Public awareness as a strategic tool for combating antibiotic resistance in low- and middle-income countries: evidence from Nigeria

Abstract Antibiotic resistance is a major global health threat driven by inappropriate antibiotic use, limited public understanding, and weak regulatory systems. Public awareness has therefore become a central component of global and national strategies aimed at reducing misuse and promoting responsible behaviours. This review examines the role of public awareness in combating antibiotic resistance, with particular attention to how communication strategies, behavioural interventions, and community education influence knowledge, attitudes, and stewardship practices. A narrative review approach was used to synthesise evidence from peer-reviewed articles, systematic reviews, policy documents, and public health reports published between 2006 and 2025. Literature was drawn from multiple disciplines, including public health, behavioural science, communication, microbiology, and One Health. Overall, public awareness initiatives have been shown to improve knowledge, reduce inappropriate antibiotic demand, and promote infection-prevention behaviours. Effective approaches include multi-channel communication campaigns, school-based programmes, healthcare-provider engagement, community outreach, and interactive public events. However, evidence from low- and middle-income countries indicates persistent challenges, including low functional awareness, self-medication, and limited access to diagnostic services. Emerging data from Nigeria further highlight widespread misuse across human and animal health sectors, as well as environmental transmission risks. Public awareness remains essential for strengthening antibiotic stewardship and supporting policy implementation. Its integration within coordinated One Health frameworks offers a promising pathway to reducing misuse and slowing the spread of resistance.