Strengthening Antimicrobial Stewardship in Nigeria: Qualitative and Quantitative Insights into Barriers, Enablers, and Implementation Strategies (2015–2025): A mixed-method systematic review of implementation barriers and facilitators

Antimicrobial resistance (AMR) poses a major global health threat, particularly in low- and middle-income countries such as Nigeria, where inappropriate antibiotic use is widespread. This systematic review synthesised evidence from 2015–2025 to identify barriers, enablers, and implementation strategies for antimicrobial stewardship (AMS) programmes across Nigerian healthcare facilities. A total of 844 studies were screened, with ten meeting inclusion criteria. Barriers included limited diagnostic capacity, inadequate training, policy gaps, resource shortages, and prescriber resistance. Facilitators encompassed leadership support, multidisciplinary collaboration, pharmacy expertise, and IT infrastructure. Implementation strategies such as AMS committees, education, audits, and policy integration improved stewardship awareness and practice. The review proposes a conceptual framework to guide future AMS implementation, highlighting the need for sustained financing, governance reform, and workforce development to achieve effective and equitable AMR control in Nigeria.