Aim: This study aimed to determine factors that contribute to antimicrobial resistance (AMR) in Ghana.
Design: This study employed a systematic review methodology.
Methodology: A systematic search of five electronic databases was conducted, adhering to Cochrane Library guidelines (PubMed/Medline, Scopus, ScienceDirect, Google Scholar, and Cochrane) from 2013 to 2023. The remaining articles were subjected to rigorous data extraction and subsequently analyzed thematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was utilized to visualize the study selection process. The review included English-language studies published between 2013 and 2023.
Results: Four primary themes emerged as significant contributors to AMR: healthcare-associated AMR, community-associated AMR, agricultural AMR, and emerging threats to antibiotic efficacy. Urgent and comprehensive interventions are essential to mitigate Ghana’s growing threat of AMR. These include promoting responsible antibiotic prescribing practices in healthcare settings, educating communities about appropriate antibiotic use and hygiene, strengthening veterinary oversight in the agricultural sector, and investing in research and development to discover novel antibiotics.
Conclusion: This systematic review highlights the multifactorial drivers of AMR in Ghana, including misuse of antibiotics, poor sanitation, and knowledge gaps across health, community, and agricultural sectors. Most studies focus on urban referral hospitals; thus, broader research and urgent, coordinated interventions nationwide are vital to preserve antibiotic effectiveness.

Antimicrobial resistance, Medications, Life-threatening infections, Databases, Cochrane Library guidelines.

From preventing life-threatening infections to keeping food safe, antimicrobials are the guardians of our health. What are antimicrobials? Antimicrobial medications are chemical substances that demonstrate potent activities against a range of microbes, encompassing both elimination and growth inhibition, with a targeted focus on clinically relevant pathogens.[1] Ubiquitous, microscopic life forms- microbes- are found in water, soil, air, and even within the human body. They influence our health in two ways, either as our friend or enemy. Some are our essential partners, aiding digestion and immunity, while others wage war, causing infections. Understanding this microscopic dance is crucial for our health and is key to combating disease.[2,3]

Mechanism of antimicrobial medications: Microbes initiate infection through a carefully orchestrated sequence. First, they navigate host tissues via chemotaxis and other targeted cues, ultimately colonizing specific niches through adhesin-mediated attachment. Rapid replication ensues, fueled by efficient nutrient acquisition from the host environment. The final twist lies in immune evasion, where diverse strategies like antigenic variation and immune suppression allow microbes to persist and thrive.[4] Antimicrobials help stop the growth of microbes and are classified into two mechanisms: the swift kill of microbicidal agents, breaching defenses and ensuring cellular collapse, and the subtle sabotage of microbistatic ones, crippling growth and leading to a gradual decline. Both uniquely neutralize the microbial threat, one with a decisive blow and the other with a controlled descent.[5] Antimicrobial medications, including antibiotics, antivirals, antifungals, and antiparasitics, are crucial in preventing and treating infectious diseases across a diverse spectrum of life, encompassing humans, animals, and plants. But over time, some of these microbes no longer respond to the antimicrobial medication, making it harder to treat infections, leading to the term AMR.[6] For resistance to occur, some microbes develop biochemical pumps that remove antimicrobial drugs before they work, while others produce enzymes that inactivate the medications. This resistance makes infections tougher to beat, sometimes impossible, raising the risk of spread, illness, and even death. At the same time, inherent to microbial evolution, emerging antimicrobial resistance is significantly amplified by the interplay of drug exposure and microbial dissemination.[7]

Background: AMR has risen to become a leading public health threat, directly claiming over 1.27 million lives in 2019 and contributing to nearly 5 million additional deaths. Beyond the human cost, AMR incurs significant economic burdens. The World Bank estimates potential healthcare costs will exceed $1 trillion by 2050, and annual gross domestic product (GDP) losses will reach $3.4 trillion by 2030.[8,9] Beyond the inherent high cost of antimicrobial research and development, AMR’s rapid evolution has choked investment returns for pharmaceutical companies. This resistance cliff, where new drugs face limited efficacy and profitability, has driven numerous companies to abandon antimicrobial development altogether, creating a critical gap in the pipeline.[10]

