Antimicrobial Resistance in Africa: Public Health Challenges and Lessons From Morocco

Antimicrobial resistance (AMR) is recognized as one of the leading global public health threats, with a disproportionate impact on low- and middle-income countries, particularly in Africa, where high infectious disease burden, inappropriate antibiotic use, limited diagnostic capacity, and heterogeneous surveillance systems contribute to the emergence and spread of resistant pathogens. This narrative review synthesizes current evidence on AMR in Africa while highlighting Morocco as a relevant case study to inform public health priorities. A comprehensive literature search was conducted using PubMed/MEDLINE, Scopus, and Google Scholar, complemented by grey literature and World Health Organization (WHO) reports. Evidence published between 2014 and 2025 addressing AMR, antibiotic use, surveillance, stewardship, and policy interventions in Africa was narratively synthesized. Available evidence indicates that in 2019, approximately 4.95 million deaths were associated with bacterial AMR globally, including 1.27 million deaths directly attributable to AMR, with the highest mortality rates reported in western Sub-Saharan Africa. Across African settings, AMR is driven by nonprescription antibiotic access, self-medication, empirical broad-spectrum prescribing, weak infection prevention and control measures, and insufficient microbiological diagnostics, while surveillance remains fragmented because of uneven implementation of the WHO-Global Antimicrobial Resistance and Use Surveillance System (GLASS) recommendations. Morocco reflects many of these continental challenges, including high resistance among WHO priority pathogens such as Escherichia coli and Acinetobacter baumannii. Strengthening laboratory capacity, standardized surveillance, antimicrobial stewardship, and coordinated One Health policies remains essential to preserve the effectiveness of existing antibiotics in Africa.