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Situational analysis of antibiotic use and resistance in Ghana: policy and regulation
Open accessAbstract
BACKGROUND: Antibiotics have played an essential role in decreasing morbidity and mortality from infectious diseases. However, indiscriminate use and unrestricted access is contributing to the emergence of bacterial resistance. This paper reports on a situational analysis of antimicrobial use and resistance in Ghana, with focus on policy and regulation. METHODS: Relevant policy documents, reports, regulations and enactments were reviewed. PubMed and Google search engines were used to extract relevant published papers. Websites of stakeholders such as Ministry of Health (MOH) and its agencies were also reviewed. An interview guide was used to elicit responses from selected officials from these sectors. RESULTS: Laws and guidelines to control the use of antimicrobials in humans were available but not for animals. There was no National Antimicrobial Policy (NAP). A health practice regulatory law mandates Physicians, Physician Assistants, Midwives and trained Nurses to prescribe antimicrobials. However, antibiotics are widely prescribed and dispensed by unauthorised persons, suggesting weak enforcement of the laws. Antibiotics were also supplied to and from unapproved medicine outlets. The Standard Treatment Guidelines (STG), Essential Medicines List (EML) and the National Health Insurance Scheme Medicines List (NHISML) provide restrictions regarding levels of prescribing of antimicrobials. However, existing guidelines on antibiotic use are mostly not adhered to. The use of Automatic Stop Orders to avoid wastage in the hospitals is also not practiced. Data on use of antibiotics for individuals are not readily available in most facilities. Again, there are no standards or guidelines on veterinary use of antibiotics. Surveillance systems for consumption of antibiotics and resistance monitoring were not in place in most health facilities. However, there is an ongoing national action to create awareness on bacteria resistance, strengthening knowledge through research and surveillance and development of NAP in line with global action plan on antimicrobial resistance. CONCLUSION: Absence of national antimicrobial policy, weak regulatory environment and non-adherence to practice standards may have contributed to increased and unregulated access to antimicrobials in Ghana, a catalyst for development and spread of antimicrobial resistance.
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“In many sub-Saharan African countries such as Ghana, antimicrobial agents are easily obtained over the counter, facilitating their abuse [7,8].”
From A Systematic Review on Antimicrobial Resistance in Ghana from a One Health Perspective (2024) · cites this paper as [7]
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“Similarly, Ghana has a national policy on IPC [39], however, the uptake by both tertiary and secondary levels of healthcare facilities is not optimal [40,41] and in most cases, compliance with hand hygiene recommendations before and after patient contact has been reported to be low [42].”
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“In many sub-Saharan African countries such as Ghana, antimicrobial agents are easily obtained over the counter, facilitating their abuse [7,8].”
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“This high rate of MDR could be a result of the extensive use of antibiotics in human medicine [39], in veterinary medicine [40] as well as other factors such as HGT and mobile genetic elements.”
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“AMR is a recognized threat in Ghana, and there is a national policy and action plan based on the global action plan on AMR [15].”
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“Fluoroquinolones, such as ciprofloxacin, are important drugs in Ghana for the treatment of infections in humans (D’Arcy et al, 2021; Yevutsey et al, 2017).”
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“Antibiotics are the only efficacious tools available to fight morbidity and mortality resulting from infectious diseases (Yevutsey et al. 2017).”
Resistance Status of Bacteria from a Health Facility in Ghana: A Retrospective Study
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“high (>40%) resistance to the generally inexpensive broadspectrum antibiotics: tetracycline, cotrimoxazole, cefuroxime, and chloramphenicol; this observation concurs with findings from a number of previous studies in Ghana [5, 25, 26].”
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“This would allow for the evidence-based selection of antimicrobials for treating infectious diseases [37] and contribute significantly to the fight against antimicrobial resistance [7].”
BackgroundResultAntibiotic Use in a Municipal Veterinary Clinic in Ghana
Adeapena, W., Afari-Asiedu, S., Najjemba, R., van Griensven, J., Delamou, A., Buabeng, K. O., & Poku-Asante, K. (2021) · Tropical Medicine and Infectious Disease · doi:10.3390/tropicalmed6030138 · Cited by 12
“There are no guidelines for the prescription of antibiotics in animal health [12,13].”
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Walana, W., Vicar, E. K., Kuugbee, E. D., Sakida, F., Yabasin, I. B., Faakuu, E., Amfoabegyi, S., & Ziem, J. B. (2023) · Frontiers in Antibiotics · doi:10.3389/frabi.2023.1291046 · Cited by 8
Trương, G., Duc, C. K. T., Ha, P. T. M., Hone, N., Duong, T. N. T., Nguyen, N.-Y., Luong, H., Trần, Q. T. B., Nguyen, M. Q., & Phạm, D. T. (2025) · ACS Omega · doi:10.1021/acsomega.5c03790 · Cited by 9
Duah, I. O., Tchiakpe, M. P., Borquaye, L. S., Amoah, K., Amankwah, F., Kumah, D. B., Ofori, L., Danso-Appiah, A., Prempeh, B. O., Gbedema, S., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-14461-x · Cited by 9
Amponsah, O., Owusu-Ofori, A., Ayisi-Boateng, N., Attakorah, J., Opare-Addo, M., & Buabeng, K. (2022) · JAC-Antimicrobial Resistance · doi:10.1093/jacamr/dlac034 · Cited by 9
Self-citationDandi, S. O., Evensen, Ø., Addo, S., Abarike, E. D., Abobi, S. M., Doke, D. A., Lyche, J. L., Mutoloki, S., Obiakara-Amaechi, A. I., Cudjoe, K. S., et al. (2025) · One Health Outlook · doi:10.1186/s42522-025-00141-z · Cited by 9
“Never-theless, unreported, unregulated, and illegal antibiotic usage is increasing alongside the rapid growth of the food-producing industry, including aquaculture [49, 54].”
