Antimicrobial Resistance (AMR) in Low-Resource Settings: A Molecular And Public Health Investigation Into the Role Of Environmental Reservoirs And Over-The-Counter Antibiotic Use In South-South Nigeria

Abstract

Antimicrobial resistance (AMR) is a significant public health challenge worldwide, particularly in underserved communities where access to healthcare is limited. Researchers are increasingly recognising that the clinical overuse and misuse of antibiotics drive antimicrobial resistance, and they also highlight habits such as the use of over-the-counter (OTC) antibiotics and environmental exposure as significant accelerators of resistance. People in underserved communities often buy antibiotics without prescriptions, misuse them or use them to treat non-bacterial sickness. Microbial resistance and resistance genes are spread due to poor sanitation and contaminated water. This study combines practical microbiological sampling and molecular analysis with public health surveys to investigate the interaction between OTC antibiotic use and environmental exposure. Common antibiotic resistance genes, such as blaTEM, tetM, and ermB, were tested for in samples collected from household water, sewage drains, and clinic sources in South-South Nigeria. The results showed that blaTEM was present in 47% of the samples, tetM in 38%, and ermB in 31%. Out of 45 environmental samples collected, 86% yielded growth of bacteria resistant to at least one antibiotic, 58% showed multi-drug resistance (MDR). Researchers surveyed 300 residents in selected communities across the Delta and Rivers States to assess their antibiotic practices and awareness of antimicrobial resistance. 78% of the participants reported buying antibiotics without a prescription, 66% admitted using antibiotics for fever, body pain, and infection before visiting a clinic, and 43% stopped their medication as soon as they felt better. Only 27% were aware of antimicrobial resistance. We found that environmental and clinical samples share the same resistance genes, particularly in areas with high rates of self-medication. People's habits and their environment play a significant role in the continued spread of antibiotic resistance. There is a clear connection between environmental risks and self-medication, even though the relationship is correlational