A one health perspective on antimicrobial resistance in Sub-Saharan Africa: synthesizing human, animal, and environmental evidence for integrated action

Abstract This review examines antimicrobial resistance (AMR) in Sub-Saharan Africa (SSA) through an integrated One Health lens, synthesizing evidence across human, animal, and environmental domains. As one of the twenty-first century’s biggest public health threats, AMR represents a particularly significant challenge in the resource-constrained settings of SSA, where surveillance systems remain fragmented and implementation of national action plans is often limited. Drawing on recent surveillance data, genomic studies, and policy analyses, this review provides a comprehensive assessment of AMR epidemiology across all three One Health sectors. It critically evaluates existing cross-sectoral surveillance frameworks, identifies key drivers of resistance transmission between compartments, and examines successful implementation of antimicrobial stewardship programs across the region. The review highlights significant knowledge gaps, particularly regarding environmental reservoirs and animal–human transmission pathways, while proposing context-appropriate interventions aligned with the 2024 WHO AMR Action Plan.