Antimicrobial self‑medication among children and adolescents in Sub‑Saharan Africa: a systematic review

Background The World Health Organization defines antimicrobial self‑medication as the use of antimicrobials without medical supervision. High antimicrobial self‑medication prevalence among children and adolescents in Sub‑Saharan Africa raises critical public health concerns. This systematic review synthesizes evidence on prevalence, determinants, and sources of antimicrobial self‑medication exclusively among children and adolescents under 18 years in Sub‑Saharan Africa. Main body Following PRISMA 2020 guidelines, we searched PubMed/MEDLINE, ScienceDirect, Europe PMC, and EBSCO Open Dissertations from January 2015 to June 30, 2025. Initial screening and data extraction were completed by December 2025. During the revision process, we performed an updated search on June 24, 2026, to capture recently published studies. Two reviewers independently screened records, assessed quality, and performed narrative synthesis. Thirteen studies met inclusion criteria. Antimicrobial self‑medication prevalence ranged from 21.9% to 92%, highest in Nigeria. Frequently self‑administered antibiotics included amoxicillin (11.4%–80.6%), ampicillin‑cloxacillin (10.3%–50.9%), penicillin (25%), and tetracycline (~ 20%); antimalarials included chloroquine (78%) and quinine (15%). Main sources were drugstores/pharmacies (up to 99.7%), pharmacy staff (70%), and leftover medications (21%). Key determinants were lower parental education, distance to healthcare over 5 km, and febrile symptoms (fever up to 85.1%, cough up to 80.5%). Conclusion Antimicrobial self‑medication increases antimicrobial exposure and represents a recognized contributor to antimicrobial resistance, though no included study directly measured resistance outcomes. Targeted public health interventions including caregiver health education and stricter enforcement of prescription‑only regulations are imperative. This review provides the first exclusive synthesis of antimicrobial self‑medication among Sub‑Saharan African children and adolescents, informing context‑specific interventions.