Monrovia, Liberia – Two recent studies led by Bode Ireti Shobayo, PhD Fellow at Karolinska Institutet (KI) and Director of Research at the (NPHIL), have revealed widespread inappropriate antibiotic use in Liberia and highlighted critical challenges in the country’s fight against antibiotic resistance (ABR). The studies provide some of the most comprehensive evidence to date on how Liberians access, use, and perceive antibiotics.
The latest study, published in BMJ Public Health, examined antibiotic purchasing practices among 584 clients in private pharmacies across Montserrado County. Researchers found that 96% of antibiotics were purchased without a prescription, while approximately one-third of those purchases involved antibiotics in the World Health Organization’s Watch category, medicines that require careful use because of their greater potential to contribute to antibiotic resistance.
The research builds on an earlier household-based study published in Antibiotics, which assessed knowledge, attitudes, and practices related to antibiotic use and antibiotic resistance among 1,160 adults across communities in Montserrado County. That study identified widespread misconceptions about antibiotics, including their inappropriate use for conditions such as colds, flu, and other illnesses that do not always require antibiotic treatment.
Taken together, the studies paint a concerning picture of antibiotic use in Liberia.
Many Liberians obtain antibiotics directly from pharmacies without consulting a healthcare professional. Others rely on previous experiences, advice from friends or relatives, or self-medication when managing common illnesses. While public awareness gaps contribute to these practices, the studies show that the problem extends far beyond knowledge alone. Economic barriers, healthcare-seeking behaviors, easy access to antibiotics, consumer expectations, and dispensing practices all play important roles in shaping how antibiotics are used.
“These findings demonstrate that antibiotic misuse is not simply a knowledge problem,” said Mr. Shobayo, Director of Research at NPHIL and lead investigator of the studies. “People often make decisions about antibiotics within the realities of their daily lives, including challenges in accessing healthcare, financial constraints, and the easy availability of medicines. Addressing antibiotic resistance therefore requires a comprehensive approach that combines public awareness, stronger stewardship, responsible dispensing practices, and improved access to quality healthcare.”
Antibiotic resistance occurs when bacteria become resistant to the medicines used to treat them, making infections more difficult and expensive to manage. The World Health Organization has identified antimicrobial resistance, which includes antibiotic resistance, as one of the most serious global public health threats, with the potential to undermine decades of progress in modern medicine.
According to the researchers, the findings underscore the need for Liberia to strengthen antibiotic stewardship across communities, pharmacies, and healthcare facilities. Efforts should include increased community engagement, strengthened regulation of antibiotic sales, improved prescription practices, enhanced access to healthcare services, and continued public education on appropriate antibiotic use.
“We hope these findings will inform policies and practical solutions that help safeguard these life-saving medicines for future generations,” Mr. Shobayo added. “Liberia has an opportunity to build a stronger, evidence-based response to antibiotic resistance, and locally generated research is essential to that effort.”
The research was conducted as part of the doctoral studies of Mr. Shobayo at KI, Sweden, under a PhD training collaboration between NPHIL and Karolinska Institutet supported by the Swedish Research Council. The collaboration, initiated through a partnership between Dr. Mosoka P. Fallah and Professor Helena Nordenstedt (KI), was established to strengthen research capacity and develop the next generation of Liberian researchers and scientists while generating evidence to address priority public health challenges in Liberia and other low- and middle-income countries.
Publications
BMJ Public Health (2026)
Prevalence, patterns and factors associated with over-the-counter antibiotic purchase: a cross-sectional study in private pharmacies in Montserrado County, Liberia – https://pmc.ncbi.nlm.nih.gov/articles/PMC13663895/
Antibiotics (2026)
Knowledge, Attitudes, and Practices Related to Antibiotic Use and Antibiotic Resistance Among Adults in Communities of Montserrado County, Liberia: A Household-Based Cross-Sectional Study – https://www.mdpi.com/2079-6382/15/7/680