“Data are surprisingly scanty” Recently published systematic review highlights antimicrobial resistance (AMR) knowledge gap in Low- and Middle-income Countries

Charlie Chaluma Luchen (he/him; AIGHD PhD Fellow and CIDRZ Researcher) recently published a systematic review of the effects of antibiotic children-under-five residing in Low- and Middle-income countries (LMICs). Link to Charlie’s article on PLOS Medicine.


The serendipitous discovery of penicillin, the world’s first antibiotic, and the subsequent development of multiple classes of antibiotics, have saved millions of lives from treatable bacterial infections. However, the commodification of antibiotics has led to the misuse and overuse of these drugs which has led to the evolution of different antibiotic resistant superbugs, bacteria that render even our strongest antibiotics useless. Reports of superbug infections are on the rise across the globe with the World Health Organization declaring that they are one of the top ten (10) global public health threats facing humanity (WHO, Antimicrobial resistance (who.int)). Most data on antimicrobial resistance comes from countries in the Global North such as in Europe and the U.S. However, deaths from antimicrobial resistance are highest in Sub Saharan Africa and low- and middle-income settings where there are limited resources to address this global health threat. There is therefore an urgent need to understand and tackle the burden of antimicrobial resistance in low-and middle-income settings. Like COVID-19, superbugs can easily hitch a ride across borders and continents.

“The data are just surprisingly scanty,” said Charlie referring to the lack of data tackling antimicrobial resistance in low- and middle-income countries especially in children. Charlie was interested in studying the impact of antibiotics on the development of antimicrobial resistance in the microbiome – bacteria in the gut.  “In conducting my search, I only came up with ten articles that described the impact of antibiotics on antimicrobial resistance genes, from all these different databases and from thousands and thousands of articles,” he added. The countries covered include Niger, Burkina Faso, India, South Africa, and Malawi. This lack of data is also what motivated him to do his research:



“I noticed a lack of data on antibiotic use and the gut microbiome from low to middle income countries. So we had this data in high income countries, the Western countries, but you didn’t have it in low to middle income countries… despite that high inappropriate use of antibiotics (in LMICs), we do not have enough data relating that to the emergence of resistance.”



What did the paper discover?

Antibiotic use is associated with the expansion of antimicrobial resistance genes in Global South countries

The study brought together the available data charting the association between antibiotic usage, its impact on children’s gut microbiome and the detection of antimicrobial resistance genes.  Now that we have a much clearer picture of what has been studied in low- and middle-income countries, we have a much greater reason to pour resources into researching AMR in these settings.

Research in this field is scarce, we need more data especially in regions with resource limitations

A few well-conducted studies were the source of almost all of the available data in low and middle income settings.  “Half (of the articles) from the 10 (selected), were part of two large clinical trials that were conducted in Africa,” Charlie stated, describing the papers that qualified his inclusion criteria. Moreover, it was difficult to compare data sets to one another as different antibiotics were tested and different methodologies used to describe the microbiome and antimicrobial resistance gene composition.

We need to campaign for community-based education and antibiotic stewardship

“We know that patients and doctors quickly reach for antibiotics when they are worried about patients with infectious diseases.  We need to balance the need for access to these life-saving drugs in low and middle-income settings with their dangerous indirect effects, such as the development of antimicrobial resistance. Communities in these settings need to better understand both what antibiotics can treat and what harm they can cause. This requires education of both patients and providers. The data we collected can help inform the public and health practitioners of the risks antibiotics carry – how they can drive resistance profiles that will make infections harder to treat now and in the future.”

It is important for communities accessing antibiotics to know that misusing and overusing antibiotics can cause long-term detrimental effects on the health of those taking these medicines. However, building awareness and creating changes in the behaviors of community constituents needs to be done in a manner that is focused on the community’s own understandings of illness and provision of care. In the first place, it is likely that these behaviors are driven by a lack of information or a lack of resources. Giving communities space to determine for themselves how good antibiotic stewardship looks and functions also empower them to reconsider and reshape their health systems.

AIGHD conducts research on a variety of AMR-related areas. For example, the GLORIA project focuses on how Rotavirus vaccinations affect gut microbiome. This gives us an insight on how we can adjust antibiotic prescriptions based on these effects. AMR is also prevalent in agricultural settings where antibiotics are fed en masse to cattle to keep them healthy. HECTOR, PIGSs, and 1H4F are projects that focus on AMR in agricultural settings.