{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:12:40Z","timestamp":1790727160555,"version":"4.1.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antimicrobial resistance is a critical global health threat. Nigeria faces particular challenges implementing antimicrobial stewardship (AMS) programs due to structural barriers and resource constraints. This review synthesizes evidence on barriers, facilitators, and strategies influencing AMS implementation in Nigerian healthcare facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of 6 databases (PubMed, Scopus, Web of Science, the Cochrane Library, CINAHL, and Google Scholar; 1 January 2015\u201331 December 2025) identified English-language studies reporting AMS implementation in Nigerian healthcare settings. Quality was assessed using Critical Appraisal Skills Program and Mixed Methods Appraisal Tool. Data were synthesized using narrative and thematic analysis. Frequencies are expressed as the number (and percentage) of the 10 included studies reporting each item (denominator = 10 studies), not as proportions of pooled participants. The review was registered with PROSPERO (CRD420251165641) and followed PRISMA 2020 guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten studies (1343 participants) met the inclusion criteria. The most frequently reported barriers were insufficient training\/knowledge (9\/10, 90%), lack of guidelines and limited resources\/funding (each 8\/10, 80%), and poor surveillance systems (7\/10, 70%). Leading facilitators were leadership support (8\/10, 80%), multidisciplinary collaboration and education\/training (each 7\/10, 70%), and availability of guidelines (6\/10, 60%). The most frequently reported implementation strategies were education and training (9\/10, 90%), antibiotic-use audits and clinical-guideline development (each 8\/10, 80%), and formulary restrictions\/policies (7\/10, 70%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This first Nigeria-specific systematic review identifies critical implementation gaps. Pharmacy-led, leadership-supported, and governance-embedded AMS programs show the greatest promise. Five evidence-based recommendations centered on policy reform, capacity building, diagnostic investment, AMS\u2013Infection Prevention and Control integration, and sustainability planning are proposed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag476","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:04:08Z","timestamp":1785585848000},"source":"Crossref","is-referenced-by-count":1,"title":["Strengthening Antimicrobial Stewardship in Nigeria: Qualitative and Quantitative Insights into Barriers, Enablers, and Implementation Strategies (2015\u20132025)"],"prefix":"10.1093","volume":"13","author":[{"given":"Omobolanle Margaret","family":"Abe","sequence":"first","affiliation":[{"name":"Department of Medicine, School of Health, Medicine and Life Sciences, University of Hertfordshire , Hatfield ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8954-0817","authenticated-orcid":false,"given":"Rasha Abdelsalam","family":"Elshenawy","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Health, Medicine and Life Sciences, University of Hertfordshire , Hatfield ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"2026081303413417300_ofag476-B1","volume-title":"Antimicrobial resistance","author":"World Health Organization","year":"2023"},{"key":"2026081303413417300_ofag476-B2","doi-asserted-by":"crossref","first-page":"e71077","DOI":"10.1002\/hsr2.71077","article-title":"The global challenge of antimicrobial resistance: mechanisms, case studies, and mitigation approaches","volume":"8","author":"Nazir","year":"2025","journal-title":"Health Sci Rep"},{"key":"2026081303413417300_ofag476-B3","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1136\/ejhpharm-2021-002762","article-title":"Antimicrobial resistance in Nigeria: challenges and charting the way forward","volume":"29","author":"Iheanacho","year":"2022","journal-title":"Eur J Hosp Pharm"},{"key":"2026081303413417300_ofag476-B4","doi-asserted-by":"crossref","first-page":"204","DOI":"10.3390\/antibiotics9040204","article-title":"Development of antimicrobial stewardship programmes in low and middle-income countries: a mixed-methods study in Nigerian hospitals","volume":"9","author":"Kpokiri","year":"2020","journal-title":"Antibiotics"},{"key":"2026081303413417300_ofag476-B5","author":"UK Health Security Agency (UKHSA)","year":"2023"},{"key":"2026081303413417300_ofag476-B6","author":"WHO"},{"key":"2026081303413417300_ofag476-B7","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.3390\/life15101598","article-title":"A one-health perspective of antimicrobial resistance (AMR): human, animals and environmental health","volume":"15","author":"Al-Khalaifah","year":"2025","journal-title":"Life"},{"key":"2026081303413417300_ofag476-B8","author":"Nigeria Centre for Disease Control and Prevention (NCDC)"},{"key":"2026081303413417300_ofag476-B9","doi-asserted-by":"crossref","first-page":"e0005731","DOI":"10.1371\/journal.pgph.0005731","article-title":"Barriers and facilitators to antibiotic stewardship in Nigeria's private healthcare sector: a qualitative interview study with national health and regulatory interest holders","volume":"6","author":"Mahdi","year":"2026","journal-title":"PLoS Glob Public Health"},{"key":"2026081303413417300_ofag476-B10","volume-title":"Core elements of hospital antibiotic stewardship programs","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"2026081303413417300_ofag476-B11","volume-title":"Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: a WHO practical toolkit","author":"World Health Organization","year":"2019"},{"key":"2026081303413417300_ofag476-B12","volume-title":"Core elements of human antibiotic stewardship programs in resource-limited settings: national and hospital levels","author":"Centers for Disease Control and Prevention","year":"2024"},{"key":"2026081303413417300_ofag476-B13","article-title":"Antimicrobial stewardship in Nigeria: a systematic review of barriers, enablers and implementation strategies across healthcare facilities and pharmacies. PROSPERO 2025; CRD420251165641","author":"Abe","year":"2026","journal-title":"PROSPERO"},{"key":"2026081303413417300_ofag476-B14","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jgar.2020.03.009","article-title":"Implementation of antimicrobial stewardship programmes in African countries: a systematic literature review","volume":"22","author":"Akpan","year":"2020","journal-title":"J Glob Antimicrob Resist"},{"key":"2026081303413417300_ofag476-B15","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.ijid.2020.05.126","article-title":"Global antimicrobial stewardship with a focus on low- and middle-income countries: a position statement for the International Society for Infectious Diseases","volume":"96","author":"Pierce","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2026081303413417300_ofag476-B16","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/S1473-3099(16)30012-3","article-title":"Antimicrobial stewardship across 47 South 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during the COVID-19 pandemic in the acute care settings: a systematic review","volume":"23","author":"Elshenawy","year":"2023","journal-title":"BMC Public Health"},{"key":"2026081303413417300_ofag476-B20","article-title":"Antimicrobial stewardship practice among healthcare professionals, knowledge, barners and facilitators In two public institutions in Nigeria","volume":"2","author":"Aika","year":"2023","journal-title":"Niger J Clin Pharm"},{"key":"2026081303413417300_ofag476-B21","doi-asserted-by":"crossref","first-page":"e198","DOI":"10.1017\/ash.2024.342","article-title":"Evaluation of interventions led by pharmacists in antimicrobial stewardship programs in low- and middle-income countries: a systematic literature review","volume":"4","author":"Marins","year":"2024","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"key":"2026081303413417300_ofag476-B22","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/j.sapharm.2024.08.006","article-title":"Effectiveness of 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