Title : Misalignment between AMR pathogen burden and national policy response: A multi-country gap analysis across five West African states
Abstract:
Background
Antimicrobial resistance (AMR) poses a growing health security crisis in West Africa, yet the responsiveness of national action plans to real pathogen threats remains poorly characterised. We assessed whether AMR strategies are aligned with the pathogen-specific burden across five countries.
Methods
A retrospective cross-sectional analysis was performed using national AMR surveillance reports (2016–2019) from Nigeria, Ghana, Senegal, Burkina Faso, and Sierra Leone. Microbiological data on patient demographics, specimen origin, and antimicrobial susceptibility were extracted and linked to 16 policy intervention domains mapped across four WHO-priority pathogens.
Results
Among 262,064 clinical specimens, 198,948 (76%) were valid, and 58,191 (29.2%, 95% CI: 29.05–29.45) were culture-positive. Of these, 45,582 (78.3%) had AST results; urine accounted for 39.1% of positive cultures. Fluoroquinolone resistance exceeded 90% in Salmonella spp. and Pseudomonas spp. in Nigeria; Ghana showed near-complete tetracycline resistance among Gram-negatives. Despite these threats, only 5 of 16 AMR interventions were implemented across all pathogens. Vaccine policy, decolonisation, and empiric therapy protocols were the most neglected domains. Nigeria showed high policy coverage but lacked Salmonellaspecific training or surveillance. Other countries had pathogen-specific blind spots—e.g., absent vaccine frameworks (Burkina Faso), no pharmaceutical regulation (Ghana), or missing empiric therapy protocols (Sierra Leone).
Conclusions
This is the first multi-country AMR gap analysis integrating microbiological resistance profiles with policy implementation. It exposes a dangerous disconnect between AMR epidemiology and strategic planning. Urgent transition to integrated, cross-pathogen frameworks is essential for AMR control in fragile health systems.
