Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future

ABSTRACT

Introduction

Antimicrobial resistance (AMR) is a concern as this increases morbidity, mortality, and costs, with sub-Saharan Africa having the highest rates globally. Concerns with rising AMR have resulted in international, Pan-African, and country activities including the development of national action plans (NAPs). However, there is variable implementation across Africa with key challenges persisting.

Areas covered

Consequently, there is an urgent need to document current NAP activities and challenges across sub-Saharan Africa to provide future guidance. This builds on a narrative review of the literature.

Expert Opinion

All surveyed sub-Saharan African countries have developed their NAPs; however, there is variable implementation. Countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; though there are concerns with implementation. South Africa appears to have made the greatest strides with implementing its NAP including regular monitoring of activities and instigation of antimicrobial stewardship programs. Key challenges remain across Africa. These include available personnel, expertise, capacity, and resources to undertake agreed NAP activities including active surveillance, lack of focal points to drive NAPs, and competing demands and priorities including among donors. These challenges are being addressed, with further co-ordinated efforts needed to reduce AMR.

KEYWORDS:

• Antimicrobial resistance
• antimicrobial stewardship programs
• antimicrobial surveillance
• national action plans
• sub-Saharan Africa
• resources
• utilization

Article highlights

• Antimicrobial resistance (AMR) rates are growing especially in sub-Saharan Africa with increasing morbidity, mortality, and costs, with sub-Saharan Africa currently having the highest mortality due to AMR globally.

• Concerns with rising AMR rates have resulted in the WHO instigating national action plans to try and address AMR among countries. This includes African countries.

• While all surveyed African countries have developed NAPs, there is currently variable introduction and implementation across Africa, with key challenges persisting.

• Currently, South Africa appears to have made the greatest strides with implementing its NAP, which includes regular monitoring of agreed activities as well as instigation and monitoring of antimicrobial stewardship programs.

• However, sub-Saharan countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; however, there are currently concerns with implementation.

• Key challenges remain across Africa with implementing NAPs, although these are starting to be addressed. Key challenges include available personnel and expertise, lack of focal points to drive NAPs forward, and resources issues to undertake active surveillance of resistance patterns across sectors exacerbated by competing demands and priorities including among donors.

Declaration of interest

A Egwuenu, E Wesangula, C Tiroyakgosi, Joyce Kgatlwane, AN Guantai, S Opanga, F Kalemeera, BE Ebruke, JC Meyer, OO Malande, O Kapona, T Kujinga, AA Jairoun, AJ Brink are employed by National Health Services or Ministries of Health, or are advisers to Ministries of Health, the WHO or other leading Infectious Disease Groups. In addition, S Opanga received a grant from Kenya AIDS Vaccine Institute -Institute of Clinical Research and Institut Merieux for tackling antimicrobial resistance in Kenya. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to the development of this paper and approved the various submissions.

Additional information

Funding

This paper was not funded.