By Pharm. Mercy Aransiola
Here is an uncomfortable truth about antimicrobial resistance (AMR) in Nigeria: we do not fully know how widespread the problem is.
Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites change over time and become less responsive to medicines designed to treat them. It is one of the biggest threats facing modern healthcare because infections that were once easy to treat can become more difficult, more expensive, and sometimes impossible to manage.
The World Health Organization (WHO) estimates that bacterial antimicrobial resistance was associated with about 4.71 million deaths globally in 2021, including 1.14 million deaths directly attributable to bacterial AMR. Nigeria is among the countries carrying a significant burden of AMR related deaths. However, beneath these figures is a major challenge: our ability to measure the true scale of resistance remains limited.
A threat that cannot be accurately measured is difficult to control. As a pharmacist practising in Nigeria, I have encountered patients whose infections do not respond to medicines that would previously have been expected to work. Healthcare providers often rely on clinical experience and available treatment options, but many of these cases never become part of national surveillance data.
They remain within the experiences of pharmacists, doctors, and other healthcare workers who see them daily. This is why surveillance matters.
Nigeria cannot effectively respond to antimicrobial resistance without knowing where resistance is increasing, which medicines are becoming less effective, and which communities are most affected. Without reliable data, policymakers are forced to make decisions without the complete picture.
Nigeria participates in the WHO’s Global Antimicrobial Resistance and Use Surveillance System (GLASS), but important gaps remain in laboratory capacity, reporting systems, and routine data collection.
The challenge is even greater because much antibiotic use in Nigeria happens outside major hospitals. Many Nigerians obtain antibiotics through community pharmacies and patent medicine vendors, often without laboratory confirmation. This means a significant part of the country’s resistance story may never enter official surveillance systems.
Available Nigerian studies already show warning signs. Research among outpatients in South East Nigeria found antimicrobial use within the previous six months among nearly 84% of participants, while self-medication was reported by more than 90%. Another survey found that many Nigerians use antibiotics without laboratory testing and discontinue treatment once they feel better.
These behaviours contribute to resistance, but they also reflect wider health system challenges, including limited diagnostic access, cost barriers, and gaps in public awareness. Surveillance alone will not solve AMR, but without surveillance, effective action becomes much harder.
Nigeria needs stronger diagnostic systems, better laboratory capacity, improved regulation of antimicrobial access, and surveillance networks that include public and private facilities, urban and rural communities, and primary healthcare settings.
The fight against antimicrobial resistance is often described as a race against evolving microorganisms. For Nigeria, it is also a race against a blind spot. We cannot effectively respond to a threat we cannot see.
Building stronger AMR surveillance systems may not attract the attention of an outbreak, but it is one of the most important investments Nigeria can make to protect the effectiveness of medicines for future generations.
Antimicrobial resistance is not a future problem waiting to arrive. It is already affecting patients today. The question is whether Nigeria will build the systems needed to understand it, respond to it, and stay ahead of it.
Pharmacist Mercy Aransiola is a public health advocate with a strong interest in antimicrobial resistance, the responsible use of medicines, and evidence-based healthcare.
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