Addressing the silent epidemic of antimicrobial resistance in the African region: a scoping review of evidence gaps and research considerations

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Abstract
Objectives: This scoping review mapped antimicrobial resistance (AMR)-related interventions in WHO African region against the five strategic objectives of the WHO Global Action Plan (GAP) on AMR and identified evidence gaps limiting progress. Design: A scoping review using the Arksey and O’Malley framework, enhanced by Levac et al and Joanna Briggs Institute methodology; reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Data sources: PubMed, CINAHL, Web of Science and Scopus searched on 9 December 2025, with grey literature from Google Scholar and Google (first 100 hits). Eligibility criteria: Studies of any design reporting interventions addressing GAP strategic objectives—stewardship, surveillance, infection prevention, education or economic approaches in the WHO African region. Data extraction and synthesis: Data were charted using a pilot-tested Excel tool by GAP strategic objective and evidence gaps and research considerations were synthesised thematically. Results: Forty-nine studies (2016–2025) were included, with country-specific evidence concentrated in South Africa, Ethiopia, Kenya, Ghana and Nigeria. Most evaluated antimicrobial stewardship or awareness/training interventions in tertiary hospitals, showing improvements in prescribing, knowledge and occasional cost savings but few assessed long-term effects or resistance trends. Surveillance had advanced but remained limited by weak laboratory capacity, diagnostic coverage, data quality and limited use of AMR/antimicrobial use data in practice. Evidence on infection prevention, vaccination and One Health interventions was scarce and no full economic evaluations were identified. Conclusions: AMR research in the African region clusters around antimicrobial stewardship and awareness in tertiary hospitals, leaving infection prevention, vaccination, One Health approaches and economic evaluation substantially underrepresented across the GAP framework. Closing these gaps will require longer-term implementation research, context-specific economic analyses and broader geographical coverage to generate the evidence needed to operationalise the global AMR research agenda in Africa.

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