With antimicrobial resistance (AMR) now a leading threat to public health in Africa--causing more fatalities than HIV, TB, and malaria combined--a new surveillance guidance released in October aims to tackle the growing threat of AMR on the continent.
Launched in September, the guidance is the culmination of collaborative efforts from countries across Africa, as well as key organizations including Africa CDC, the African Society for Laboratory Medicine (ASLM), the East, Central and Southern Africa Health Community (ECSA-HC), the West African Health Organization (WAHO), and the Fleming Fund.
AMR occurs when microorganisms such as bacteria, viruses, fungi, and parasites become resistant to antimicrobial treatments, like antibiotics, making infections significantly harder to treat. This phenomenon not only increases disease transmission but also intensifies illness severity and raises mortality rates.
Africa is particularly vulnerable to AMR due to weak healthcare infrastructure, limited access to effective antimicrobials, and inadequate surveillance systems. The misuse of antimicrobial drugs in human health and agriculture further exacerbates the issue, allowing resistant strains to spread more rapidly. As a result, routine infections are becoming more difficult to treat, and life-saving medical procedures, like surgeries and cancer treatments, are being compromised.
In 2022, the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP) project--a multi-year, multi-country study--revealed the dire state of AMR surveillance and the under-reported scope of the crisis in Africa. Based on these findings, Africa CDC called for intensified efforts to improve the quality and quantity of AMR and antimicrobial consumption (AMC) surveillance data across the continent to guide AMR control strategies.
A key milestone in this fight is the publication of the AMR Surveillance Guidance for the African Region, which provides a structured framework to strengthen surveillance systems across the continent. The guidance aligns national strategies with regional and global approaches to improve the monitoring and management of antimicrobial resistance, consumption, and usage data.
The guidance is aligned with the African Union AMR Landmark Report: Voicing African Priorities on the Active Pandemic, launched on the margins of the 78th UN General Assembly. The document emphasizes a One Health approach for AMR surveillance, integrating human, animal, plant, and environmental health.
Importance of Collaboration and AMR Surveillance in Africa
The guidance emphasizes the need for collaboration among African governments, international organizations, and the private sector to respond effectively to AMR. Partnerships with institutions such as the WHO, FAO, and the World Organisation for Animal Health (WOAH) are vital for data sharing, standardizing surveillance methods, and enhancing capacity. Regional organizations like ASLM and the Antimicrobial Resistance Surveillance Network (AMRSNET) also play an integral role in supporting national surveillance efforts and fostering knowledge exchange across countries.
Integrating AMR surveillance data into existing health information systems to ensure sustainability and efficiency is a core recommendation of the guidance. Countries are encouraged to establish National Central Coordinating Units (NCCUs) to oversee AMR surveillance activities and ensure effective data sharing and analysis. The formation of national and sub-national AMR steering committees is also advised to align national efforts with broader public health priorities.
Improving AMR Surveillance in Africa
Effective AMR surveillance is essential for identifying emerging resistance trends, enabling healthcare providers to adjust treatment protocols, and helping governments develop sound antimicrobial use policies. However, AMR surveillance in Africa faces significant challenges, including limited bacteriology services, inadequate laboratory infrastructure, and insufficient testing capabilities. Many laboratories are not equipped to test for AMR, and only a few of WHO's priority pathogens are consistently monitored. This data gap hinders the tracking of resistance patterns and timely responses to public health threats.
The guidance addresses these challenges by recommending diverse surveillance sites, including both rural and urban healthcare facilities, to ensure representative data collection. It also calls for comprehensive data management systems that capture patient demographics, clinical profiles, laboratory results, and antimicrobial use information, with all data centralized in national repositories for streamlined analysis.
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The guidance stresses the importance of quality assurance measures, including External Quality Assessment (EQA)programs, to maintain the accuracy and reliability of AMR surveillance data. These initiatives help laboratories uphold consistent testing standards, ensuring that data is reliable and actionable. Additionally, the guidance highlights the need for capacity building, urging countries to invest in training healthcare workers and laboratory technicians in AMR testing, data collection, and management practices. However, African countries face additional significant challenges in maintaining robust AMR surveillance systems, such as limited funding, human resource shortages, and outdated paper-based data management systems. The new guidance offers a roadmap to overcome these barriers by focusing on governance, infrastructure development, and capacity building.
