Kapatsa Thandizo, Lubanga Adriano Focus, Bwanali Akim N, Harawa Gracian, Mudenda Steward, Chipewa Pascal C, Kamayani Mapeesho, Makole Tumaini John, Ali Abdisalam Yusuf, Mohamed Abdullahi Abdirasak, Tae Youn Kim, Kim Lorie, Daniel Won D, Kim Matthew, Chehab Tarek Emir, Nyirenda Thomas
Education and Research, Clinical Research Education and Management Services (CREAMS), Lilongwe, Malawi.
Department of Laboratory Science, Dedza District Hospital, Ministry of Health, Dedza, Malawi.
Infect Drug Resist. 2025 Feb 13;18:855-873. doi: 10.2147/IDR.S503730. eCollection 2025.
Antimicrobial resistance (AMR) is currently one of the twenty-first century's biggest threats to public health. Addressing AMR is often operationalized as requiring 'behavior change' of clinicians and patients and improving the drug development pipeline. Few studies and interventions have approached AMR as a challenge fundamentally embedded within the cultural fabric of modern societies and their varied economic, social and political organizations. This systematic review aimed to gather and review the available data on the behavioral and socio-economic determinants of AMR in sub-Saharan Africa (SSA).
Articles were sourced from PubMed using search terms across five domains: "Antimicrobial resistance", "Sub-Saharan Africa", "Behavioral", "Socio-economic", and specific SSA country names. References were also reviewed for relevant data. This systematic review included original studies published in English between 2015 and 2023, focusing on behavioral and socio-economic factors influencing AMR in human populations in SSA, with AMR as a key outcome.
This systematic review identified 30 studies, with 83% (n=25) focusing on self-medication and antibiotic use practices, 67% (n=20) on healthcare providers' practices and knowledge, and 60% (n=18) on community knowledge and perceptions of AMR while 50% (n=15) of studies explored various socio-economic factors. The common themes that emerged from these studies included inadequate evidence-based prescription practices (63%, n=19), financial barriers to accessing antibiotics (50%, n=15), poor community awareness of AMR (53%, n=16), regulatory challenges in antibiotic sales and distribution (47%, n=14), and healthcare infrastructure limitations, including deficient diagnostic capabilities and antimicrobial stewardship programs (40%, n=12).
This review's findings provide crucial insights into the behavioral and socioeconomic patterns influencing AMR in sub-Saharan African populations. For AMR interventions to be effective, there is a need for a thorough understanding of people's behaviors and practices about AMR knowledge and antimicrobial use which will help in developing more targeted interventions and policies to address inappropriate antimicrobial use and the spread of AMR.
抗菌药物耐药性（AMR）是当前21世纪对公共卫生的最大威胁之一。应对AMR通常被具体化为要求临床医生和患者“改变行为”，并改善药物研发流程。很少有研究和干预措施将AMR视为现代社会文化结构及其多样的经济、社会和政治组织中所固有的一项根本性挑战。本系统评价旨在收集和审查撒哈拉以南非洲（SSA）地区AMR行为和社会经济决定因素的现有数据。
通过在PubMed上使用跨越五个领域的检索词来获取文章：“抗菌药物耐药性”、“撒哈拉以南非洲”、“行为”、“社会经济”以及特定的SSA国家名称。还对参考文献进行了相关数据审查。本系统评价纳入了2015年至2023年间以英文发表的原创研究，重点关注影响SSA地区人群AMR的行为和社会经济因素，并将AMR作为关键结果。
本系统评价共识别出30项研究，其中83%（n = 25）关注自我用药和抗生素使用习惯，67%（n = 20）关注医疗服务提供者的习惯和知识，60%（n = 18）关注社区对AMR的知识和认知，而50%（n = 15）的研究探讨了各种社会经济因素。这些研究中出现的共同主题包括循证处方习惯不足（63%，n = 19）、获取抗生素的经济障碍（50%，n = 15）、社区对AMR的认识不足（53%，n = 16）、抗生素销售和分发方面的监管挑战（47%，n = 14）以及医疗基础设施限制，包括诊断能力不足和抗菌药物管理计划（40%，n = 12）。
本综述的结果为影响撒哈拉以南非洲人群AMR的行为和社会经济模式提供了关键见解。为使AMR干预措施有效，有必要深入了解人们关于AMR知识和抗菌药物使用的行为和习惯，这将有助于制定更具针对性的干预措施和政策，以解决不适当的抗菌药物使用及AMR的传播问题。