Marasini, S., Sharma, S., Joshi, A., Kunwar, S., Mahato, R., Shrestha, A., & Karmacharya, B. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297282 · Cited by 8
Boakye-Yiadom, E., Najjemba, R., Thekkur, P., Labi, A., Gil-Cuesta, J., Asafo-Adjei, K., Mensah, P., van Boetzelaer, E., Jessani, N. S., & Orish, V. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20176631 · Cited by 8
“This problem is also compounded by the fact that being a tertiary facility, some of these patients would have received prior antimicrobial therapy either from their referring facilities or from self-administration as commonly practised in the community [57,58].”
BackgroundMutatina, A. W., Lomnyak, E. M., Bizimana, T., Francis, E., Msasi, D., Nuhu, Z., Magembe, E., & Sangeda, R. (2025) · Antimicrobial Stewardship and Healthcare Epidemiology · doi:10.1017/ash.2025.10199 · Cited by 7
“31,32 Several barriers may contribute to the underutilization of microbiology services, including clinicians not requesting tests, high costs, stockouts of reagents, incomplete patient records, and a lack of skilled personnel.”
Yeboah, E. E. A., Agyepong, N., Mbanga, J., Amoako, D. G., Abia, A. L. K., Owusu-Ofori, A. K., & Essack, S. Y. (2023) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2023.10.045 · Cited by 9
“This may be an underestimation, especially in Ghana, where people can access unprescribed antibiotics through unauthorized outlets and may not be familiar with the names of antibiotics especially in rural areas (Afari-Asiedu et al., 2020; Yevutsey et al., 2017).”
BackgroundAzaglo, G. S., Khogali, M., Hann, K., Pwamang, J., Appoh, E., Appah-Sampong, E., Agyarkwa, M. A.-K., Fiati, C., Kudjawu, J., Hedidor, G., et al. (2021) · Tropical Medicine and Infectious Disease · doi:10.3390/tropicalmed6030110 · Cited by 7
“Ghana has good policy and regulatory systems to assess antibiotic use and resistance in the country [30], and regular data and information from ambient air samples can add to the evidence base.”
BackgroundEkhosuehi, A., Ikhimiukor, O. O., Essandoh, H. M. K., Asiedu, N. Y., Aighewi, I. T., Sunmonu, G. T., Odih, E. E., Oaikhena, A. O., Cyril‐Okoh, D., Yeboah, C., et al. (2024) · Environmental Microbiology Reports · doi:10.1111/1758-2229.70018 · Cited by 7
Adade, E., Tawiah, P., Roos, C., Chuma, I., Lubinza, C., Mfinanga, S., Knauf, S., & Sylverken, A. (2023) · Veterinary Medicine and Science · doi:10.1002/vms3.1271 · Cited by 6
“The resistance to Penicillin antibiotics may be due to the inappropriate use of these broad-spectrum antibiotics in humans and in animal husbandry leading to the selection for resistant bacteria (Yevutsey et al., 2017).”
BackgroundSefah, I. A., Nyamadi, D. M., Kurdi, A. B., Bugri, A. A., Kerr, F., Yamoah, P., Pichierri, G., & Godman, B. (2023) · Hospital Practice · doi:10.1080/21548331.2023.2241344 · Cited by 7
“Ghana is no exception with the introduction and monitoring of its NAP [15–17].”
BackgroundModupe, S. L., Yaa, N.-B., Henaku, O. E., Ohya, K., Suzuki, M., Opare, O. J., & Baboreka, K. B. (2021) · Environmental Health Insights · doi:10.1177/11786302211017687 · Cited by 6
Vicar, E. K., Feglo, P., Acquah, S., Williams, W., Saba, C., & Mensah, G. (2021) · doi:10.18502/jfsh.v5i4.5701 · Cited by 6
“The lack of regulation and testing can also contribute to the overall resistance of microorganism (25).”
BackgroundDeku, J. G., Aninagyei, E., Kpodo, C. E., Bedzina, I., Kinanyok, S., Asafo-Adjei, K., Mensah, P., Duneeh, R. V., Sewornu, R., & Duedu, K. O. (2024) · Discover Medicine · doi:10.1007/s44337-024-00073-z · Cited by 5
“%) resistance to the generally affordable antibiotics such as tetracycline, cotrimoxazole, cefuroxime, and chloramphenicol, and this observation is consistent with results from previous studies in Ghana [13, 19].”
