Antimicrobial Stewardship, Laboratory Surveillance, and Quality Management in Africa: A Narrative Review of Challenges and Opportunities for Integrated AMR Control.

INTRODUCTION: Antimicrobial resistance (AMR) is a growing public health threat that disproportionately affects African countries due to high infectious disease burdens, widespread antimicrobial misuse, weak health systems, inadequate diagnostic capacity, and fragmented surveillance infrastructure. Effective AMR control requires coordinated strengthening of antimicrobial stewardship (AMS), laboratory surveillance, and laboratory quality management systems. Therefore, the aim of this narrative review is to identify persistent challenges and structural barriers and to highlight opportunities for strengthening these systems as interconnected pillars of the continent's AMR response. METHODS: This narrative review draws together published and gray literature on AMS, laboratory surveillance, and laboratory quality management across Africa. Sources spanning 2016-2026 were retrieved from PubMed, Scopus, Web of Science, and Google Scholar, supplemented by technical reports from the World Health Organization, Africa CDC, the ASLM, and the Fleming Fund. Findings were organized thematically to surface recurring implementation obstacles, examples of successful practice, and opportunities to strengthen integrated AMR control. RESULTS: The review identified persistent gaps across the three pillars of AMR control. AMS implementation remains inconsistent despite widespread adoption of national AMR action plans, with shortages of trained personnel, inadequate financing, and weak governance limiting effectiveness. Laboratory surveillance systems continue to face challenges related to insufficient diagnostic capacity, poor data sharing, fragmented reporting systems, and limited genomic surveillance infrastructure. Laboratory quality management programs such as SLIPTA and SLMTA have improved quality standards in several countries, but progress remains uneven because of resource constraints, workforce shortages, and sustainability challenges. The review further demonstrates that weaknesses in laboratory quality directly undermine surveillance reliability and stewardship decision-making. CONCLUSION: Strengthening laboratory quality management, surveillance systems, and AMS as interconnected components of a unified health-system response is essential for controlling AMR in Africa. Sustainable financing, workforce development, digital integration, and One Health collaboration are critical to achieving resilient and effective AMR control systems across the continent.