Within the World Health Organization’s (WHO) regional framework, Africa bears the brunt of the global AMR burden.[11] An estimated 4.1 million lives in Africa are projected to be lost to antimicrobial resistance by 2050, highlighting the significant public health burden of this emerging threat. Though present in most African nations, national action plans fall short against AMR due to weak political commitment, insufficient surveillance infrastructure, and limited capacity for optimized antibiotic use and public awareness. Furthermore, inadequate infection control, poor water, sanitation, and hygiene (WASH) services exacerbate the issue.[12] Low-and middle-income countries like Ghana bear a weighty AMR burden, jeopardizing healthcare and patient outcomes. AMR in these settings fuels increased morbidity, mortality, and healthcare costs, further straining already limited resources.[13] A recent sentinel site study in Ghana paints a concerning picture of AMR within Gram-negative bloodstream infections. A staggering 88% of isolated bacteria exhibited multi-drug resistance, with alarming resistance rates ranging from 56-78% for third-generation cephalosporins, a critical class of antibiotics.[14] Despite existing legislation regulating antibiotic sales in Ghana, weak enforcement remains a formidable obstacle. The primary culprit? Inadequate funding to monitor compliance with established regulations. Additionally, self-medication remains a pressing public health issue in Ghana, with a significant prevalence rate that remains unresolved.[15,16] This insufficient budgetary support hinders effective oversight, allowing gaps in enforcement to persist and potentially contribute to the ongoing challenge of antimicrobial resistance.

Understanding the drivers of AMR in Ghana is crucial for crafting effective interventions to address its high prevalence and optimize antibiotic usage. This review aims to delve into the key factors contributing to AMR in the Ghanaian context, pinpointing areas demanding further research to inform robust and targeted solutions.

Study population: Ghana is in West Africa with approximately 32 million inhabitants.[17] This population is distributed among the coastal plains of the south to the savannas and forest areas of the north. The bustling urban centers like Accra hum with activity, while the vast rural communities paint a contrasting picture of potential disparities in healthcare access and antibiotic use.[18,19] Ghana comprises sixteen administrative regions, each with unique characteristics and challenges from the urban centers of Accra to the rural communities in the Upper East region.[20] Ghana, classified as a lower-middle-income country, faces significant challenges within its healthcare system, contributing to the rise of antimicrobial resistance, such as a shortage of healthcare personnel and limited access to essential medicines.[21,22] All these factors create a breeding ground for the ineffectiveness of antibiotics in treating common infections.

Search strategy: This systematic review adhered to the rigorous methodological standards outlined by the Cochrane Library guidelines. To ensure comprehensive coverage of relevant literature, this systematic review utilized five databases: PubMed/Medline, Scopus, ScienceDirect, Google Scholar, and Cochrane. Search strategies were tailored to teach the database using appropriate keywords and indexing terms. The search strategy employed Boolean operators (AND and OR) to optimize the retrieval of relevant literature related to AMR. Key terms included “antimicrobials (antibiotics, antifungals, antivirals, antiparasitic)”, “resistance”, “Ghana”, “Ghanaians”, “drugs”, “medications”, “stewardship”, causes, determinants, or factors. These were used to identify impactful studies investigating the multifaceted drivers of AMR.

Selection criteria: This review adopted an inclusive approach, encompassing studies of all methodological types (qualitative, quantitative, mixed-methods) across diverse global contexts. This comprehensive strategy aimed to capture the full spectrum of research investigating AMR in Ghana, ensuring insightful findings. This review systematically examined literature published from January 1, 2013, to August 31, 2023, encompassing peer-reviewed journals, published books, and WHO reports relevant to AMR globally and in Ghana. The selection criteria prioritized studies in the English language with full-text availability that directly addressed the research questions of this review.

