The public health impacts of antimicrobial resistance in Africa and responses to reduce this: A scoping review.

Abstract

Background: Antimicrobial resistance (AMR) is a cogent public health issue bedevilling low- and middle- income countries of Sub-Saharan Africa. Up until now, existing research on AMR in Africa have not assessed the state of AMR surveillance and monitoring as part of measures to curb the menace of AMR. This research mapped the literature on AMR surveillance in the World Health Organisation (WHO) African region with the intent of providing an understanding of the current trends in AMR surveillance in the region and justifying the need for a systematic review on the topic or otherwise.

 Methods: The identification of eligible sources was carried via systematic searches on the databases: PubMed, CINAHL, Medline and Google Scholar. Furthermore, screening of identified sources was carried out using a pre-defined eligibility criterion. The database search yielded 1796 records in total which were screened based on the eligibility criteria. 20 sources that fulfil the eligibility criteria were included in the scoping reviews. Moreover, narrative synthesis approach guided the summary and synthesis of findings of the eligible studies.

Results: The coding process for the narrative synthesis yielded three distinct themes: poor data availability and management; poor implementation of National Action Plans (NAPs) and inadequate AMR surveillance systems and variable implementation of NAPs. The outcome of the narrative synthesis demonstrate that African countries are at different levels of NAP implementation. In addition, findings indicate that countries of Eastern Africa sub-region were more successful with AMR surveillance strategies and are more accomplished in terms of NAPs implementation and AMR surveillance of antimicrobial use. Furthermore, the outcome of the narrative synthesis demonstrates that infrastructural deficit, shortage of laboratory facilities for AMR testing and diagnostics, poor healthcare funding, poor data management due to paucity of laboratory-based AMR surveillance, weak regulation of antimicrobial drug sale, purchase and use, and paucity of financial resources and skilled AMR diagnostics experts are debilitating factors undermining AMR surveillance in the African continent.

Conclusion: This scoping review provides a comprehensive overview of current literature on AMR surveillance in Sub-Saharan Africa. The outcome of the study provides directions for further research and provides impetus for the conduct of a systematic review on the current state of AMR surveillance and AMR stewardship in Africa. In addition, the study provides valuable information that can guide policy formulation on AMR surveillance in the WHO African region.