The Burden of Antimicrobial Resistance in Zambia, a Sub-Saharan African Country: A One Health Review of the Current Situation, Risk Factors, and Solutions

Abstract

Background: Antimicrobial resistance (AMR) is a growing public health concern, with far-reaching consequences for modern medicine. Zambia, like many other low- and middle-income countries, faces significant challenges in addressing AMR. Further, high rates of resistance have been reported among various microorganisms in Zambia. This review paper aims to summarize the current situation of the burden of AMR in Zambia, including the prevalence, risk factors contributing to its emergence and spread, challenges in addressing this issue, and the required solutions to combat this growing public health threat. Additionally, the paper also outlines existing efforts to combat AMR and proposes required solutions and recommendations to address this threat to public health. Materials and Methods: This study employed a comprehensive narrative review design that included studies published from January 2000 to November 2024. The literature search was done using PubMed, Scopus, Web of Science, and Google Scholar. Results: In 2019, 1.27 million deaths were attributed to AMR of which 255,000 were from sub-Saharan Africa. Currently, the burden of AMR in Zambia is not well understood. This study found that the drug resistance index (DRI) in Zambia was 60.9%, demonstrating high resistance rates of pathogens to antimicrobials commonly used in humans and animals. The high DRI indicates the low effectiveness of antibiotics in treatment of infections. Most pathogens with high resistance to antimicrobials include Klebsiella pneumoniae , Staphylococcus aureus , Streptococcus pneumoniae , Escherichia coli , Salmonella species, Enterococcus species, Mycobacterium tuberculosis , Acinetobacter baumannii , and Pseudomonas aeruginosa . Additionally, the study found that there was low awareness, knowledge, attitudes, and suboptimal practices regarding AMR in Zambia. The contributing factors to the emergence and spread of AMR include self-medication practices, overuse and misuse of antimicrobials in humans and animals, non-adherence to treatment guidelines, limited diagnostic capacity, substandard and falsified antimicrobials, and a lack of surveillance of AMR. There is a need to develop strategies to address the identified gaps in Zambia to successfully combat AMR. Conclusion: This study revealed high resistance of microbes to antimicrobials in Zambia. The high prevalence of AMR in Zambia indicates its burden on the country, thereby providing opportunities for further research to quantify this problem. The findings highlight the need for a One Health multi-sectoral approach to address AMR in Zambia, including strengthening surveillance and monitoring, improving antimicrobial stewardship and prescribing practices, enhancing infection prevention and control practices, increasing access to quality healthcare and diagnostic services, promoting public awareness and education, and encouraging research and development of new antimicrobial agents. The proposed solutions and recommendations can serve to strengthen the implementation of the Zambia National Action Plan (NAP) to combat AMR.