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Investigating the factors influencing antibiotic use practices and their association with antimicrobial resistance awareness among poultry farmers in Enugu State, Nigeria

Published online by Cambridge University Press:  25 September 2025

Chika P. EjikeugwuOpen the ORCID record for Chika P. Ejikeugwu[Opens in a new window],
Emmanuel A. Nwakaeze,
Chikaodi W. AniekweOpen the ORCID record for Chikaodi W. Aniekwe[Opens in a new window],
Euslar N. Onu,
Michael U. Adikwu and
Peter M. EzeOpen the ORCID record for Peter M. Eze[Opens in a new window]
Chika P. Ejikeugwu*
Affiliation:
Department of Pharmaceutical Microbiology and Biotechnology, Enugu State University of Science and Technology (ESUT), Agbani, NigeriaDepartment Angewandte Mikrobielle Ökologie, Helmholtz-Zentrum für Umweltforschung – UFZ, Leipzig, Germany
Emmanuel A. Nwakaeze
Affiliation:
Department of Pharmaceutical Microbiology and Biotechnology, Chukwuemeka Odumegwu Ojukwu University, Igbariam, Nigeria
Chikaodi W. Aniekwe
Affiliation:
Department of Pharmaceutical Microbiology and Biotechnology, Enugu State University of Science and Technology (ESUT), Agbani, Nigeria
Euslar N. Onu
Affiliation:
Department of Microbiology, Faculty of Biological Science, Alex Ekwueme Federal University Ndufu-Alike, Ikwo, Nigeria
Michael U. Adikwu
Affiliation:
Department of Pharmaceutics, University of Nigeria Nsukka, Enugu, Nigeria
Peter M. Eze
Affiliation:
Department of Environmental Health Science, Nnamdi Azikiwe University, Awka, NigeriaSchool of Biological Sciences, Queen’s University Belfast, Belfast, NI, UKDepartment of Agriculture and Food, University of La Rioja, Logroño, Spain
*
Corresponding author: Chika P. Ejikeugwu; Email: chika.ejikeugwu@esut.edu.ng

Abstract

Objective:

Effectively addressing poultry farmers’ antibiotic use and its role in antimicrobial resistance (AMR) presents a significant challenge, but improving their knowledge and practices is crucial for mitigating AMR risks and safeguarding public health. This study aimed to assess farmers’ understanding and behaviors to identify public health risks and inform targeted interventions.

Design:

Survey-based cross-sectional study.

Setting:

200 poultry farms in Enugu State, Nigeria.

Participants:

Poultry farmers.

Methods:

A cross-sectional survey of 200 poultry farms in Enugu State, Nigeria, was conducted using a validated questionnaire targeting farmers responsible for key farm decisions. The questionnaire covered sociodemographic data, AMR knowledge, and antibiotic use practices. Ethical approval was obtained, and participants provided oral consent.

Results:

Findings showed that 90.5% of farmers used antibiotics, primarily for treating infections (80.5%) and for growth promotion or prophylaxis (61%). Ampicillin (75%), ciprofloxacin (71.5%), and doxycycline (71%) were the most commonly used antibiotics, with monthly administration being prevalent (48%). Additionally, 89% of respondents believed antibiotics promote poultry growth. Alarmingly, 65% were unaware of AMR, and only 16% recognized its health risks.

Conclusion:

The heavy reliance on antibiotics, particularly ampicillin, raises concerns about beta-lactamase selection amid Nigeria’s carbapenem resistance issues. The significant knowledge gap among farmers highlights the urgent need for targeted education and stricter antibiotic regulation to mitigate AMR risks in poultry farming.

