Patterns of Antimicrobial Use, Access, and Stewardship Awareness Among Clinical Medical and Dental Students at the University of Nigeria, Enugu Campus (UNEC)

Background Antimicrobial resistance (AMR) is a major public health concern in low- and middle-income countries such as Nigeria, worsened by self-medication and poor stewardship expectations among future healthcare givers, reinforcing the challenge. This study investigated antimicrobial use patterns, misuse behaviours and awareness of stewardship among clinical medical and dental students with the aim of supporting the implementation of specific interventions. Methods A cross-sectional online survey was conducted between January and February 2026. The structured questionnaire assessed data on demographics, knowledge of antimicrobials (6-point rating scale), recent use (last 12 months), indicators of misuse (such as starting treatment without a prescription and not completing the course of treatment), and exposure to stewardship. After exclusions, 237 responses were analysed using Python for descriptives, chi-square/t-tests, Spearman correlations, logistic regression, and exploratory clustering/factor analysis. Misuse was defined as a composite binary outcome. Results The mean age was 22.3 years (SD 1.9), male 54%, clinical sciences 92%. The knowledge score was 5.15/6 (SD 1.02) with deficiencies observed in empiric therapy (65% correct). Recent antibiotic use was 66% (mean 2.5 courses), mostly for respiratory (31%) and malaria-like symptoms (18%), with 70% having no diagnostics. Non-prescription use was 40%, and incomplete course was 35%. Behaviours were correlated (for example, sharing-keeping leftovers, ρ = 0.45 for ρ = 0.57). No significant determinants of misuse were found (e.g. male OR = 1.25, 95% CI 0.74–2.11, p = 0.40). Seventy-four per cent (mostly 1–2 hours) received stewardship instruction; 36% (more in clinical years, p < 0.001) were aware of guidelines. Clustering revealed high-misuse profiles; 76% expressed training interest. Conclusions Although knowledge was adequate, students in Nigeria commonly misused antimicrobials; this was influenced by self-medication and limited stewardship exposure. The integration of diagnostics and AMS education in the curriculum could reduce risks and be in line with the national AMR plans.