To ensure the review’s focus on current, readily accessible, and directly relevant research, systematic reviews and studies lacking full-text availability were excluded. Additionally, the scope was strictly limited to AMR in Ghana, excluding information on AMR in other countries.

Selection process: Initial article selection commenced with a meticulous screening of titles and abstracts to identify studies relevant to this review’s scope. Following title and abstract screening, the remaining articles underwent a full-text evaluation against the established inclusion and exclusion criteria. Identified duplicate articles or studies were eliminated, and only relevant selections were retrieved and saved for further analysis. Additionally, the bibliographies of these articles were scrutinized to identify potentially relevant publications not captured by the initial database search. A total of 50 articles were retrieved, comprehensively exploring the drivers and consequences of AMR in Ghana. These encompass analyses of AMR’s impact across diverse sectors (agriculture, healthcare settings, individual health, and economic ramifications), alongside proposed interventions and mitigation strategies.

Following careful selection, the identified articles were systematically organized into thematic categories. PRISMA flow diagram (Figure 2) was adopted to ensure transparency in the review process.[23] A dedicated data extraction sheet was developed to capture key information from each article to facilitate further analysis and thematic exploration.

Table 1: General characteristics of the study

Figure 1: Study population by different regions

Figure 1 shows a geographical finding that reveals a severe imbalance in AMR research, with 70% of study assignments concentrated in the Greater Accra and Ashanti regions. This bias towards major urban centers leaves four of Ghana’s 16 regions – North East, Oti, Savannah, and Western North – with zero studies, representing a critical national surveillance gap.

Figure 2: Article search and selection process

This review explored the latest research on factors contributing to AMR in Ghana, focusing exclusively on studies published from 2013 to 2023 to reflect the most recent dynamics and evidence. Table 1 illustrates the distribution of research methodologies employed within the reviewed studies. This research was dominated by observational quantitative methods, which comprise nearly 70% of all studies. The most frequent design was the cross-sectional survey/study at 40.0%, primarily used to capture a snapshot of knowledge or prevalence. A significant portion was dedicated to evaluating clinical practice, with retrospective audits (20.0%) and point prevalence surveys (PPS; 10.0%) measuring compliance and antibiotic consumption in healthcare facilities. Beyond quantifying the problem, the field adopted a holistic approach by utilizing mixed methods (10.0%) and qualitative research (6.0%) to explore the behavioral and social drivers of misuse. Finally, laboratory and environmental surveillance studies (12%) confirmed research is being conducted under the “One Health” framework to track resistance in clinical, animal, and environmental settings.

Healthcare-associated AMR (Human health/Clinical):

Table 2: Pooled analysis – Suboptimal antibiotic prescribing practice

This table shows the high burden of poor antibiotic prescribing practices in Ghana (pooled estimate: ≈ 45%). It aggregates different types of errors—such as prescribing the drug too frequently, for the wrong duration, or failing to meet official guidelines—to quantify the overall quality deficit in antibiotic use within healthcare settings.

Table 3: Pooled analysis – Antibiotic use prevalence in inpatients (Proportion of patients receiving ≥1 antimicrobial on survey day)