Information

Type
Original Article
Information
Antimicrobial Stewardship & Healthcare Epidemiology , Volume 5 , Issue 1 , 2026, e236
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Introduction

Antimicrobial resistance (AMR) is a major global public health threat, driven largely by antibiotic misuse in animal production, particularly poultry farming.Reference Ejikeugwu, Nworie and Saki1,Reference Cycon, Mrozik and Piotrowska-Seget2 The persistence of multidrug-resistant bacteria, including carbapenemase producers (eg, metallo-beta-lactamases), in Nigeria highlights the urgent need for intervention.Reference Ejikeugwu, Nworie and Saki1,Reference Cycon, Mrozik and Piotrowska-Seget2 Reducing antibiotic use in livestock could mitigate AMR spread, but addressing ecological gaps and improving knowledge of antibiotic use in food production is crucial. Studies indicate that antibiotic use in food animals significantly contributes to AMR emergence, resistant bacteria, and antibiotic resistance genes (ARGs) in the environment.Reference Ejikeugwu, Nworie and Saki1–Reference Thiele-Bruhn4 Globally, around 75% of antibiotics are used in livestock, often as growth promoters or for disease prevention.Reference Thiele-Bruhn4–Reference Chander, Kumar and Goyal6 Projections estimate that by 2,050, AMR could cause 10 million deaths annually.Reference Hooban, Joyce and Fitzhenry5 Developing countries, including Nigeria, face a rising AMR burden due to unregulated antibiotic use in poultry farming.Reference Ejikeugwu, Nworie and Saki1,Reference Hamscher, Sczesny, Höper and Nau7 Poultry farms in Nigeria serve as a major source of environmental antibiotic contamination, particularly through soil pollution, where the resistome facilitates the evolution and spread of resistance genes.Reference Chander, Kumar and Goyal6–Reference Wu, Xiang and Yan9 Over-the-counter antibiotic sales without prescriptions are common,Reference Ejikeugwu, Nworie and Saki1,Reference Boamah, Agyare, Odoi and Dalsgaard10 and many poultry farmers lack formal training, leading to antibiotic misuse.Reference Farrell, McKernan and Benson11–Reference Rayner, Higham and Gill13 Antibiotics are often administered without veterinary guidance, and failure to observe withdrawal periods before slaughter increases the risk of residues and resistant bacteria entering the food chain. Consequently, poultry farms act as reservoirs for AMR dissemination.Reference Ejikeugwu, Nworie and Saki1,Reference Boamah, Agyare, Odoi and Dalsgaard10 Although studies have examined AMR prevalence in Nigerian poultry production,Reference Alhaji, Haruna and Muhammad14 limited research exists on farmers’ perspectives regarding antibiotic use and resistance, particularly in Enugu State. Poultry manure, commonly used as fertilizer, further exacerbates environmental contamination, contributing to resistant bacteria spread through runoff and leaching into water systems.Reference Chander, Kumar and Goyal6–Reference Wu, Xiang and Yan9 Understanding farmers’ knowledge, attitudes, and practices (KAP) is vital for informing strategies to curb antibiotic misuse and AMR spread in Southeast Nigeria. Given poultry farming’s economic importance, assessing farmers’ knowledge and behavior is essential for safeguarding antibiotic efficacy and public health. Research suggests that farmer education significantly influences antibiotic use decisions.Reference Boamah, Agyare, Odoi and Dalsgaard10 Targeted training programs could foster responsible antibiotic use and reduce AMR in poultry systems.Reference Farrell, McKernan and Benson11,Reference Caudell, Dorado-Garcia and Eckford Set12 This study aimed to investigate the drivers of irrational antibiotic use in poultry farming, which fuel AMR in the environment. A validated questionnaire collected data on farmers’ sociodemographics, AMR knowledge, and antibiotic use practices. Face-to-face interviews minimized bias. The findings will bridge knowledge gaps by assessing KAP among poultry farmers in Enugu State and contribute to mitigating public health risks associated with AMR.

Materials and methods

Study design, location, and sampling approach

The study was conducted from April 1 to August 31, 2024, using a cross-sectional design. A total of 200 poultry farms, each with at least 100 birds, were selected through stratified random sampling to ensure representation across the major geographic zones of Enugu State, Nigeria (Figure 1). Within each zone, farms were randomly selected from updated lists provided by local veterinary offices and poultry associations. The study focused on poultry farmers directly responsible for key agricultural decisions, including antibiotic use, feed management, and input procurement.

