Quality and Patterns of Antimicrobial Dispensing and Consumption among Patent Medicine Vendors

Background: Antimicrobial resistance (AMR) poses an escalating public health threat globally, with sub-Saharan Africa (SSA) disproportionately affected due to weak regulatory systems, limited access to qualified healthcare providers, and high reliance on informal drug outlets. In many SSA communities, antimicrobials are easily accessible without prescription from patent medicine vendors, drug hawkers, and unlicensed shops. This widespread, often unregulated access promotes inappropriate antimicrobial use, contributing to the growing burden of resistant infections. Despite global and regional initiatives to promote antimicrobial stewardship, there remains a substantial gap in understanding how community members access and use antimicrobials, as well as how informal healthcare providers influence these practices. Generating evidence on these patterns is vital for developing context-appropriate interventions and regulatory mechanisms that can curb AMR at the community level. Impact: This scoping review will provide a comprehensive synthesis of existing evidence on antimicrobial access, use, and dispensing practices in sub-Saharan Africa, emphasizing informal healthcare settings. By mapping available literature, the review will identify research gaps, highlight the contextual factors shaping antimicrobial behaviors, and inform the design of regulatory, educational, and behavioral interventions. Ultimately, the findings will support national AMR action plans and strengthen community-based antimicrobial stewardship efforts across SSA. Efforts and Challenges: While regional and global initiatives such as the WHO Global Action Plan on AMR and Africa CDC’s AMR framework have sought to guide rational antimicrobial use, implementation in SSA has been constrained by systemic weaknesses. These include inadequate enforcement of drug regulations, limited laboratory capacity, and poor public awareness. Informal healthcare providers (often the first point of contact for many), continue to operate with minimal oversight, and their dispensing practices remain poorly understood. Similarly, community-level beliefs, treatment preferences, and social norms that influence antimicrobial use have received limited empirical attention. Addressing these gaps through a systematic evidence synthesis will provide a foundation for developing effective interventions that are culturally relevant. Primary Research Objective: The primary objective of this scoping review is to synthesize available evidence on antimicrobial access, use, and dispensing practices in sub-Saharan Africa, with particular attention to informal healthcare providers and community contexts. The review seeks to answer the following research questions: 1. Where do community members in sub-Saharan Africa access antimicrobials? 2. What is the pattern of antimicrobial use in sub-Saharan African communities? 3. What is the pattern of antimicrobial dispensing among informal healthcare providers in sub-Saharan African communities? 4. What are the key factors that influence antimicrobial dispensing practices among informal healthcare providers and antimicrobial use among community members?