Public Health Challenges in the Prevention and Management of Urinary Tract Infections in Nigeria

Abstract

Background. Urinary tract infections (UTIs) are among the most common bacterial infections in Nigeria, yet their prevention and management are undermined by a distinctive set of public-health challenges—weak diagnostic capacity, widespread self-medication and over-the-counter antibiotic sales, and escalating antimicrobial resistance (AMR).

Objective. To synthesise the public-health challenges in the prevention and management of UTIs in Nigeria, encompassing the burden and microbiology of disease, the drivers of antimicrobial resistance, health-system barriers, and the policy response, and to identify priorities for action.

Methods. We conducted a structured synthesis of published Nigerian and West African evidence, including hospital-based microbiological studies, national surveillance and policy documents (notably the National Action Plan on AMR), and the international literature.

Results. Escherichia coli is consistently the predominant uropathogen across Nigerian studies (often around 50–62% of isolates), with women disproportionately affected. Resistance to commonly used oral agents—ampicillin, co-trimoxazole, and increasingly fluoroquinolones—is high and rising, while nitrofurantoin retains comparatively better activity in several settings. Key drivers include very high rates of self-medication (a 2024 national survey reported around 48%), an estimated 60% of antibiotic prescriptions being inappropriate, and widespread over-the-counter sales despite prescription-only regulation. Antimicrobial stewardship programme coverage remains low (around 23% of facilities).

Conclusion. Effective UTI control in Nigeria requires strengthened diagnostic and surveillance capacity, enforcement of prescription-only antibiotic sales, scaled-up antimicrobial stewardship, public education to curb self-medication, and improved water, sanitation, and hygiene—delivered within the One Health framework of the National Action Plan on AMR.