Health workers’ knowledge, perceptions, and practices relating to antimicrobial use and resistance in cross river state, Nigeria: a cross sectional study

Antimicrobial resistance (AMR) is a serious global health issue with health workers (HWs) being central to addressing this issue. This study aimed to assess the knowledge, perceptions, and practices of HWs regarding antimicrobial use/AMR in Cross River State, Nigeria. This cross-sectional survey involved 431 HWs in randomly selected healthcare facilities (13 primary and 23 secondary facilities) in Cross River State. Data were collected using a structured questionnaire. Descriptive and inferential analysis were performed using SPSS version 23. Of 431 HWs approached, 427 (99.1%) responded. Nurses comprised the largest group (37%), followed by medical doctors (26.5%). Overall, 60% of the respondents demonstrated good knowledge 30% demonstrated moderate knowledge, and 10% demonstrated poor knowledge of AMR and antimicrobial use. Perceptions were positive, with 81% categorized as good. Practices were good in 65% (of consenting HWs although 54.3% (n = 232) admitted to prescribing antibiotics not in accordance with guidelines. Identified gaps included prescribing due to patient pressure (47%) and stock availability (66%). Professional role (χ² = 41.72, df = 18, p = 0.001) and years of experience (χ² = 26.78, df = 10, p = 0.013) were significantly associated with good knowledge. Also, professional role (χ² = 28.41, df = 9, p = 0.001) and years of experience χ² = 14.67, df = 5, p = 0.012) were significantly associated with good practices. No statistically significant associations were found with perceptions. HWs in Cross River State exhibited predominantly good knowledge and perceptions of AMR, but practices, though good, revealed areas for improvement, particularly in guideline adherence and resistance to external pressures.