Antimicrobial Resistance Knowledge, Training Exposure, and Prescribing Influences Among Community Health Workers in...

Antimicrobial resistance (AMR) is a major public health threat, particularly in low- and middle-income countries where inappropriate antibiotic use remains common. Community Health Workers (CHWs) are important providers of primary healthcare (PHC) in Nigeria, yet evidence on their AMR knowledge, stewardship training, and prescribing influences remains limited. This study assessed AMR/AMS knowledge, training exposure, prescribing attitudes, and factors influencing antimicrobial prescribing among CHWs in Kaduna State, Nigeria.

A descriptive cross-sectional study was conducted among 286 CHWs selected from 27 government-owned PHC facilities in Kaduna State using multistage sampling. Data were collected between August and September 2025 using a structured self-administered questionnaire. Data were analyzed using IBM Statistical Package for the Social Sciences version 25.0 (IBM Corp., Armonk, NY). Descriptive statistics were presented as frequencies and percentages, while chi-square tests assessed associations between AMR/AMS training, knowledge level, and attitude level.

Most respondents had heard of AMR (87.4%), correctly identified bacteria as the target of antibiotics (90.9%), and recognized that inappropriate antibiotic use contributes to resistance (92.7%). Only 20.6% had received formal AMR/AMS training. Although many respondents reported guideline use (68.6%) and prescription documentation (70.3%), 62.3% prescribed antibiotics based on experience without diagnostic tools, while 38.1% reported patient demand-influenced prescribing decisions. Formal AMR/AMS training was significantly associated with both knowledge level and attitude level.

Despite generally good AMR knowledge, formal stewardship training among CHWs was limited. Strengthening AMR/AMS training, diagnostic support, supervision, and guideline-based prescribing may improve antimicrobial stewardship at the PHC level.