8 years of strengthening AMR response capacity in the WHO African region (2017–2024): progress in antimicrobial consumption monitoring, surveillance and laboratory capacity

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Background Antimicrobial resistance (AMR) is a major global health threat, and African countries are disproportionately affected due to limited diagnostic capacity, weak surveillance and inadequate monitoring of antimicrobial consumption (AMC). This study analysed regional trends using the Tracking Antimicrobial Resistance Country Self-Assessment Survey (TrACSS), a standardised tool for monitoring national progress in AMR response. Methods We conducted an analysis of the TrACSS database covering 47 African countries (2017–2024). Indicators included national AMC monitoring systems, national AMR surveillance systems and laboratory capacity focusing on public and private bacteriology coverage and antimicrobial susceptibility testing (AST) for WHO-priority bacteria and critical fungi. Descriptive and trend analyses were performed, and the association between AMC and AMR system maturity was examined using logistic regression and correlation tests. Results Between 2017 and 2024, the proportion of countries with advanced AMC monitoring more than doubled (13%–30%), while advanced AMR surveillance quadrupled (13%–57%). From 2022 to 2024, public-sector bacteriology coverage rose from 80%–94% and private sector coverage from 60%–75%. Nearly all countries (95.7% in 2024) reported at least one reference laboratory performing AST for priority bacteria, though pathogen-specific reporting remained limited, with the lowest capacity for Campylobacter spp. (reported by a maximum of 12.2% of countries annually). Dual Candida and Aspergillus testing increased from 23% to 30%, but nearly half (46.8%) of countries still lacked a national mycology reference laboratory. Countries with advanced AMC systems were significantly more likely to also have advanced AMR surveillance (OR 8.1; p<0.001). Conclusion The WHO African Region has made measurable progress in AMR response over the past 8 years, though gains remain uneven. Strengthening mycology services, expanding bacteriology coverage and integrating AMC and AMR data systems are critical next steps towards achieving resilient, evidence-driven surveillance networks that can better guide stewardship and investment decisions.

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