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The Self-Medication Crisis: How Antibiotic Misuse in Africa Fuels the Rise of Antimicrobial Resistance

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By Dr. Frankline Sevidzem Wirsiy, Associate Director, Global Public Health and Development

Antibiotic self-medication has been confirmed to be one of the major factors in facilitating the clinical problem of antimicrobial resistance (AMR). AMR is an important threat to global health security predominantly in developing countries and is partly related to high levels of antibiotic use especially in Africa with a huge burden of infectious diseases. AMR remains one of the top global public health threats facing humanity and has been associated with the death of millions of people globally. Importantly, it is also a threat to the global economy, with an impact on healthcare systems, international trade, and the pharmaceutical industry. If no action is taken, AMR could cost the world’s economy US$ 100 trillion by 2050.

Self-medication is defined by the World Health Organization (WHO) as the treatment of self-recognized disorders or symptoms by use of medicines without prior consultation by a qualified health professional or intermittent/continued use of medicines previously prescribed by a physician for chronic/recurring diseases.

Many undesired outcomes may result from inappropriate self-medication use, especially with antibiotics. WHO defines inappropriate antibiotic use as the use of antibiotics without proper indication, or administering wrong dosages, incorrect treatment duration, late or absent downscaling of treatment, poor adherence to treatment, and use of poor quality or substandard antibiotics. 

Self-medication with antibiotics (SMA) contributes to accelerating the emergence, re-emergence, and spread of antimicrobial resistance (AMR).

In Low and Middle-Income Countries (LMIC) including those of Sub-Saharan Africa, where there is limited control of antimicrobial use, it is estimated that about 80% of antibiotics are used outside official healthcare facilities, of which about 20–50% are used inappropriately.

Other unfavorable effects of self-medication include the waste of financial resources from extended treatment times brought on by improper infection management, delayed or inaccurate diagnosis, drug interactions, and unfavorable reactions.

The increasing practice of self-medication, especially with antibiotics in Africa, warrants context-specific interventions and sensitization of the general public and health professionals to avoid inappropriate use thus contributing to curbing the threat of AMR. The global research agenda for antimicrobial resistance in human health prioritizes 40 research topics for evidence generation to inform policy by 2030. It aims to guide policy-makers, researchers, funders, implementing partners, industry, and civil society in generating new evidence to inform antimicrobial resistance policies and interventions as part of efforts to address antimicrobial resistance, especially in low-and-middle-income countries.

Here are 5 strategies to improve antimicrobial resistance in Africa, specifically related to self-medication with antibiotics, include:

1. Public Education and Awareness Campaigns: Implementing targeted awareness campaigns to educate the general public about the risks and consequences of self-medication with antibiotics. This can be done through various channels such as television, radio, social media, and community engagement programs.

2. Strengthening Regulatory Measures: Enforcing stricter regulations and policies on the sale and distribution of antibiotics, particularly outside of healthcare facilities. This includes monitoring and penalizing unauthorized sales, implementing prescription-only policies for certain antibiotics, and promoting responsible prescribing practices among healthcare professionals.

3. Access to Healthcare: Improving access to quality healthcare services, especially in rural areas, to ensure that individuals have prompt and appropriate medical care when needed. This includes investing in healthcare infrastructure, training healthcare professionals, and expanding healthcare coverage to underserved populations.

4. Surveillance and Monitoring Systems: Establishing robust surveillance and monitoring systems to track the prevalence of self-medication with antibiotics and its impact on antimicrobial resistance. This data can be used to inform evidence-based policies and interventions.

5. Collaboration and Partnerships: Promoting collaboration and partnerships between governments, non-governmental organizations (NGOs), pharmaceutical companies, and international organizations to collectively address the issue of self-medication with antibiotics. This includes sharing best practices, resources, and funding for research, education, and awareness initiatives.

By implementing these strategies, it is possible to mitigate the problem of self-medication with antibiotics and reduce the burden of antimicrobial resistance in Africa, ultimately protecting public health and preserving the effectiveness of antibiotics for future generations.

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