Glorious Erhuanga is rarely ill, she says. Which is a good thing because she does not care much for medical drugs. And because, by her own admission, she is an abuser of drugs. “I do abuse drugs in the sense that I don’t completely do the course. If you feel strong enough, you stop. But your illness is not gone completely, they [pathogens] hide in your body,” she explains.

She also admits that even though she knows about prescription drugs because her mother is a nurse, she never understood how they work or how dangerous abusing them and even self-medicating can be until she joined the Health and Hygiene Club at her school two years ago, where she met “Aunty Biola”, the person in charge of the club.

“She told us about our health and also about some things we take unserious, which can actually damage our health, like self-medication,” recalls Glorious.

Aunty Biola was talking about the rampant practice among students that people from her organization could not help but observe when they first introduced the Health and Hygiene Club in four schools in Nigeria’s Lagos state. They had started the club concept to promote good water, sanitation and hygiene habits, like handwashing, as a way to prevent the spread of infections common to the country.

It was an alternative to the one-off events and campaigns typically staged once a year, a model that the Dr. Ameyo Stella Adadevoh (DRASA) Health Trust, an organization working to strengthen Nigeria’s health security, believed was not working.

The club concept embedded emphasis on “harnessing peer pressure for good” with students leading the way to changing behaviours among their peers. As “health ambassadors”, the club members learned the facts on a variety of topics in each weekly club session then passed on that knowledge to their peers in various ways, including during a morning assembly in the school yard and through any format they chose: dance, dramas, debates, competitions, writing essays, music, even rap songs.

Stumbling onto the AMR problem

Week after week in the four experimental club programmes in 2016–2017, the DRASA staff noticed the alarming way the students shared what should be prescription-only drugs. Students were taking antibiotics for headaches and antimalarial drugs for fever. Yet, few of them ever went to see a doctor.

The reality of malaria and little household resources for health clinic visits in Nigeria often leads students and their parents to street-side vendors peddling real and possibly fake medications for the asking and for bargain prices. It is a dangerous level of over-the-counter self-medicating that prompted DRASA to expand its focus.  

“We decided to empower young people to make decisions about their health from a point of knowledge and not from a point of ignorance,” says DRASA Managing Director Niniola Williams. “We’re giving them facts and getting them to understand why what they are currently doing is harmful. We are not telling them what to do.”

DRASA partnered with the World Health Organization (WHO) to focus the education on antimicrobial resistance, or AMR, and expand into six more schools. AMR is a problem that is rampant across the African continent, and globally leads to some 700 000 deaths annually, according to WHO data.

AMR featured prominently when Glorious, now 17, listened to the Health and Hygiene Club introduction. And she was hooked.

“What struck me about the club?” she pauses. “They told us about Dr Ameyo Stella Adedevoh and how she helped protect Nigeria from Ebola. I thought wow wow wow, these people really have lots to offer us, and we'll get to know what we don't know concerning our health matter. I told my friends we have to join these people – let's not follow the crowd. No knowledge is wasted.”

The evaluation data for the first year of the club programme’s partnership with WHO indicated the AMR club model had been influential: Among the 320 health ambassadors, awareness that antibiotics should only be used for bacterial infections went from 34% at the start of the school year to 82% at the end. And awareness that the full dose of antibiotic must be consumed went from 39% to 74%.

“I remember we had another student whose mother was a nurse,” says Williams, “and they had a shelf of medication at home. The mother taught the children which drugs to take for various symptoms, without a test. As a result of our programme, the student was able to change that practice at home.”

Why schools?

Omotayo Hamzat, WHO National Programme Officer for Health Technology and Innovation in Nigeria, says the Organization was looking for innovative ways to tackle the AMR problem. They found the DRASA clubs already in a few schools, where infections pass more easily than study notes. “We concluded we could use youth as champions or ambassadors for change to drive good hygiene and antibiotic practices,” he explains.

“I am forever a DRASA ambassador,” says Glorious of the club’s impact on her. “It changed my thinking. I don't just assume sickness should be treated my special way, I need to seek the advice of a doctor. With what I have learned, I don't think I'll be able to forget it.”

DRASA is confident this approach can work with all students like Glorious. “I hope it catches on all around the world. The students come up with things we could never dream of,” says Williams.

The Government agrees. Although the COVID-19 pandemic put the expansion plans on hold, DRASA and WHO are currently working on scaling the club model to ensure students around the country have access to this type of learning.

In addition to the many crises the pandemic has wrought, it is now is threatening to exacerbate the level of AMR.

Many people in Nigeria presume they have malaria or typhoid whenever they feel feverish and treat it without testing or seeking professional advice, William explains.

 This is especially concerning with the COVID-19 outbreak and the seemingly low numbers across the country. The poor health-seeking behaviours are adding to the problem due to the heavy level of self-medicating with antimalarial drugs or paracetamol for what could be the coronavirus or other serious infections.

“That’s why now, more than ever,” she stresses, “we need to empower our youth all over the country to understand the extent of the AMR challenge and be our ambassadors for behaviour change in their schools, homes and communities.”