Antimicrobial Resistance in Africa: An Underreported Public Health Emergency

In 2019, antimicrobial resistance (AMR) was directly responsible for 1.27 million deaths worldwide — more than HIV/AIDS or malaria. A further 4.95 million deaths were associated with drug-resistant infections. Africa bore a disproportionate share of this burden, accounting for the highest AMR-attributable mortality rates of any global region. Yet AMR receives a fraction of the attention given to other infectious threats.

The drivers of AMR in Africa are well understood, if poorly addressed. Widespread over-the-counter access to antibiotics — without prescription, without diagnosis, without clinical indication — creates the conditions under which resistant strains flourish. A child with a viral fever receives amoxicillin because it is cheap and available. A patient with malaria is also given an antibiotic 'just in case.' Each unnecessary prescription contributes, incrementally, to a commons tragedy.

Healthcare-associated infections represent a second major driver. In facilities with inadequate infection prevention and control measures, resistant organisms spread from patient to patient. Studies from Nigeria, Kenya, and South Africa have documented alarming rates of multidrug-resistant Klebsiella pneumoniae and Staphylococcus aureus in ICU settings — organisms that leave clinicians with few or no effective treatment options.

Agricultural antibiotic use adds a third layer of complexity. Antibiotics are routinely administered to livestock in Africa — often as growth promoters rather than for treatment — creating reservoirs of resistance that enter the food chain and environment.

The solution requires action at every level. At the individual level: never take an antibiotic without a prescription from a qualified clinician, always complete the full course prescribed, never share antibiotics between family members. At the facility level: implement infection prevention protocols, stewardship programs, and resistance surveillance. At the policy level: regulate antibiotic sales, invest in diagnostic infrastructure, and support global AMR surveillance networks.

Be Okay's clinical platform incorporates antibiotic stewardship principles directly into its prescribing workflows. Clinicians are prompted to document clinical indication before prescribing antibiotics, and the system flags potential overprescribing patterns for peer review. Small interventions at the point of prescription, aggregated across thousands of clinicians, can meaningfully shift the trajectory of resistance.