Strengthening Antimicrobial Stewardship in Nigeria: Qualitative and Quantitative Insights into Barriers, Enablers and Implementation Strategies (2015-2025)

IntroductionAntimicrobial resistance (AMR) poses a major global health threat, particularly in low- and middle-income countries such as Nigeria, where antibiotic misuse is common. Strengthening antimicrobial stewardship (AMS) is essential but remains fragmented and underexplored. This study investigates key barriers, facilitators, and implementation strategies influencing AMS programmes in Nigerian healthcare facilities to inform more effective interventions. MethodsA systematic search of six databases (2015-2025) identified English-language studies on AMS implementation in Nigeria. Eligible studies reported barriers, facilitators, or strategies. Quality was assessed using the Critical Appraisal Skills Programme (CASP) and the Mixed Methods Appraisal Tool (MMAT, 2018). Data on study characteristics, interventions, and outcomes were extracted and synthesised using thematic and quantitative analyses to identify key factors affecting AMS implementation. ResultsFrom 844 screened articles, 10 met inclusion criteria. Major barriers included prescriber resistance (10%), workload (20%), poor infrastructure (40%), policy gaps (50%), limited resources (60%), and inadequate training, with 70% of healthcare professionals showing poor AMS awareness. Facilitators included IT infrastructure (10%), policies (20%), multidisciplinary teams (30%), training (30%), expertise (70%), and leadership support (80%). Common strategies included digital integration, audits, pre-authorisation, education, policy development, surveillance, and AMS committees, outlining a framework to strengthen AMS and reduce AMR in Nigeria. ConclusionThis review highlights substantial challenges to AMS implementation in Nigeria, particularly inadequate diagnostics, limited training, and weak policy enforcement. However, pharmacy-led initiatives and multidisciplinary collaboration show promise. Investment in diagnostic infrastructure, workforce capacity building, policy reform, and sustained leadership commitment is essential to improve AMS effectiveness and combat AMR in Nigerian healthcare systems.