The rampant emergence of antibiotic resistance has become a major public health concern worldwide. This is especially true in sub-Saharan Africa, where access to proper healthcare is limited and infectious diseases are prevalent. According to a recent report, Africa has the highest burden of infectious diseases in the world, accounting for an estimated 50% of global deaths. In the fight against these diseases, antibiotics have been the go-to treatment, but their misuse and overuse have led to the development of drug-resistant strains. In this article, we delve into the current state of antibiotic use among hospitals in sub-Saharan Africa, exploring the challenges and efforts to combat antibiotic resistance in the region.
Antimicrobial resistance (AMR) is a growing concern worldwide, with significant impacts on morbidity, mortality, and costs. A recent estimate suggests that 4.95 million deaths were associated with bacterial AMR globally in 2019, with the highest number of deaths per head of population in sub-Saharan Africa. The high rates of AMR in Africa are driven by high rates of inappropriate use of antimicrobials, poor infection prevention and control in healthcare facilities, a lack of inexpensive and rapid diagnostic tests, and patient demand. Prevalence rates of antimicrobial use among participating hospitals in Africa ranged from 27.8% to 74.7% of patients, according to the 2015 Global Point Prevalence Survey (PPS) on antimicrobial consumption. A lack of appropriate diagnostic services, limited institutional groups including infection, prevention and control (IPC) committees, and antimicrobial stewardship groups are some of the factors contributing to the high rates of empiric prescribing across Africa.
However, the implementation of antimicrobial stewardship programs (ASPs) is beginning to improve antibiotic prescribing among hospitals across Africa. This includes encouraging greater adherence to national guidelines, which can reduce antimicrobial use, reduce hospital stay, improve clinical outcomes, and reduce AMR. The instigation of ASPs is crucial given the current high rates of AMR in Africa and the continued increase in antibiotic utilization among low- and middle-income countries (LMICs), including African countries. A key part of World Health Organization (WHO) activities to reduce AMR is the development of National Action Plans (NAPs), which are now being instigated across Africa.
PPS studies have shown high prevalence of antibiotic use among hospitals across sub-Saharan Africa, with most reporting prevalence rates of over 50%. Typically, two antibiotics were prescribed per patient, with the cephalosporins, penicillins, and nitroimidazoles being the most prescribed antibiotics. There were appreciable concerns about the inappropriate prescribing of antibiotics, with a number of studies reporting that documentation regarding the rationale for prescribing was either missing or poor.
The most reported quality indicators for improving future antibiotic prescribing across Africa include antibiotic use prevalence and the use of microbiological tests. ASPs have improved antibiotic utilization, with a reduction in antibiotic use from pre- to post-ASP, increased compliance to guidelines, and no deterioration in clinical outcomes. However, there is still room for improvement in the implementation of ASPs in hospitals, alongside the need for additional funding, awareness, and engagement across all levels of healthcare management.
In conclusion, the high rates of AMR in Africa require urgent attention to reduce inappropriate antimicrobial prescribing and improve infection prevention and control in healthcare facilities. The implementation of ASPs, including the use of quality indicators to guide improvements in prescribing practices, can play a crucial role in reducing the burden of AMR in the region.
In conclusion, the current state of antibiotic use in hospitals across sub-Saharan Africa is a cause for concern. The over-reliance on broad-spectrum antibiotics without proper microbiological testing and the widespread availability of antibiotics without a prescription have led to the emergence of antibiotic-resistant strains of bacteria. It is essential for healthcare providers in the region to adopt strategies that ensure appropriate use of antibiotics, including antimicrobial stewardship programs, and investing in laboratory infrastructure and personnel training. By taking these steps, we can slow the spread of antibiotic-resistant infections and ensure that antibiotics remain a valuable resource for generations to come.
