Antimicrobial resistance (AMR) is one of the most urgent global health threats, responsible for an estimated 4.95 million deaths annually, including 1.27 million directly linked to drug-resistant infections. Nigeria is particularly affected, ranking 19th globally in AMR-related mortality, with an estimated 64 500 attributable and 263 400 associated deaths in 2019. These estimates are likely conservative due to limited surveillance. Economically, AMR could cost Nigeria 5%–7% of its GDP by 2050.

Despite this burden, antibiotic misuse remains widespread, with 42% of adults and over 46% of children under 5 receiving antibiotics without prescriptions. At the primary healthcare (PHC) level, where most antibiotics are prescribed, challenges such as limited diagnostics, inconsistent prescription and poor access to digital tools hinder effective antimicrobial stewardship (AMS).

The primary objective of this study is to assess the knowledge, attitudes and practices regarding antimicrobial resistance (AMR) among PHC prescribers in Imo State, Nigeria. A secondary objective is to explore preliminary indicators of their digital readiness to inform future technological interventions for AMS.

A cross-sectional study using an online questionnaire.

PHC facilities across all 27 local government areas of Imo State, Nigeria.

A purposive sample of 547 facility-based public PHC prescribers included 84% of all facility Officers-in-Charge of health facilities in the state and 16% of other PHC workers who were involved in prescription.

The primary outcome measures were composite scores for knowledge (adequate/inadequate), attitude (positive/negative) and prescribing practice (good/poor), derived from a validated questionnaire. Secondary measures included sources of AMR information and indicators of digital readiness.

While 77.1% demonstrated adequate knowledge, only 32.7% exhibited positive attitudes and 88.5% reported poor prescribing practices. Attitude was the strongest predictor of good practice (OR=17.585, p

These findings underscore a critical gap between knowledge and practice, driven in part by limited access to digital decision-support tools. To address the documented gaps in tool access and training, strengthening digital inclusion through context-adapted e-learning, offline-compatible AMS tools and simplified digital antibiograms is a necessary implication for improving antibiotic stewardship and clinical outcomes at the PHC level.

Pregnancy and childbirth among adolescents have a higher risk of adverse outcomes than among older women. Adolescent mothers often lack physiological, psychological, social and financial capabilities, risking adverse birth outcomes such as preterm birth (PTB), low birth weight (LBW), asphyxia and stillbirth. We investigated birth outcomes and associated factors among adolescent mothers in the Nabdam District of Ghana.

Retrospective, health facility-based, cross-sectional study.

12 health facilities in Nabdam District, January 2021 to December 2022.

Census of all 373 births recorded in the maternity registers of the selected health facilities.

The main outcome measure was adverse birth outcome, a composite outcome measured as the presence of at least one of PTB, LBW, asphyxia and stillbirth. The data collected were analysed using SPSS V.22. Proportion, mean, ² and binary logistic regression models were used.

141 (37.8%) of the adolescent mothers in the selected health facilities had at least one adverse birth outcome: PTB (78, 20.9%), newborn with asphyxia (56, 15.0%), LBW (55, 14.7%) and stillbirth (1, 0.3%). Adolescents in the Pelungu subdistrict were 2.95 times (95% CI 1.44 to 6.05) more likely to have an adverse birth outcome compared with those in the Zanlerigu subdistrict. Lower odds of adverse birth outcomes were found among adolescents aged 16–19 years (adjusted OR (aOR) 0.26, 95% CI 0.08 to 0.89) and those with eight or more antenatal care (ANC) visits (aOR 0.30, 95% CI 0.10 to 0.96) compared with those younger than 16 years and those with fewer than eight ANC visits, respectively.

Adverse birth outcomes were common among adolescent mothers in the district and were more likely among younger adolescents, those living in disadvantaged subdistricts and those with fewer ANC visits. These findings indicate the urgent need for targeted interventions and support for this vulnerable population, as well as those directed towards improving access to comprehensive prenatal care, promoting proper nutrition during pregnancy and enhancing the overall well-being of adolescent mothers in resource-limited settings, in order to facilitate the attainment of Sustainable Development Goals 3.1 and 3.2 on reducing maternal mortality and improving foetal health outcomes.