Prescription habits in Nigeria are largely characterized by the irrational use and over-prescription of medicines, particularly antibiotics, and high rates of polypharmacy (prescribing multiple drugs). These practices deviate significantly from World Health Organization (WHO) standards and contribute to a growing public health challenge, notably antimicrobial resistance (AMR). 

Efforts to address these issues include calls for better implementation of legislation, continuous education for healthcare workers, and the establishment of antimicrobial stewardship programs. 

Key Characteristics of Prescription Habits

Self-Medication: A high prevalence of self-medication with both over-the-counter and prescription drugs is observed among the general population, further contributing to irrational drug use. 

Over-Prescription of Antibiotics: The most prominent issue is the high rate of antibiotic prescription, often for conditions where they are not necessary, such as unconfirmed typhoid fever, common colds, and non-specific diarrhea. This is a major driver of antimicrobial resistance. The prescription rate for antibiotics can be as high as 98.2% among some primary healthcare workers.

Polypharmacy: It is common for multiple drugs to be prescribed per encounter, with studies reporting an average of 3 to 6 medicines per prescription, which is higher than the WHO standard of less than 2.

Easy Access to Prescription-Only Medicines (POM): Despite regulations, prescription-only medicines are easily accessed over-the-counter from pharmacies and patent and proprietary medicine vendors (PPMVs) without a valid prescription.

Suboptimal Adherence to Guidelines: Prescribers often do not adhere to national or international treatment guidelines and essential medicines lists, partly due to a lack of awareness, weak enforcement of penalties, and the absence of functional national antibiotic policies.

Influence of Non-Clinical Factors: Prescribing decisions are frequently influenced by patient pressure, pressure from pharmaceutical sales representatives, and a desire to help patients, rather than objective clinical judgment.

Poor Prescription Quality: Issues such as illegible handwriting, incorrect dosages or duration of therapy, and a lack of clear instructions to the pharmacist or patient are commonly observed, leading to potential medication errors.

Causes and Contributing Factors

• Weak Regulation and Monitoring: There is a lack of effective monitoring and enforcement of existing drug policies and regulations at all levels of healthcare.
• Inadequate Training: Many frontline healthcare providers, such as Community Health Extension Workers (CHEWs), receive minimal training on appropriate antimicrobial use and prescribing.
• Weak Laboratory Support: Reliance on clinical symptoms due to a lack of robust laboratory support leads to unconfirmed diagnoses (e.g., typhoid fever), resulting in unnecessary antibiotic prescriptions.
• Economic Factors: The high cost and unavailability of medicines can influence prescribing decisions and lead patients to seek cheaper, potentially inappropriate, options from informal vendors.