The above table shows AMU is near-universal in Ghanaian hospitals, with a highly precise pooled estimate of 67.0%. Two out of three inpatients are exposed to antibiotics on any given day, underscoring a critical need for large-scale Antimicrobial Stewardship. A significant number of the research results show that factors associated with healthcare-associated AMR are as follows: prescription adherence behaviors; a research result from the analyzed findings revealed a significant correlation between poor adherence to prescribed medications and several healthcare worker-related factors. These factors included ineffective communication strategies that emphasized illness severity and fear-mongering, as well as inadequate explanations regarding medication instructions, gaps in knowledge, and attitude of AMR among prescribers; variability in prescribers’ knowledge of antimicrobials emerges as a significant contributor to antimicrobial resistance as seen in these two results [23-29]. This variability likely stems from differences in prescriber experience, which can influence their understanding of the appropriate medication selection based on the causative organism, gaps in prescription patterns; a review of ten studies revealed a concerning association between inappropriate prescribing patterns and the rise of antimicrobial resistance. This association appears to be driven by several factors, including a significant number of prescribers deviating from WHO-recommended prescribing guidelines for all patient groups, including neonates. Furthermore, the increased prescription of antibiotics categorized as “WATCH” by WHO, which are highly susceptible to resistance development, further exacerbates the problems, gaps in dispensing practices; from the research result, health students’ knowledge, attitude, and self-medication practices, inappropriate antibiotics usage, widespread distribution of healthcare-associated infections [30-42].

Ineffective nurses’ communication and behavior towards nosocomial infection, hospital waste disposal and prescribers’ behaviors are all contributing factors to the alarming increase of antimicrobial resistance according to these four results listed here, inadequate implementation of antimicrobial stewardship (AMS) and infection prevention and control (IPC) programs within healthcare facilities creates a significant risk for the emergence of antimicrobial resistance [43-47,71]. A research publication showed an inappropriate proportion of prescribed antibiotics, their distribution, and completeness according to the WHO awareness category, diagnostic investigation before antibiotics prescription, and these are all contributing factors to antimicrobial resistance [13,48]. The findings from five studies consistently demonstrated a critical issue: the absence of essential diagnostic tools, particularly blood culture and susceptibility testing, can significantly compromise results. In some cases, even when these tests are ordered, delays or limitations in laboratory quality can lead to inaccurate results, and anti-microbial resistance biomarkers transmitted through blood transfusion; the presence of mutant alleles of p. falciparum in tested donor blood can reduce the effectiveness of some of these anti-malaria drugs [24,26,32,49,50].

Environmental & community-associated AMR (Self-medication & Health/Food safety):

Table 4: Pooled analysis – Antimicrobial self-medication (ASM) prevalence

This summary shows that ASM is common in Ghana (pooled estimate: 34.1%). It aggregates data from various studies to quantify the practice, but notes high variability in rates between subgroups, such as students and general community members, which informs the need for targeted public health action.

Table 5: Pooled analysis – Environmental and food contamination

The combined prevalence of AMR contamination across seven studies (N=495) in Ghana is 55.6% (Precision (95% CI): 51.2%-59.9%). This means over half of all tested samples contain AMR risks (MDR bacteria, AMR genes, or antibiotic residues), confirming widespread environmental contamination that necessitates a “One Health” intervention. Major issues can lead to community-associated AMR, some of which include: unsafe and inappropriate antibiotic usage; several factors contribute to unsafe household antibiotic use: increased utilization without professional guidance, high prevalence of self-medication based on experiences, and limited access to healthcare leading to reliance on unlicensed sellers, as seen in these six articles [51-55]. Inappropriate knowledge and attitude toward antibiotics: three research results showed that sellers’ knowledge gaps contribute to AMR, as evidenced by inappropriate antibiotic selection for the causative organism. Self-reported illnesses necessitating antibiotic use: a tendency to self-medicate with antibiotics on perceived illness, without disclosing symptoms or undergoing diagnostic testing, contributes to the problem of antimicrobial resistance, as seen in the research results by widespread antimicrobial resistance amongst the community, inappropriate wastewater treatment, and inadequate hygiene practices across households [56,67,70]. According to the research studies, poor hygiene and sanitation are linked to the rise of AMR in communities. Treated wastewater showed a higher level of resistant bacteria compared to untreated water, suggesting the potential reintroduction of resistant strains back into the environment [57-59]. Additionally, studies found elevated levels of antibiotic-resistant pathogens in street vendors’ water sources, particularly reused storage water, and non-compliance with the WHO prescription completeness.

