Antibiotics are failing in many countries in Africa, new study reveals.

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The largest retrospective study on antibiotic resistance (AMR) in Africa highlights the need for major investments to enhance laboratory capabilities and healthcare access.

A new study covering 14 African countries from 2016 to 2019 ─ published today in the journal PLOS Medicine ─ found resistance to critical antibiotics used to treat severe bacterial infections is widespread, with significant variations across countries.

(Above) Data collection training in Malawi as part of MAAP study (Credit: ASLM).

The AMR study is the largest to date in Africa, which examined over 187,000 bacterial samples from 205 laboratories in Burkina Faso, Cameroon, Gabon, Ghana, Kenya, Eswatini, Malawi, Nigeria, Senegal, Sierra Leone, Tanzania, Uganda, Zambia, and Zimbabwe. The most frequently isolated pathogens were Escherichia coli (22%) and Staphylococcus aureus (15%).

The research was conducted by the Fleming Fund-supported project, ‘Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP)’ research consortium led by the African Society for Laboratory Medicine (ASLM), including the Africa Centres for Disease Control and Prevention (Africa CDC) and the One Health Trust.

The study highlights the spread of AMR in Africa and the systemic gaps in laboratory infrastructure that hinder efforts to combat it. Key findings show:

• High resistance rates: Bacteria, such as Escherichia coli and Staphylococcus aureus, common causes of infections, showed resistance to key antibiotics in up to 70% of cases in some countries.
• Testing capacity gaps: The number of positive cultures with Antibiotic Susceptibility Testing results per 100,000 people varied from nine in Sierra Leone to 452 in Eswatini.
• Data gaps: Only 12% of records included patient clinical information, and many laboratories lack the resources for routine testing, limiting the ability to understand and tackle AMR.

The study also revealed that inadequate laboratory capacities and inconsistent data reporting systems hinder efforts to track and combat AMR. Consequences arising from the dramatic lack of bacteriology testing and AMR capacity in the participating countries were previously reported in an earlier paper from the same research effort.

In some countries, testing is often reserved for the sickest patients, potentially overestimating resistance rates, while limited access to diagnostics may miss many cases, underestimating the true burden.

The lack of effective antimicrobial resistance surveillance in Africa complicates mitigation efforts and reflects healthcare capacity gaps that, among other things, limit patients' access to appropriate antibiotics,” said Dr Ramanan Laxminarayan, senior author of the study and President of the One Health Trust. “This study shows that Africa faces critical challenges with AMR control, but with investment in laboratories, better data systems, and public health measures, we can reverse the trend.”

Nqobile Ndlovu, the CEO of ASLM, commented: “This groundbreaking study reveals a pressing need to strengthen bacteriology testing and AMR detection in sub-Saharan Africa. With only 1% of labs equipped for bacterial testing and limited population access, it exposes critical healthcare gaps. This is a call to action for governments and global health partners to invest in lab infrastructure, quality systems, and diagnostics to improve care and enable effective AMR surveillance across the region.”

“For African countries, AMR remains a wicked and complex problem, leaving countries with a million-dollar question, ‘where do we start from?’ This study brings to light groundbreaking AMR data for African countries. We must act now and together to address AMR,” said Dr Yewande Alimi, the One Health Unit Lead for Africa CDC.

The study authors call for urgent action, including:

• Expanding access to diagnostic tools and bacteriology laboratories.
• Implementing electronic data systems to improve AMR tracking.
• Promoting public health measures such as clean water, sanitation, and vaccinations to reduce infections.

The other members of the MAAP consortium are: IQVIA; the West African Health Organisation; the East, Central, and Southern African Community; and Innovative Support to Emergencies, Diseases, and Disasters. Operating in 14 countries across West, East, Central, and Southern Africa, MAAP facilitated the collection and sharing of data on antimicrobial resistance and use.

The study ‘Antimicrobial resistance in Africa ─ a retrospective analysis of data from 14 countries, 2016–2019’ is available in PLOS Medicine, here.