A scoping review of intersectional drivers of antimicrobial use and misuse among consumers in sub-Saharan Africa

Antimicrobial resistance (AMR) is a major global health threat, disproportionately affecting sub-Saharan Africa (SSA) due to systemic healthcare challenges and weak regulatory systems. However, the intersection of gender and sociocultural factors influencing antimicrobial use and misuse, and consequently AMR, remains underexplored in the region. This study maps and synthesizes existing evidence on antimicrobial use and misuse among consumers in SSA using an intersectional lens. A scoping review was conducted following PRISMA-ScR guidelines. Relevant studies published between January 2014 and August 2024 were identified from four major databases using predefined search terms. Twelve studies met the inclusion criteria and were analyzed thematically. The findings show that antimicrobial use and misuse in SSA are shaped by a complex interplay of gender roles, sociocultural norms, and economic constraints. Men often control access to and procurement of antibiotics, frequently without prescriptions, while women are primarily responsible for administering them. Misuse is further driven by reliance on informal healthcare sources, cultural beliefs about treatment, and financial barriers limiting access to formal healthcare services. Addressing AMR in SSA requires a comprehensive approach that goes beyond biomedical solutions to incorporate gender-sensitive policies, equitable healthcare access, and culturally appropriate interventions. Engaging communities, promoting inclusive decision-making, and reducing financial barriers are critical to improving appropriate antimicrobial use.