Agricultural AMR:

Table 6: Pooled analysis – Agricultural AMU

AMU is consistently high and pervasive in Ghana’s animal sectors (pooled: estimate: 71.6%). Nearly three-quarters of all animal health cases or farm operations involve antibiotic use. The highest rates are seen in poultry (82.3%), but the problem spans all key sectors, including veterinary practice and aquaculture. Antibiotic misuse in the agricultural sector was another contributing factor to AMR, these factors obtained from our search include inappropriate antibiotics use in animal farming and production; four articles came out with a result that some agricultural practices for example heavy reliance on antimicrobials by domestic and commercial farmers, often led to misuse due to lack of professional guidance, also informal knowledge sharing among farmers, where they rely on advice from friends or colleagues instead of consulting veterinarians contributed to AMR in Ghana, factors influencing farmers’ choice of antibiotics [60-62]. Knowledge gaps among Ghanaian farmers lead to excessive antibiotic use in livestock, potentially compromising the future effectiveness of these drugs, as seen in a research study [58]. Finally, one result of inappropriate antibiotic prescription practices and issues with the accurate investigation of bacterial contamination in farming water contributed to the rising AMR issue in Ghana [60].

Emerging threats to antibiotic efficacy: A concerning trend of increasing resistance to commonly used antibiotics among commonly isolated pathogens in Ghana, and a specific concern about some WHO-listed antibiotics losing their effectiveness [63]. This study demonstrated a worrying trend of increasing antimicrobial resistance in common pathogens like E. coli, emphasizing the critical need for novel antibiotics due to diminishing treatment options.

Table 7: Data Extraction sheet

Ghana confronts a relentless foe: the escalating threat of AMR. This chronic challenge demands immediate action. AMR erodes the bedrock of modern medicine, rendering antibiotics ineffective against bacterial infections. The consequences are dire: prolonged illnesses, soaring costs, and even mortality. To combat this menace, we must dissect the intricate web fueling AMR in Ghana, encompassing healthcare practices, patient behavior, and socio-economic realities. This study sheds light on this complex public health threat. Unravelling these factors is crucial in crafting effective interventions and safeguarding antibiotic efficacy in Ghanaian healthcare.

Healthcare-associated AMR: This systematic review underscores the critical role healthcare workers and healthcare facilities play in the rise of AMR in Ghana. Their practices and limitations emerge as a significant factor contributing to the problem. Patient adherence to antibiotic regimens is a complex issue influenced by various factors, including potential shortcomings in healthcare workers’ communication of essential prescription instructions. Healthcare workers’ (HCWs) communication tactics focused on severity and fear may be linked to lower patient adherence to antibiotic regimens. An emphasis on illness severity, fear-induction, and leveraging lab results to highlight seriousness might be associated with decreased adherence rates, as evidenced by a potential drop from 90.3% to 82.9%.[23]

Prescribers’ knowledge and behavior are also recognized as significant contributors to the rise of AMR. This study showed that prescribers’ knowledge of AMR exhibited significant variability. While senior prescribers demonstrated a high level of understanding regarding the extent and causes of AMR, junior prescribers displayed a tendency to underestimate the problem within their departments.[24,25] Another particularly concerning element is the presence of inconsistency and dissonance within antimicrobial prescribing practices. Hospital-acquired infections (HAIs) represent a significant contributor to the rise of AMR within the healthcare settings in Ghana. While the overall prevalence of HAIs remained relatively low in Ghana, a cause for concern emerged in the high levels of environmental contamination with Staphylococcus aureus (S. aureus) and Methicillin-resistant S. aureus (MRSA) on hospital door handles, particularly in areas with high surgical caseloads. Similar concerns extend to water sources. The presence of antibiotic residues in hospital effluents and leachate from dumpsites raises concerns about potential environmental contamination. Notably, Ciprofloxacin was detected at alarmingly high concentrations, exceeding levels known to contribute to the development of antimicrobial resistance. Furthermore, the isolated strains of S. aureus and MRSA exhibited concerning resistance patterns, with some isolates demonstrating resistance to a broad spectrum of antibiotics, including a particularly alarming resistance to pan-resistant MRSA.[43,44,46] Adding to the complexities of addressing AMR in Ghana, a separate study revealed a knowledge gap regarding nosocomial (Hospital-acquired) infection (NCI) prevention among a significant portion of nurses. While this finding may not necessarily generalize to all healthcare workers, it underscores a potential vulnerability within the Ghanaian healthcare system. Inadequate knowledge of NCI prevention practices could facilitate the spread of antimicrobial-resistant pathogens within hospitals, ultimately contributing to the rise of AMR.[45]

