From Self-Medication to Antimicrobial Resistance: Socioeconomic Realities and Public Health Implications in Kibera, Nairobi

Self-medication with antibiotics is a widespread practice that significantly accelerates antimicrobial resistance (AMR), particularly in informal settlements such as Kibera, Nairobi. This study carefully collects research from 2016-2025 and uses the Health Belief Model (HBM) to look at the behavioral, environmental, and structural causes of antibiotic misuse. These include widespread poverty, limited access to formal healthcare, unregulated pharmaceutical markets, and poor sanitation. Findings reveal that high perceived susceptibility to infection, limited understanding of AMR severity, and strong confidence in self-diagnosis reinforce habitual antibiotic use. The perceived benefits of informal access—such as affordability, convenience, and social trust—consistently outweigh barriers to formal care, including cost, distance, and long wait times. Social and environmental cues, such as peer influence and poor sanitation, further normalize inappropriate antibiotic use. Despite national estimates of 8500 AMR-attributable deaths in 2019, community awareness of AMR risks remains low. This study adds to the body of research on AMR by combining theory-driven behavioral analyses with policy-relevant insights specific to low-income urban contexts. It highlights the need for multifaceted interventions, including regulatory enforcement, community education, health system expansion, environmental sanitation upgrades, and localized AMR surveillance. Future research should assess intervention effectiveness and develop HBM-aligned communication strategies. A One Health, multisectoral approach is essential to curbing AMR in urban informal settlements like Kibera and similar settings globally.