Figure 1.

Map of Enugu State, Nigeria, showing study locations (map adapted from Enugu Connect). 15.

Study instrument

A standardized, self-administered questionnaire in English was used to collect data on sociodemographics, AMR knowledge, and antibiotic use practices. Adapted from validated tools used in similar studies in Nigeria and other low- and middle-income countries (LMICs),Reference Caudell, Dorado-Garcia and Eckford Set12–Reference Alhaji, Haruna and Muhammad14 it was reviewed by veterinary and epidemiology experts for content validity. A pilot test with 10 poultry farmers (excluded from the main study) assessed clarity and reliability, informing minor revisions. The final questionnaire had three sections: (1) sociodemographics; (2) AMR knowledge; and (3) antibiotic use practices. Pretesting with a veterinarian ensured accuracy. Responses were collected anonymously in categorical, ordinal, and open-ended formats for both quantitative and qualitative analysis.

Data management and analysis

Data were collated and analyzed using Microsoft Excel version 16.92. Categorical variables were summarized as frequencies and percentages to provide insights into prevalent farming practices, as well as the respondents’ knowledge and awareness levels concerning AMR and antibiotic use. A two-way ANOVA was performed to evaluate statistical significance across the respondent outcomes.

Ethical approval

Ethical approval for the study was granted by the Enugu State Ministry of Health (Reference number: MH/MSD/REC21/630). Informed oral consent was obtained from all study participants. Additionally, participants provided consent for the publication of the study data.

Results

Sociodemographic features of poultry farmers

This study included 200 privately owned poultry farms (each with at least 100 birds) in Enugu, Southeast Nigeria. Table 1 presents sociodemographic characteristics (gender, age, marital status, occupation, education, and internet usage) influencing farmers’ KAP regarding antibiotic use and AMR. Female respondents (56%) slightly outnumbered males (44%). Most farmers (52%) were aged 21–40 years, while younger (<20 yr, 4%) and older (>60 yr, 11.5%) groups were minimally represented (Table 1). No significant associations were found between knowledge of antibiotic use and sociodemographic factors (p > 0.05; Table S1). Male (93.18%) and female (97.32%) respondents showed high knowledge (p = 0.570). Across age groups, knowledge ranged from 90.91% (41–50 yr) to 100% (p = 0.392). Marital status (p = 0.487), occupation (p = 0.448), and education (p = 0.457) had no significant impact. University graduates (38%) were the largest group; primary school graduates were minimal (2.5%). Daily internet use was 54%, with no significant effect on knowledge (p = 0.467). Overall, poultry farmers exhibited strong awareness of antibiotic use and AMR (Table S1).

Table 1.

Distribution of the studied respondents according to socio-demographic data

KAP of poultry farmers regarding antibiotic application in poultry farms

About 80% of respondents knew the class, names, or brands of antibiotics used on their birds. While 2.5% applied antibiotics at all times, 24% administered them without symptoms, and 77% did so when signs of infection appeared. Only 15% followed veterinary recommendations (Table S2). Regarding frequency, 48% used antibiotics monthly, while 29.5% applied them bi-weekly. Ampicillin (75%) was the most used, followed by ciprofloxacin (71.5%), gentamicin (67%), and amoxicillin (59%). Most (80.5%) used antibiotics for treatment rather than growth promotion (12.5%), while 43.5% applied them prophylactically. Surprisingly, 89% believed antibiotics promote growth in poultry (Figure 2, Table S2). Regarding knowledge, 90.5% had used antibiotics in the past year. Only 42% considered vaccination a viable alternative, while 50.5% were uncertain. Notably, 86.5% consulted veterinarians before use (Figure 2, Table S2).

Figure 2.

Commonly used antibiotics in poultry farms in Enugu, Nigeria.