While some studies indicate instances of guideline adherence for antimicrobial prescribing, a concerning trend emerges.[28,33] Overall, antibiotic use by healthcare providers significantly exceeds recommendations established by both local and international (WHO) guidelines.[27,30,34,48] This concerning pattern extends even to pediatric populations, particularly neonates.[31,32] Furthermore, research suggests a prevalence of prescriptions within the “Watch” category, a class of antibiotics associated with a higher risk of resistance development.[33,34] Beyond prescription practices, gaps in the AMS-IPC infrastructure fuel AMR in Ghana. Weaknesses in both AMS capacity and IPC conformity within Ghanaian healthcare facilities represent significant vulnerabilities that contribute to the rise of AMR.[47]

The widespread practice of prescribing antibiotics without proper diagnostic investigation is another critical challenge facing the fight against AMR in Ghana. This concerning trend extends to both inpatients and outpatients. Healthcare providers, aware of the potential viral nature of some infections and the limited benefit of antibiotics in such cases, nonetheless choose to prescribe these medications. This phenomenon can be attributed, in part, to the dearth of facilities equipped with culture and sensitivity testing capabilities, a crucial tool for identifying the causative agent of infection. Research corroborates this, revealing that less than half of both adult UTI patients and neonates with suspected sepsis receive confirmatory testing. Furthermore, even when such testing is requested, delays and potential laboratory quality issues can compromise its clinical utility.[24,26,29,32,49,64] This fight extends beyond prescribing practices to the realm of community pharmacy dispensing. This research identified a troubling trend: patients receiving inappropriate medication information during the dispensing process. Paradoxically, dispensers with extensive experience (over 10 years) were less likely to dispense the lifesaving Antimalarial combination therapy (ACT) medications appropriately. Conversely, pharmacy interns exhibited a higher level of adherence to proper ACT dispensing protocols.[35] The battle against AMR in Ghana takes an unexpected adversary with the emergence of a potential hidden reservoir: asymptomatic malaria parasites in donated blood. A recent study revealed a concerning prevalence: 11.8% of blood donors in Ghana tested positive for malaria despite exhibiting no symptoms. Further analysis revealed a troubling element-the presence of mutant alleles in key genes of P. falciparum, the malaria parasite, within these infected donors. These mutations could potentially reduce the efficacy of standard antimalarial therapies, raising the specter of AMR in transfusion-transmitted malaria cases.[50]

Community-associated AMR: AMR presents a formidable challenge to global healthcare, jeopardizing the effectiveness of antibiotics in treating common infections. This study also shows the alarming rise of community-acquired AMR in Ghana. It delves into the factors driving this public health threat, aiming to identify effective interventions to safeguard the community. There was a concerning prevalence of antibiotic use in households, with a significant portion coming from unlicensed vendors. This highlights the issue of self-medication with antibiotics, often driven by factors like past experiences, healthcare access limitations, and cost considerations. Another study also investigates antibiotic self-medication (ASM) in Ghana. It reveals a high prevalence of ASM in urban informal settlements, with concerning aspects like using leftover antibiotics and acquiring them from unlicensed sellers. Another study also suggests factors influencing ASM, such as limited knowledge, economic hardship, and difficulties getting prescriptions at hospitals. Additionally, the presence of unregulated sellers who dispense antibiotics undermines efforts to promote responsible antibiotic use.[52-55]

