Antimicrobial resistance preparedness in sub-Saharan African countries

Abstract

Background: Antimicrobial resistance (AMR) is of growing concern globally and AMR status in sub-Saharan Africa (SSA) is undefined due to a lack of real-time data recording, surveillance and regulation. World Health Organization (WHO) Joint External Evaluation (JEE) reports are voluntary, collaborative processes to assess country capacities and preparedness to prevent, detect and rapidly respond to public health risks, including AMR. The data from SSA JEE reports were analysed to gain an overview of how SSA is working towards AMR preparedness and where strengths and weaknesses lie.

Methods: SSA country JEE AMR preparedness scores were analysed. A cumulative mean of all the SSA country AMR preparedness scores was calculated and compared to the overall mean SSA JEE score. AMR preparedness indicators were analysed, and data were weighted by region.

Findings: The mean SSA AMR preparedness score was 53% less than the overall mean SSA JEE score. East Africa had the highest percentage of countries reporting having AMR National Action Plans in place, as well as human and animal pathogen AMR surveillance programmes. Southern Africa reported the highest percentage of countries with training programmes and antimicrobial stewardship.

Conclusions: The low mean AMR preparedness score compared to overall JEE score, along with the majority of countries lacking implemented National Action Plans, suggests that until now AMR has not been a priority for most SSA countries. By identifying regional and One Health strengths, AMR preparedness can be fortified across SSA with a multisectoral approach.

Keywords: Antimicrobial resistance; Joint external evaluation; One health.

Fig. 1

Maps showing the status of JEE completion of SSA countries. Black indicates that a country has not completed a JEE (at the time of writing Angola, Cape Verde, Djibouti, Equatorial Guinea, Somalia and Sudan are either in the process of completing or have not yet undertaken a JEE report), blue indicates a country that has a completed JEE. Countries in grey denote Northern African countries not included in this review

Fig. 2

Explanation of how JEE data was analysed in this study. The mean of country AMR category scores was used as a ‘mean country AMR score’ (indicated by the blue solid line) and compared to other SSA countries (indicated by the black dotted line). The mean of all the ‘Mean country AMR scores’ was used as a ‘Mean SSA AMR score’ (indicated by the blue solid line) and then compared to other mean SSA sub-areas, e.g. immunisation (indicated by the black dotted line). ‘Mean country AMR scores were also weighted into regions (West, Central, East and Southern Africa) and compared (indicated by the black dotted line)

Fig. 3

Map showing SSA country mean AMR JEE scores by colour category. Black denotes a country that has not completed a JEE and grey denotes North African countries not included in this review. Red indicates a JEE score of 1 (‘no capacity’). Yellow indicates a score of 2 or 3 (‘limited capacity’ or ‘developed capacity’) and green indicates a score of 4 or 5 (‘demonstrated capacity’ or ‘sustainable capacity’)