The Nigerian Institute of Medical Research (NIMR) has warned that drug-resistant infections are surging across hospitals in Lagos State, raising fears that Nigeria may be heading toward a ‘post-antibiotic era.’
A senior research scientist at NIMR, Emelda Chukwu, told journalists during the institute’s February Media Chat, that antimicrobial resistance (AMR) is no longer a looming threat but already a reality in Lagos hospitals.
Ms Chukwu said the institute has seen an increase in resistance that is threatening to overturn decades of medical progress, noting that medicines that were once guaranteed to save lives are failing.
She said surveillance across four major hospitals in Lagos revealed dangerously high resistance to third-generation cephalosporins, broad-spectrum antibiotics reserved for severe infections that do not respond to other treatments.
“These are reserve drugs, but we are now seeing that even these third-generation medicines are losing their effectiveness. That is a major red flag,” she warned.
She added that the surge in resistance is putting patient safety at serious risk, limiting treatment options, prolonging hospital stays, and increasing complications and mortality.
“When our reserve antibiotics begin to fail, patient safety is at serious risk,” she said.
AMR prevalence in Nigeria
AMR is the ability of microorganisms, such as bacteria, viruses, fungi and parasites, to survive and grow despite exposure to medicines designed to kill them or stop their growth.
When these microorganisms become resistant, antimicrobial medicines, including antibiotics, antivirals, antifungals and antiparasitic drugs, no longer work effectively, making infections significantly harder to treat.
AMR develops gradually, often due to the misuse or overuse of antimicrobial medicines, poor infection prevention practices, and the spread of resistant strains across communities, healthcare facilities, food systems, and the environment.
The World Health Organisation (WHO) warned that AMR remains a silent but escalating threat, claiming more than 60,000 lives in Nigeria every year.
According to WHO estimates, the country has been recording this burden annually since 1990, underscoring the deep-rooted nature of the problem.
In 2021 alone, Nigeria recorded an estimated 50,500 deaths directly attributable to AMR and 227,000 associated deaths, with children under five bearing the heaviest toll.
Global burden
WHO estimates that AMR was associated with 4.71 million deaths in 2021, including 1.14 million directly attributable to drug-resistant infections.
It also noted that Sub-Saharan Africa alone recorded about 250,000 deaths in the same year.
Also, it indicates that the world loses an estimated 178 million disability-adjusted life years (DALYs) to AMR, and projections indicate the crisis could cost the global economy nearly $1 trillion annually if left unchecked.
Recent modelling also shows that AMR could claim up to 39 million lives by 2050.
Human behaviour driving resistance
Tracing the rise in drug-resistant infections, Ms Chukwu pointed to misuse and overuse of antibiotics as a major driver.
She stated that irrespective of whether one uses antibiotics correctly or not, resistant organisms can spread as it does not respect boundaries.
She said her team has developed facility-specific antibiograms to guide treatment, noting that 80 per cent of prescriptions in hospitals are empirical.
“If doctors are guided by data from their own facilities, it can significantly improve outcomes,” she said.
Wastewater canals signal looming outbreaks
Ms Chukwu said her research revealed that the threat extends beyond hospitals noting that environmental surveillance across all 20 local government areas in Lagos detected antimicrobial-resistant bacteria and cholera-causing Vibrio cholerae O1 in wastewater canals.
“Out of the 20 LGAs surveyed, nine had Vibrio cholerae O1 incubating in their wastewater canals. That was extremely alarming,” she said.
She also said that the findings prompted a policy advisory to Lagos authorities ahead of the 2024 cholera outbreak, which spread across 36 states.
“This approach allows us to detect threats early and act before they spiral out of control,” Ms Chukwu said, highlighting the value of wastewater-based epidemiology in epidemic preparedness.
She added that risky behaviours such as illegal dumping and open defecation are fuelling infections.
“When the canals overflow, they carry pathogens back into people’s homes. It becomes a cycle of reinfection,” she explained.
Surveillance not enough
Ms Chukwu stressed that monitoring infections alone will not stop AMR.
Studies by her team show pressure on doctors to over-prescribe and low public awareness of proper antibiotic use.
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“Even prescribers are under pressure to prescribe. The public believes antibiotics are cure-alls. These practices are fueling resistance,” she said.
She called for sustained awareness campaigns, stronger stewardship programmes, and coordinated One Health interventions linking human, animal, and environmental health.
“Antimicrobial resistance is not a future threat. It is here with us. If we do not act decisively, we risk losing the gains made since the discovery of antibiotics in the 1920s. The time to strengthen surveillance and change behaviour is now,” she warned.
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