Environmental Antimicrobial Resistance in Africa: Wastewater, Aquatic Ecosystems and the One Health Surveillance Gap

Antimicrobial resistance (AMR) is increasingly recognised as an environmental problem and not only a clinical one, yet Africa’s wastewater and aquatic ecosystems remain an understudied part of its emergence and spread. This review synthesises recent evidence on antimicrobial-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs) in African wastewater, rivers and sediments, drawing on studies from Nigeria, Ghana, Kenya, Uganda, South Africa, Ethiopia, the Democratic Republic of Congo, Mali, Zambia and Tanzania. Hospital and municipal wastewater consistently carry high loads of ARB and clinically important ARGs, much of which survives treatment and is discharged into receiving rivers, where resistance levels often rise rather than fall downstream. Sediments and aquatic microbial communities act as additional, longer-term reservoirs. Because these environmental reservoirs connect directly to human, animal and agricultural compartments, a One Health perspective is essential, yet integrated cross-sectoral surveillance remains rare on the continent. The review identifies the principal surveillance gaps and outlines priority directions needed to close Africa’s environmental AMR surveillance gap.