This study further explores knowledge, attitudes, and practices (KAP) related to AMR in Ghana. Despite some general knowledge about antimicrobials and resistance in the community, there are concerning gaps. The study identifies a knowledge gap among some sellers of medications, potentially leading to misuse. Additionally, misconceptions and economic factors significantly influence how people use antimicrobials. These factors contribute to practices like using ineffective medications (using antibiotics for a viral infection) or stopping prescribed treatments prematurely.[56]

This study further examines the relationship between hygiene and sanitation practices in the community and the concerning rise of AMR. The findings provide evidence that deficiencies in these practices contribute significantly to the environmental spread of AMR. Wastewater analysis revealed the presence of antibiotic-resistance genes (ARGs) for various antibiotics, including those used for first-line and second-line tuberculosis (TB) treatment. This concerning result highlights the potential for the dissemination of AMR within the community. Furthermore, the study identified that the concentration of ARTs in treated wastewater was sometimes higher than in untreated wastewater. This suggests that existing wastewater treatment plants may not be entirely effective in removing these genes from the effluent, potentially creating a reservoir for the spread of resistant bacteria back into the community. Household cleaning practices were also investigated. While participants reported frequent cleaning routines, significant knowledge gaps were identified regarding the connection between dust and germs and the proper use of disinfectants. This suggests that current cleaning practices may be inadequate for effectively eliminating bacteria, potentially including those harboring antibiotic resistance. Further evidence for the link between hygiene and AMR was identified in the analysis of environmental samples from Ghana. The presence of antibiotics in concerning concentrations within street vendors’ water sources, particularly reused storage water, suggests potential fecal contamination and the transmission of antibiotic-resistant bacteria. In conclusion, deficiencies at both the community level, such as wastewater treatment inefficiencies, and the household level, through inadequate cleaning practices, contribute to the environmental spread of antibiotic-resistance genes.[46,57,59,65]

Agriculturally associated AMR: This study also unveils that the Ghanaian agricultural system is a potential reservoir for AMR transmission. Economic constraints lead heavily to antimicrobials, which are often misused. Domestic farmers, while using less overall, exhibit concerning trends: excessive daily use, unverified advice (from friends and other farmers), and readily available pharmacy purchases, bypassing veterinary services. Limited veterinary outreach and herbal remedy use alongside antimicrobials further exacerbate AMR risks. Inadequate communication with agro-vets and unhygienic environments suggest a link between antibiotic use and poor farm sanitation. Interestingly, a study showed that farmers reported no antibiotic use but displayed high bacterial contamination and resistance to specific antibiotics.[58,60-62] These findings highlight the urgent need to address farmers. Education, veterinary services, and antimicrobial use regulations to mitigate AMR within Ghana’s agricultural sector and safeguard public health.

This study also identified incomplete antibiotic courses and disregard for withdrawal periods on livestock farms in Ghana. These practices likely stem from a lack of veterinary oversight or farmer education. Incomplete courses expose microbes to sub-lethal antibiotic doses, promoting the development of resistance. Skipping withdrawal periods allows antibiotic residues to persist in animal products destined for human consumption.[58] These findings highlight the need for interventions that improve farmer knowledge and ensure proper veterinary guidance on antibiotic use in livestock.

