Date of Conferral





Public Policy and Administration


Victoria A. Landu-Adams


The misuse of antimicrobials (AM) constitutes a huge problem in developing countries, including Nigeria, posing severe public health threats to the populace’s health. Misuse contributes to the high consumption of AM, driving the emergence and spread of antimicrobial resistance (AMR). Establishing functional antimicrobial stewardship (AMS) programs at the health facility levels is recognized as an effective and efficient strategies to tackle AMR. Literature is replete with evidence of poor prescription practices, but few studies assessing the factors contributing to inappropriate use of AM in Nigeria exist. The purpose of this study was to improve the understanding of AMS practice at the three-tiered level of care to promote rational use of AM. The theoretical framework is the theory of planned behavior. A qualitative case study was used with a purposeful sample size of 30 participants drawn from two primary, two secondary, and two tertiary health facilities in Nigeria. Data were coded and categorized for thematic analysis. Emergent themes include lack of AMS programs, no guidelines, lack of modern equipment and incorrect diagnosis, absence of continuous medical education, limited access to quality-assured and affordable medicines, imbalance of power among professionals, and pervasive external influence of pharmaceutical marketing companies. The recommendation is to strengthen AMS programs’ policy and governance framework at the national and health facility levels. Strengthening process governance aligned with the aims and structure of the AMS program would contribute to positive social change through rational AM use. Rational AM use would preserve universal access to quality-assured, effective, and affordable AM for those seeking care in Nigeria.