Strengthening antimicrobial resistance surveillance across African military settings.

Abstract

While antimicrobial resistance (AMR) surveillance within civilian health systems has progressed, military health systems remain under-represented in related research and policy frameworks. Military personnel, particularly during deployments, often operate in environments characterised by combat-related injuries, overcrowding and inadequate sanitation, which increase the risk of spread and emergence of drug-resistant infections. Despite these vulnerabilities, national AMR strategies in Africa largely prioritise civilian systems, with minimal integration of military health surveillance data or clinical insights from military medical facilities. As a result, AMR trends within military populations and conflict zones remain poorly documented. This paper examines the distinctive AMR challenges in African military settings and proposes strategies for incorporating military medical surveillance data into national AMR frameworks. Drawing on international models, such as the US Armed Forces Health Surveillance Division's Antimicrobial Resistance Monitoring and Research programme, it highlights the potential for military facilities to serve as sentinel sites for resistance monitoring. Integrating military medical surveillance data into national systems would enhance understanding of resistance patterns and support more inclusive and effective containment strategies, while strengthening antimicrobial stewardship within military health facilities to reduce inappropriate antimicrobial use.