Antimicrobial resistance (AMR), as defined by the WHO, occurs when bacteria, viruses, fungi, and parasites no longer respond to medications. This is a growing global health crisis because AMR makes infections harder to treat and increases the risk of disease spread, severe illness and death. In Africa, this threat looms large, particularly for children. According to a 2023 study published in The Lancet Global Health, AMR caused over 1.05 million deaths in the WHO African region, with 250,000 deaths directly attributable to it. This makes AMR a significant health threat, outnumbering HIV and malaria deaths in the region.
Imagine a young child, let us call her Asante. Asante is a lively 5-year-old living in a small town in Uganda. One day, she comes down with a simple infection, perhaps pneumonia or meningitis. Her doctor prescribes a course of antibiotics, a common treatment for such infections. However, her condition worsens. The antibiotics seem to have little effect. As Asante’s condition deteriorates, her family grows increasingly fearful. They know that without effective treatment, Asante’s life is in danger. Her doctor at the clinic, recognising the severity of the situation, sends her blood sample to a laboratory for testing. The results confirm their worst fears: the bacteria causing the infection are resistant to multiple antibiotics. Asante has contracted an antibiotic-resistant infection. This is the harsh reality of AMR, where common infections become deadly. The antibiotics typically used to treat these infections no longer work, causing them to spiral into a life-threatening ordeal.
According to the Africa CDC’s report, African Union AMR Landmark Report: Voicing African Priorities on the Active Pandemic, the emergence and re-emergence of AMR could potentially send us back to an era when antibiotics did not exist, and minor surgeries and common infections were often fatal. In comparison to high-income countries where indiscriminate antimicrobial use is the main cause of AMR, many African countries face additional challenges, such as inadequate access to clean and safe water, poor Water, Sanitation and Hygiene (WASH) programs, insufficient infection prevention measures, and poor vaccinations for preventable diseases. Currently, the infections driving this threat in children living in Africa are some of the most common.
Angela Dramowski, Professor and Head of Paediatrics at Tygerberg Hopsital and Stellenbosch University (SA) and member of the Penta ID Network, emphasises the particular vulnerability of children to AMR. Their developing immune systems make them more susceptible to infections and less able to fight them off. But many antibiotics are not specifically formulated for children, and treatment adherence can be difficult, leading to incomplete treatment course and drug resistance. These factors contribute to the significant public health concern of AMR in children.
Penta is actively addressing this challenge through research initiatives like PediCAP, SNIP-AFRICA, NeoIPC, Team-COACH, and Value-Dx, which aim to improve the diagnosis and treatment of severe infections in children. By supporting these efforts, Penta is working to ensure a future where children are protected from the devastating consequences of AMR.
Vaccines are a powerful tool in the fight against AMR. By preventing infectious diseases, vaccines reduce the need for antibiotics and, consequently, the risk of antibiotic resistance. Ensuring high vaccination coverage for common childhood infections like whooping cough, pneumococcal disease, and influenza and developing new vaccines for respiratory syncytial virus, Group B streptococcus and Klebsiella to protect pregnant people and their babies is crucial in reducing the burden of AMR in Africa.
Prof. Dramowski adds that it is also essential to have a comprehensive approach to the fight. This includes strengthening healthcare systems, training healthcare workers, and improving access to quality care. Educating healthcare providers and the public about the appropriate use of antibiotics can significantly reduce unnecessary prescriptions. She states that investing in research to develop new antibiotics and diagnostic tools to stay ahead of bacteria that are resistant to antibiotics is crucial and international cooperation is key to sharing knowledge, resources, and expertise, fostering a global effort to combat AMR.
Now imagine this, Dalila, a bright-eyed 5-year-old from a small town in Tanzania, woke up feeling feverish and unwell. Her mother, concerned, takes her to the nearest health clinic. The doctor diagnoses her with a severe bacterial infection and prescribes a course of antibiotics. Fortunately, Dalila’s community had access to a well-equipped health facility with trained healthcare workers. The doctor ensure that the antibiotics are prescribed appropriately, considering the specific infection and Dalila’s age. The clinic also has a strong infection prevention and control program, minimising the spread of resistant bacteria. Dalila receives the prescribed course of antibiotics, and under the watchful eye of the healthcare workers, she begins to recover. The timely and appropriate use of antibiotics, coupled with good infection prevention and control practices, allows Dalila to overcome the infection without complications.
The future of African children depends on our ability to address AMR. By working together, we can protect the next generation and ensure outcomes such as Dalila’s and ensure a healthier future for all.
We are grateful to Prof. Angela Dramowski for her expertise and insights, which significantly enriched this article.