Antimicrobial Resistance Rates and Surveillance in Sub-Saharan Africa: Where Are We Now?

Abstract

Introduction: Although antimicrobials have traditionally been used to treat infections and improve health outcomes, resistance to commonly used antimicrobials has posed a major challenge. An estimated 700,000 deaths occur globally every year as a result of infections caused by antimicrobial-resistant pathogens. Antimicrobial resistance (AMR) also contributes directly to the decline in the global economy. In 2019, sub-Saharan Africa (SSA) had the highest mortality rate (23.5 deaths per 100,000) attributable to AMR compared to other regions.

Methods: We searched PubMed for articles relevant to AMR in pathogens in the WHO-GLASS list and in other infections of local importance in SSA. In this review, we focused on AMR rates and surveillance of AMR for these priority pathogens and some of the most encountered pathogens of public health significance. In addition, we reviewed the implementation of national action plans to mitigate against AMR in countries in SSA.

Results and discussion: The SSA region is disproportionately affected by AMR, in part owing to the prevailing high levels of poverty, which result in a high burden of infectious diseases, poor regulation of antimicrobial use, and a lack of alternatives to ineffective antimicrobials. The global action plan as a strategy for prevention and combating AMR has been adopted by most countries, but fewer countries are able to fully implement country-specific action plans, and several challenges exist in many settings.

Conclusion: A concerted One Health approach will be required to ramp up implementation of action plans in the region. In addition to AMR surveillance, effective implementation of infection prevention and control, water, sanitation, and hygiene, and antimicrobial stewardship programs will be key cost-effective strategies in helping to tackle AMR.

Keywords: GAP; NAP; antimicrobial resistance; sub-Saharan Africa; surveillance.

Figure 1

Resistance elements inserted into the novel pVC_ESBL plasmid in Kenyan cholera strains.

Figure 2

There are three main regions on the pVC_ESBL: SXT R319 carrying the floR-dhfrA1-strA-StrB-sul2 genes, class 1 integron carrying aadB-arr2-bla_TEM1B-cmlA-bla_OXA-10-arr-2-aadA1 cassettes and with sul1 and a truncated qacEΔ1 gene at the 3’ conserved end, and resistance genes inserted into the plasmid backbone encoding resistance to bla_CTX-M-15), aac(3)-IIc that confer resistance to streptomycin, kanamycin, and tobramycin, and a putative gene for tunicamycin resistance.