KAP of poultry farmers regarding AMR

The poultry farmers’ KAP on AMR are summarized in Figure 3. Most (65%) were unaware of AMR, while 33% indicated awareness. Regarding antibiotics’ role in resistance, 42.5% agreed, 22.5% disagreed, and 25% were uncertain (Figure 4; Table S3). About 55.5% saw AMR as a health threat, but only 18% strongly agreed. Despite 86.5% wanting AMR education, only 39.5% were willing to stop antibiotic use in feed. Excessive use (81.5%), unnecessary use (39%), and treatment interruption (22.5%) were identified as major AMR contributors. Awareness varied by age (p ≤ 0.05), occupation (p = 0.006), education (p = 0.020), and internet use (p = 0.014) (Figure 4; Tables S3, S4).

Figure 3.

Distribution of insights into the KAP on antibiotics use by farmers in Enugu, Nigeria.

Figure 4.

Distribution of insights into KAP on AMR by farmers in Enugu, Nigeria.

Discussion

AMR is rising globally, posing a serious health challenge. In Nigeria, poultry farming lacks standardized antibiotic guidelines, and over-the-counter (OTC) access drives unregulated use. This study evaluated poultry farmers’ KAP regarding antibiotic use and AMR in Enugu.

LMICs are disproportionately affected by AMR. Inadequate training and misuse of antibiotics in poultry farming remain key drivers. The use of antibiotics that are critical for human medicine, often without veterinary oversight, poses serious risks to both human and environmental health. In this study, 90.5% of poultry farmers used antibiotics, mostly for treatment, but 89% also reported use for growth promotion - a practice similarly reported in India and Pakistan.Reference Aseem, Sagar and Reddy16,Reference Habiba, Khan and Mmbaga17 This suggests entrenched practices influenced by economic motivations and perceived benefits, despite growing global discouragement of antibiotic use for non-therapeutic purposes.

The prevalent belief (89%) that antibiotics promote growth underscores persistent misinformation and a gap in veterinary extension services. Commonly used antibiotics – ampicillin (75%), ciprofloxacin (71.5%), and doxycycline (71%) – are medically important, raising concerns over selective pressure and increasing resistance, including carbapenem resistance.Reference Ejikeugwu, Nworie and Saki1,Reference Ejikeugwu, Eze and Okonkwo18 Similar patterns in Southwest Nigeria and PakistanReference Habiba, Khan and Mmbaga17,Reference Adebowale, Adeyemo and Awoyomi19 reflect a regional trend of misuse. Widespread use of antibiotics from major therapeutic classes – including beta-lactams, fluoroquinolones, aminoglycosides, sulfonamides, and tetracyclines – in other parts of NigeriaReference Sawadogo, Kagambèga and Moodley22 underscores the broader national implications.

Although 86.5% of farmers sought expert advice, antibiotics were still widely sourced from veterinary clinics (70%), pharmacies (23%), open markets (21%), and patent medicine shops (14.5%). Easy access without stringent regulation facilitates self-medication and undermines rational use. Studies from Ethiopia, Burkina Faso, and Pakistan report similar dynamics.Reference Alhaji, Haruna and Muhammad14,Reference Habiba, Khan and Mmbaga17,Reference Adebowale, Adeyemo and Awoyomi19,Reference Woyessa, Agga and Gumi21 These patterns highlight a systemic weakness: insufficient regulation and monitoring of antibiotic sales and usage, alongside gaps in veterinary infrastructure.

Knowledge of AMR was low, with only 33% having heard of it. This aligns with findings from Reyher et al.Reference Reyher, Barrett and Tisdall23 and another study in Burkina Faso,Reference Sawadogo, Kagambèga and Moodley22 where the majority of farmers lacked AMR awareness. Limited access to accurate information, reliance on informal networks, and inadequate farmer education contribute to this knowledge gap. Such systemic deficiencies create behavioral inertia, where farmers continue antibiotic use unaware of long-term risks.

