Keyword: Antimicrobial Resistance

ABSTRACT: Diabetic foot ulcers (DFUs) are among the most severe complications of  diabetes mellitus, contributing to infection, limb loss, and premature mortality. In Africa, the rising prevalence of diabetes, combined with limited laboratory capacity and frequent empirical antibiotic use, has intensified the problem of multidrug-resistant (MDR) infections. Understanding the microbial spectrum and associated outcomes is critical for guiding evidence-based management. This review systematically synthesizes data on microbial etiologies, antimicrobial-resistance patterns, and clinical outcomes of DFUs in African populations. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, Embase, Web of Science, African Journals Online, and Google Scholar were searched for studies published between 2000 and 2025. Eligible studies included adults with DFUs in African settings that reported bacterial isolates, resistance profiles, or clinical outcomes. Two reviewers independently screened and extracted data, and study quality was appraised using the Joanna Briggs Institute checklist. Data were synthesized narratively and summarized using descriptive statistics. Sixteen verified studies from ten African countries, encompassing approximately 2,700 participants, were included. Staphylococcus aureus and Pseudomonas aeruginosa were the predominant isolates, followed by Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. MDR prevalence was high, with methicillin-resistant S. aureus (MRSA) detected in 25–45% of isolates and extended-spectrum β-lactamase (ESBL)–producing Enterobacterales in 30–50%. Among studies reporting outcomes, amputation rates ranged from 15% to 38% and mortality from 7% to 16%, with poorer outcomes in MDR infections. Considerable heterogeneity existed in sampling and testing methods across studies. Saureus remains the dominant pathogen in African DFUs, but AMR is pervasive across bacterial species. Strengthening diagnostic laboratory systems, infection-control practices, and antimicrobial stewardship (alongside integrated diabetic foot care) is essential to reduce preventable amputations, mortality, and the continent’s growing burden of drug-resistant infections.
Keywords: Diabetic

ABSTRACT: Antimicrobial resistance (AMR) is a growing global threat, and sub-Saharan Africa (SSA) bears a disproportionate share of this burden. This narrative review examines how deficiencies in water, sanitation, and hygiene (WASH) contribute to AMR in SSA. It draws on peer-reviewed literature, institutional reports, and regional policy documents published between 2015 and 2025. Sources were identified through databases such as PubMed, Google Scholar, and WHO/UN databases using combinations of keywords including ‘AMR’, ‘WASH’, ‘Sub-Saharan Africa’, and ‘One Health’. We survey recent literature on the regional AMR problem, the role of inadequate WASH in propagating resistant infections among humans, animals, and the environment, and the relevance of a One Health approach. Key themes include the high AMR mortality in Africa, the persistence of antibiotic residues and pathogens in poorly managed water and sanitation systems, and how poverty-related WASH gaps drive frequent infections that require antibiotics. Evidence suggests that unsafe water and sanitation facilitate the environmental circulation of resistant bacteria and genes. The One Health framework is highlighted as essential for addressing these links, since AMR crosses human, animal, and ecological domains. We conclude that improving WASH infrastructure and practices, alongside integrated AMR strategies, is critical to curb resistance in the region. Focusing on WASH under a One Health perspective can reveal overlooked pathways of AMR spread and inform targeted interventions in SSA.