Lagos: Across Nigeria’s crowded pharmacies and drug stalls, millions reach for ‘strong medicine’ to treat everything from coughs to malaria. Many do so without understanding what they are taking. Behind these mistakes lies a deeper communication gap. As antibiotics are misused and misunderstood, bacteria are learning to fight back, fueling a silent epidemic of drug resistance that language must help to cure.
According to News Agency of Nigeria, in Waru, a suburb of the Federal Capital Territory, 32-year-old Hadiza Bello looks at a half-used bottle of antibiotics in a small pharmacy. The label is filled with English words she barely understands. Her five-year-old son has been coughing for weeks. When a local patent medicine vendor handed her what he called ‘strong infection medicine’, she assumed it was safe. A week later, the fever worsened. Stories like hers are increasingly common across Nigeria, reflecting a broader and largely invisible health crisis of antimicrobial resistance.
Analysts say many health workers write prescriptions in English, while patients think in Hausa, Igbo, Yoruba, or Pidgin. Misunderstandings, incorrect dosages, unfinished courses, and self-medication all contribute to the rise of resistant bacteria, which experts warn could soon surpass malaria as a leading killer in Nigeria. Antimicrobial resistance occurs when bacteria, viruses, fungi, or parasites evolve to survive drugs designed to kill them. Each misuse of antibiotics teaches microorganisms to adapt and endure.
Nigeria faces one of the highest burdens of resistance globally. The NCDC reports that between 2019 and 2023, resistance to commonly used antibiotics such as Ciprofloxacin and Ceftriaxone rose sharply in hospitals across Lagos, Sokoto, and Enugu. This worrying trend reflects global resistance patterns. In 2019 alone, over 263,000 Nigerians died from infections linked to resistance; more than those lost to malaria or respiratory diseases combined. Globally, 1.27 million deaths are directly attributed to drug-resistant infections annually.
Yet, the crisis remains poorly understood at the community level. Many families rely on over-the-counter medications, while trained health workers are scarce. For millions, English-language prescriptions are incomprehensible. Complex medical terms such as ‘antimicrobial resistance’ mean little. Antibiotics are often called ‘strong medicine,’ leading patients to demand them for malaria, colds, or pain. ‘Patients often stop taking their medicine too early because they think it is too strong,’ says Mr Rasheed Olawale, a community health worker in Oyo. ‘They don’t understand what the doctor said, and they don’t ask questions’.
Recognizing this challenge, DRASA Health Trust, in partnership with the NCDC and education stakeholders, launched the SayAMR Language Hackathon under the Strategic Action on Youth and Antimicrobial Resistance programme. The initiative brings together linguists, youth, cultural advocates, and scientists to co-create simple, culturally grounded translations of antimicrobial resistance in Hausa, Igbo, Yoruba, and Pidgin English. DRASA believes that translating AMR into the four major languages empowers young people to lead community awareness and bridge language barriers.
This approach drives grassroots action, making the fight against antimicrobial resistance more inclusive, relatable, and impactful across Nigeria. ‘We are imagining a future where simple infections can no longer be treated, and we cannot allow that to happen,’ says Ms Niniola Williams, Managing Director of DRASA Health Trust. ‘If we fail to act, the drugs we depend on today could become useless tomorrow’.
Prof. Haruna Andrew, Secretary-General of the Committee of Vice-Chancellors of Nigerian Universities, adds: ‘If a nation does not have science in its own language, it may never fully understand it. Language is power’. For 24-year-old linguistics graduate Kate Bature, the project is personal. ‘My mother once gave me the wrong drug because she couldn’t read the label. I want families like mine to understand health information,’ she says.
Nigeria’s youthful population presents a unique opportunity. ‘We have a generation that is highly educated and digitally savvy,’ says Okwor. ‘If we empower them, they will transform how people think about medicines’. Dr Jide Idris, Director-General of the NCDC, believes the hackathon’s impact will extend beyond antimicrobial resistance. ‘These ideas can be applied to future outbreaks; cholera, Mpox, even new pandemics. When language meets science, understanding spreads faster than infection,’ he says.
Public health experts stress that resistance is not only a human health issue, but also an environmental and agricultural one. Antibiotics are used in livestock to promote growth, and waste from hospitals often contaminates waterways. ‘People should avoid taking antibiotics without a doctor’s prescription and must complete the full course,’ advises Dr Nafiu Lawal, a Senior Lecturer and Virologist at Usmanu Danfodiyo University, Sokoto. ‘Leftover medicines should never be shared, and patients must ask for explanations in a language they understand’.
Environmental contamination worsens the problem. Studies show that hospital effluent and farm runoff in Nigeria carry antibiotic residues and resistant bacteria into rivers and streams. Experts warn that without regulation, resistance could become embedded in the environment, making infections harder to control. To tackle resistance effectively, experts advocate for a One Health approach; linking human, animal, and environmental health. Coordinated policies must regulate antibiotic use, improve waste treatment, and ensure access to proper healthcare.
Okwor notes that informal healthcare channels compound the problem. ‘In many communities, patent medicine vendors fill the gap where formal healthcare is scarce, but this convenience comes with a high risk of misuse,’ he explains. As Nigeria moves towards its second National Action Plan on resistance, initiatives like SayAMR could be game-changers. By making science accessible and locally owned, they can empower communities to act.
For Hadiza Bello, understanding came too late to save her son, but she is determined to prevent others from facing the same pain. ‘If I had known better words to ask, maybe things would be different,’ she says. Public health experts argue that community engagement is critical. ‘Health is not just about policies on paper; it’s about how people understand and act,’ says Dr Idris. ‘When communities speak the language of science, health stops being policy, it becomes everyone’s responsibility’.
It is worthy to note that the SayAMR Hackathon will culminate in a national innovation conference, where youth-led communication tools and language concepts will be showcased. All in all, experts hope these tools will influence health behaviour nationwide.