Infection prevention and control in low- and middle-income countries: policy, practice, and implementation challenges in sub-Saharan Africa
File(s)
Accepted version
Author(s)
Okomo, Uduak
Fitzgerald, Felicity
Feasey, Nicholas
Mehtar, Shaheen
Dramowski, Angela
Type
Journal Article
Abstract
Infection prevention and control (IPC) programs are essential for safe healthcare; yet, implementation across sub-Saharan Africa remains constrained by chronic underfunding, weak water, sanitation, and hygiene (WASH) systems, limited laboratory capacity, and shortages of trained staff. Healthcare-associated infections (HCAIs) are presumed common, underreported, and often severe, with a disproportionate burden among hospitalized neonates and postpartum women, and they pose substantial risks to healthcare workers during outbreaks. Gram-negative pathogens such as Klebsiella, Escherichia coli, Pseudomonas, and Acinetobacter predominate, alongside methicillin-resistant Staphylococcus aureus, with widespread resistance to third-generation cephalosporins and other key antibiotics linking HCAIs directly to the region’s antimicrobial resistance crisis. National and regional IPC policy frameworks have expanded, but facility-level implementation lags, reflected in patchy surveillance, weak accountability, and unreliable supplies of alcohol-based hand rub (ABHR), personal protective equipment, environmental cleaning materials, and core WASH and ventilation infrastructure. Evidence from sub-Saharan Africa shows that pragmatic multimodal strategies, locally produced ABHR, infrastructure designed to facilitate hand hygiene, role-specific training for clinical and non-clinical staff, and inclusive approaches involving families can improve practices and outcomes when supplies and supervision are sustained. A whole-system approach is required, prioritizing fit-for-purpose surveillance, stronger WASH and waste management services, development of an IPC workforce, and support for African-led innovation, including local manufacturing and context-specific decision-support tools. Implementing these actions through community engagement, empowered leadership at all levels, and sustainable financing is critical to reducing HCAIs, slowing antimicrobial resistance, and strengthening healthcare quality and resilience in sub-Saharan Africa.
Date Issued
2026-06-11
Date Acceptance
2026-05-01
Citation
Clinical Microbiology Reviews, 2026, 39 (2)
ISSN
0893-8512
Publisher
American Society for Microbiology
Journal / Book Title
Clinical Microbiology Reviews
Volume
39
Issue
2
Copyright Statement
Copyright © 2026 American Society for Microbiology. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/42132371
Subjects
antimicrobial resistance (AMR)
environmental cleaning
health systems strengthening
healthcare-associated infection (HCAI)
hospital hygiene
hospital infections
infection prevention and control (IPC)
maternal and newborn health
sub-Saharan Africa
water, sanitation, and hygiene (WASH)
Publication Status
Published
Coverage Spatial
United States
Article Number
e00142-22
Date Publish Online
2026-05-14