Prescription Patterns and Knowledge of Rational Antimicrobial Use among Primary Healthcare Workers in a Humanitarian Setting in Nigeria

Background: Antimicrobial resistance (AMR) is a major global health threat, particularly in low- and middle-income countries such as Nigeria, where inappropriate antibiotic use is common. This study assessed antimicrobial prescription patterns and knowledge of AMR among primary healthcare workers in humanitarian settings. Methods: A cross-sectional survey was conducted among primary healthcare prescribers using a structured digital questionnaire (Kobo/ODK). Data were analysed with SPSS v29. Knowledge of AMR was assessed through 10 binary questions and categorized as poor (0–50%), moderate (51–70%), or good (71–100%). Results: A total of 112 respondents participated, including 94(83.9%) females, with a mean age of 36.6 years (SD = 9.7). Participants comprised 50(44.6%) CHEWs, 34 (30.4%) nurses/midwives, 15 (13.4%) CHOs, and 13 (11.6%) JCHEWs. Only 36(32.1%) had AMR-related training in the past year. While 109(97.3%) correctly defined AMR and 102(91.1%) acknowledged its link to mortality, gaps remained. Thirty-four (30.4%) believed antibiotics treat viral infections, 19(17.0%) prescribed antibiotics for influenza, and 79(70.5%) co-prescribed them for malaria. Overall, 39 (34.8%) had poor knowledge, 39(34.8%) moderate, and 34(30.4%) good. Knowledge differed significantly by age (p = .017) and cadre (p = .018), with nurses/midwives and CHOs scoring higher. Commonly prescribed antibiotics were amoxicillin (12%), metronidazole (11%), ciprofloxacin (10%), and gentamicin (9%). Conclusion: Despite high awareness, irrational prescribing and knowledge gaps persist. Targeted training, revised standing orders, and strengthened antimicrobial stewardship at the PHC level are urgently needed to curb AMR in Nigeria.