If you or your child caught a bacterial infection, you’d expect antibiotics to work. That’s been the case for around a century. In many parts of the world, they do. But across much of Sub-Saharan Africa, more and more children are being failed by the very drugs that should save their lives.
Researchers found an alarming rise in antibiotic-resistant infections among children in this region. And the numbers are not just concerning — they’re terrifying.
How Bad Is It?
In children already sick with infections, the team found that a staggering 85% of Klebsiella and 41% of E. coli bacteria were resistant to third-generation cephalosporins — antibiotics often used when other drugs fail. These are not fringe pathogens. These are the main bacterial culprits behind life-threatening infections like sepsis; and they’re incredibly resilient to antibiotics already.
And sepsis isn’t rare here. In Sub-Saharan Africa, it’s a common, often deadly occurrence. About 30% of newborns with sepsis in the region don’t survive, according to the study.
It gets even worse.
Researchers looked at more than 9,000 children and found that nearly one in three — 32.2% — already carried bacteria resistant to these powerful antibiotics, even without being sick. This colonization often goes unnoticed, but it can be very dangerous. And whenever the children’s immune system is down, the bacteria inside can take over; and they may already be untreatable.
Even this wasn’t the end of it. Over half of the children who arrived at a hospital without these resistant bacteria tested positive for them by the time they were discharged. Hospitals, it turns out, are not just places of healing. They are often breeding grounds for superbugs. Children discharged with resistant bacteria can carry them home, into communities where basic sanitation is often lacking. There, the bacteria spread easily — from sibling to sibling, neighbor to neighbor.
A Perfect Storm
So, how did we get here?
Part of the answer lies in the way antibiotics are used. In regions where diagnostic tools are scarce, doctors often have little choice but to guess. Faced with a fever and lacking lab tests, many will prescribe broad-spectrum antibiotics “just in case.”
The result is a kind of bacterial arms race. The more we use antibiotics, the faster bacteria evolve to resist them. And, in Sub-Saharan Africa, where 83% to 100% of hospitalized children receive antibiotics — even when the infection might be viral — resistant bacteria thrive.
This overuse isn’t due to negligence. It’s a problem of infrastructure. Many facilities lack even the basic lab capacity to identify bacteria or test which drugs might still work.
What happens in hospitals doesn’t stay in hospitals.
Can We Fix This?
First, health systems need basic microbiology. The researchers call for wider availability of diagnostic tools like inflammatory markers and bacterial cultures. These would allow doctors to distinguish between bacterial and viral infections and tailor treatments accordingly.
One promising solution is the “Mini-Lab” developed by Médecins Sans Frontières. These transportable, low-cost labs can bring essential testing to areas that lack full hospital labs.
But testing isn’t enough, because drug resistance is already so widespread. Antimicrobial stewardship programs—systems that help doctors prescribe antibiotics more judiciously — are also crucial. Infection prevention, including better hygiene in hospitals, must be scaled up.
If you’re reading this from Europe or the U.S., you might be tempted to see this as a faraway issue. But antibiotic resistance doesn’t respect borders. Bacteria travel — on planes, in food, through trade, and with people. Resistant strains found in one corner of the world today can end up in your neighborhood tomorrow. In fact, resistance genes found in Sub-Saharan Africa have already turned up in Europe and Asia.
Global health isn’t just about charity or aid. It’s about self-preservation.
- Ruef et al., Carriage of third-generation cephalosporin-resistant Enterobacterales among children in sub-Saharan Africa, eClinicalMedicine
- Kowalski et al., Antimicrobial resistance in Enterobacterales infections among children in sub-Saharan Africa, eClinicalMedicine