Despite general awareness of AMR, misconceptions remain prevalent. Only 47.5% of respondents recognized the link between antibiotic use in poultry and AMR, while the rest were unsure or unaware, limiting the potential for behavior change. Younger, more educated farmers with internet access demonstrated greater awareness, with education, occupation, and gender significantly influencing AMR knowledge. Internet use was significantly associated with AMR awareness (P ≤ 0.05), underscoring the role of online information access. However, no significant association was found between internet use and antibiotic use practices (P > 0.05), suggesting that awareness alone does not translate into more responsible antibiotic use.

These insights point to key behavioral and systemic barriers – economic dependency on antibiotics, limited veterinary support, weak regulatory enforcement, and low risk perception. Tackling AMR requires a multifaceted strategy. Promoting non-pharmaceutical infection control – biosecurity, hygiene, and vaccination – is vital to reducing reliance on antibiotics.

Tailored educational campaigns addressing specific misconceptions, improving veterinary outreach, and enforcing OTC regulations are essential in settings like Nigeria. Although this study focused on Enugu, the findings reflect broader national trends and underscore the urgency of comprehensive antibiotic stewardship in poultry farming. As a next step, we aim to use whole-genome sequencing (WGS) to characterize the ARGs prevalent in these farms following antibiotic application, providing deeper insight into resistance mechanisms and environmental dissemination pathways.

This study offers context-specific insights into antibiotic use and AMR awareness among poultry farmers in Enugu, Nigeria identifying key misuse drivers to guide interventions. Study limitations include potential social desirability bias related to literacy and awareness. Future work will therefore stratify participants by education level and incorporate observational measures to mitigate this bias.

Conclusion

AMR in Nigerian poultry farming is driven by antibiotic misuse, low awareness (33%), and unregulated access. About 90.5% of farmers use antibiotics, mainly for infections and growth. Ampicillin is the most used, raising beta-lactamase concerns. Urgent education, stricter regulations, and alternative practices are needed to curb AMR and protect public health.

Supplementary material

The supplementary material for this article can be found at https://doi.org/10.1017/ash.2025.10141.

Acknowledgments

We acknowledge the management of Enugu State University of Science and Technology (ESUT), Agbani, Nigeria and the Administrative/Technical staff from ACEGID, Redeemer’s University, Ede, Osun State, Nigeria for all administrative support toward the successful conduct and completion of this study.

Author contributions

Conceptualization: CPE. Methodology: CPE, CWA, PME. Formal analysis: EAN, ENO, MUA, PME. Data analysis: CPE, EAN, PME. Supervision: CPE, MUA, PME. Writing, review and editing: CPE, EAN, CWA, ENO, MUA, PME

Transparency declarations

The authors declare no financial conflicts of interest related to this study. This research was funded by the National Institutes of Health (NIH) under the CAMRA (Combatting AntiMicrobial Resistance in Africa Using Data Science) initiative, Federal Award Number: 5U54TW012056-03. The funders had no role in the study design, data collection, analysis, manuscript preparation, or decision to publish. No professional medical writer or similar service was involved in the preparation of this manuscript. All authors have no conflicts of interest to declare.

Funding support

This study was supported by funding received under the Combatting AntiMicrobial Resistance in Africa Using Data Science (CAMRA) project (Project Number: 5U54TW012056-03) from the National Institutes of Health (NIH), through the Data Science for Health Discovery and Innovation in Africa (DS-I Africa) Initiative.

Competing Interests

No conflicts of interest to disclose.

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Figure 0

Figure 1.Map of Enugu State, Nigeria, showing study locations (map adapted from Enugu Connect).15.

Figure 1

Table 1.Distribution of the studied respondents according to socio-demographic data

Figure 2

Figure 2.Commonly used antibiotics in poultry farms in Enugu, Nigeria.

Figure 3

Figure 3.Distribution of insights into the KAP on antibiotics use by farmers in Enugu, Nigeria.

Figure 4

Figure 4.Distribution of insights into KAP on AMR by farmers in Enugu, Nigeria.

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