Emerging threats to antibiotic efficacy: The specter of antibiotic resistance looms large in Ghana. While responsible use is crucial, our current arsenal is weakening. New antibiotics are urgently needed to combat this growing threat. A study at a healthcare referral facility in Ghana identified a worrying trend of antibiotic resistance among common bacterial pathogens. E. coli, Pseudomonas spp., and Klebsiella spp. were frequently isolated from patients with urinary tract infections and ear infections. These pathogens exhibited concerning resistance levels, particularly to beta-lactam antibiotics like ampicillin, piperacillin, ceftriaxone, and ceftazidime. The emergence of resistance to even last-resort antibiotics like colistin is particularly alarming.[63] These findings highlight the urgent need for the development of new antibiotics. The current arsenal of antibiotics is becoming increasingly ineffective in Ghana, leaving healthcare providers with limited options for treating serious infections. Investing in research and development of novel antibiotics is essential to combat the growing antimicrobial resistance.

In conclusion, this systematic review identified a multifactorial challenge driving AMR in Ghana. Inappropriate antibiotic use, knowledge gaps, and sanitation deficiencies across healthcare facilities, communities, and the agricultural sector all contribute significantly to the rise of AMR. Notably, most of the research originated from referral hospitals within prominent Ghanaian cities. Further research is necessary in other regions, especially newly created regions and rural areas, to obtain a more comprehensive national understanding of AMR in Ghana. Urgent interventions are required to address these issues and preserve the efficacy of antibiotics in Ghana. These include promoting responsible prescribing practices within healthcare facilities, educating communities on proper antibiotic use and hygiene practices, strengthening veterinary oversight in the agricultural sector, and investing in research and development of novel antibiotics. By implementing a multi-pronged approach across all Ghanaian regions, the nation can combat AMR and safeguard public health for future generations.

I wish to express my profound gratitude to my esteemed mentor, Dr. Christopher Ukpong, for his unwavering support, intellectual guidance, and selfless dedication throughout this research journey. His expertise and encouragement were invaluable in shaping the direction and outcome of this work. I am also deeply grateful to my co-authors, whose collaboration, perseverance, and commitment were instrumental in bringing this project to completion. The countless hours of discussion, reflection, and hard work invested in this study stand as a testament to the power of teamwork and shared passion for knowledge. This research would not have been possible without the many individuals who offered their support, insight, and encouragement along the way. I am truly thankful for the opportunity to work with such an inspiring team and look forward to future collaborations.

The authors received no funding for this study.

Corresponding Author:
Solomon Godwin Udoh
Department of Nursing
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Email: u.solomong@gmail.com

Co-Authors:
Onyinyechi Stella Emelife, Chinaza Emmanuella Ugezu
Department of Nursing
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

Solomon Godwin Udoh (SGU) was responsible for the conceptualization of the study, overall methodology design, primary data analysis, and visualization of tables and figures. He also drafted the initial manuscript, including the abstract, introduction, discussion, and conclusion, and served as the overall supervisor of the work. Onyinyechi Stella Emelife (OSE) executed the comprehensive systematic search across all five databases, performed the initial screening and article selection, conducted data extraction, and contributed to writing, reviewing, and editing the introduction, results, and discussion sections. Chinaza Emmanuella Ugezu (CEU) contributed to refining the selection criteria, carried out the secondary screening, participated in data extraction and thematic synthesis for the results section, and provided critical review and editing of the background and conclusion sections. All authors actively participated in discussions regarding the interpretation of data, presentation of results, and overall structure of the paper. Any potential conflict of interest, intellectual disagreement, or discrepancy regarding authorship tasks or content was discussed and resolved amicably among the co-authors. All authors have read and agreed to the published version of the manuscript and attest to the accuracy and integrity of the work presented.

This systematic review is based on data from previously published studies, in which ethical approval and informed consent were presumably obtained by the original researchers. Therefore, no additional ethical approval was required for this review.

The Authors declare no conflict of interest.

None

https://doi.org/10.63096/medtigo3062345

Udoh SG, Emelife OS, Ugezu CE.  A Systematic Review Study on the Factors Contributing to Antimicrobial Resistance in Ghana. medtigo J Med. 2025;3(4):e3062345. doi:10.63096/medtigo3062345 Crossref