Clinical, economic, and health-system challenges of antimicrobial resistance in Africa (2020–2025): a scoping review

Abstract Background Antimicrobial resistance (AMR) is a major global health threat, with particularly severe consequences in Africa, where it is associated with high mortality and substantial strain on healthcare systems. Despite this burden, empirical African data on the clinical, economic, and health-system impacts of AMR remain limited, and many global estimates are derived from modeling studies rather than primary African evidence. Methods A scoping review of studies published between January 2020 and December 2025 was conducted in accordance with PRISMA-ScR guidelines and Joanna Briggs Institute recommendations. Searches were performed across PubMed, Scopus, Embase, Web of Science, the Cochrane Library, and African Index Medicus. Empirical African studies were systematically distinguished from modeled and global estimates. Data were narratively synthesized, with extraction of mortality rates, length of hospital stay, and direct healthcare costs. Results Ninety-four studies from 32 African countries were included. Empirical evidence indicates substantial AMR-associated mortality, with case fatality rates ranging from 30 to 50% overall, 35–60% in neonatal sepsis, and 45–70% in ICU multidrug-resistant Gram-negative infections. Mortality associated with carbapenem-resistant Acinetobacter baumannii reached up to 75%. AMR infections were consistently associated with prolonged hospital stays (5–20 days), treatment failure rates of 25–40%, and direct patient costs ranging from USD 300 to 3600. Modeled and global estimates suggest that AMR may be associated with over 1 million deaths in Africa and potential reductions of up to 5% in global GDP; however, these estimates are not derived from empirical African studies. Regional variation was observed, with the highest burden reported in West Africa, moderate outcomes in East and Central Africa, and comparatively lower mortality but persistent multidrug resistance in North Africa. Health systems face major challenges, including ICU overcrowding, diagnostic delays, and limited infection prevention and control (IPC) capacity. Conclusions AMR is associated with substantial clinical, economic, and health-system impacts across Africa. Strengthened surveillance, antimicrobial stewardship, improved diagnostics, enhanced IPC measures, and integrated One Health approaches are urgently needed to mitigate the growing burden of AMR on the continent.