examine the impact of such educational interventions on actual prescribing practices and explore whether these findings are consistent across other Nigerian medical schools.
References
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