Strengthening Antimicrobial Stewardship in Nigeria: Quantitative and Qualitative Insights into Barriers, Enablers, and Implementation Strategies (2015–2025) to Confront Antimicrobial Resistance (AMR)

Background: Antimicrobial resistance (AMR) is a critical global health threat. Nigeria faces particular challenges implementing antimicrobial stewardship (AMS) programmes due to structural barriers and resource constraints. This review synthesises evidence on barriers, facilitators, and strategies influencing AMS implementation in Nigerian healthcare facilities.

Methods: A systematic search of six databases—PubMed, Scopus, Web of Science, the Cochrane Library, CINAHL, and Google Scholar—identified English-language studies published between 1 January 2015 and 31 December 2025 reporting AMS implementation in Nigerian healthcare settings. Study quality was assessed using CASP and MMAT tools. Data were synthesised using narrative and thematic analysis. The review was registered with PROSPERO (CRD420251165641) and followed PRISMA 2020 guidelines.

Results: Ten studies, encompassing 1,343 participants, met the inclusion criteria. The most frequently reported barriers were insufficient training and knowledge (90%), lack of guidelines and limited resources or funding (80% each), and poor surveillance systems (70%). Leading facilitators included leadership support (80%), multidisciplinary collaboration and education or training (70% each), and availability of guidelines (60%). The most frequently reported implementation strategies were education and training (90%), antibiotic-use audits and clinical-guideline development (80% each), and formulary restrictions or policies (70%).

Conclusions: This first Nigeria-specific systematic review identifies critical implementation gaps. Pharmacy-led, leadership-supported, and governance-embedded AMS programmes show the greatest promise. Five evidence-based recommendations centred on policy reform, capacity building, diagnostic investment, AMS–IPC integration, and sustainability planning are proposed.