Mirsepasi-Lauridsen, H., Vranckx, K., Nielsen, H. V., Andersen, L., Archampong, T., Krogfelt, K., & Petersen, A. (2022) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2022.832500 · Cited by 5
“coli among the Ghana UC patient groups in comparison with the healthy control group might be explained by the increased use of antibiotics, as antibiotics are widely used, especially when patients suffer from intestinal disorders/diseases such as IBD (Yevutsey et al., 2017).”
BackgroundGibernau, E. C. I., Aglanu, L. M., Zakane, A., Dekker, D., Jahn, A., Sié, A., Amuasi, J., & Souares, A. (2025) · Antimicrobial Resistance and Infection Control · doi:10.1186/s13756-025-01594-7 · Cited by 4
“As the poor level of AMR awareness among the general population has been well documented by other studies [43–45], this highlights the need of an intervention to sensitize people about this matter [44, 45].”
Gyamerah, J., Kumi, J., Nyarko, E. N. Y., Ampofo, J., Hamidu, S., Ampem-Danso, E., Adjei, V. Y., & Owusu, F. (2025) · BioMed Research International · doi:10.1155/bmri/8787650 · Cited by 4
“Antimicrobial resistance is a serious public health concern in Ghana, because it is complicated to treat infections caused by resistant bacterial strains, which could quickly spread across the population to endemic and epidemic levels [16].”
Attram, N., Dela, H., Behene, E., Kyei, N., Ocansey, K., Yanney, J. N., Nyarko, E., Addo, K., Koram, K., Fox, A., et al. (2023) · Antimicrobial Resistance and Infection Control · doi:10.1186/s13756-023-01351-8 · Cited by 4
“Identification of pharmacists as the primary source for obtaining antimicrobials for symptomatic treatment of urethritis or cervicitis aligns with previous research and signifies a persistent and crucial aspect of healthcare access and medication distribution [23].”
BackgroundGreene, H. C., Makovi, K., Abdul-Mumin, R., Bansal, A., & Frimpong, J. A. (2023) · medRxiv · doi:10.1371/journal.pone.0281699 · Cited by 4
Bekoe, S., Orman, E., Asare-Nkansah, S., Sørensen, A., Björklund, E., Adosraku, R., Hansen, M., & Styrishave, B. (2020) · SN Applied Sciences · doi:10.1007/s42452-020-03742-7 · Cited by 4
Nortey, R., Kretchy, I., & Opare-Addo, M. (2025) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2025.100696 · Cited by 3
“14,15 Despite this well-defined legislative framework for control, antibiotics are supplied and distributed from community drug retail outlets without any regard to the existing FDA classification and permissions.”
Sefah, I. A., Quagraine, A. M., Kurdi, A. B., Mudenda, S., & Godman, B. (2024) · PLoS ONE · doi:10.1371/journal.pone.0313019 · Cited by 4
Implementing essential diagnostics-learning from essential medicines: A scoping review
Nyanchoka, M., Mulaku, M., Nyagol, B., Owino, E. J., Kariuki, S., & Ochodo, E. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000827 · Cited by 3
Gibernau, E. C. I., Krumkamp, R., Aglanu, L. M., Zakané, A., Jahn, A., Sié, A., Amuasi, J., & Souares, A. (2025) · Journal of Global Antimicrobial Resistance · doi:10.1016/j.jgar.2025.04.020 · Cited by 3
Turkson, P. K. (2023) · Small Animal Advances · doi:10.58803/saa.v2i2.13 · Cited by 2
Dougnon, V. T., Legba, B. B., Gbaguidi, B., Agbodjento, E., Agbankpe, A. J., Rocha, D. K., Ayi, I., Azonbakin, S. A., Diallo, A., Bonkoungou, I. J. O., et al. (2022) · International Journal of One Health · doi:10.14202/ijoh.2022.124-160 · Cited by 7
“However, national action is underway to raise awareness of bacterial resistance, building knowledge through research and surveillance and the development of NAPs in line with the Global Plan of Action on AMR [38].”
BackgroundAkenten, C. W., Ofori, L., Mbwana, J., Sarpong, N., May, J., Thye, T., Obiri-Danso, K., Paintsil, E., Philipps, R. O., Eibach, D., et al. (2022) · doi:10.21203/rs.3.rs-1268707/v1 · Cited by 2
Duah, I. O., Tchiakpe, M. P., Borquaye, L. S., Amoah, K., Amankwah, F., Kumah, D. B., Ofori, L., Danso-Appiah, A., Prempeh, B. O., Gbedema, S., et al. (2022) · doi:10.21203/rs.3.rs-1249919/v1 · Cited by 2
Nortey, R., Kretchy, I., Opare-Addo, M., & Buabeng, K. (2026) · Journal of Pharmaceutical Policy and Practice · doi:10.1080/20523211.2026.2670691 · Cited by 1
“At the same time, participants acknowledged that maintaining the status quo also implied endorsing the irrational use of antibiotics, a challenge well documented in Ghana and similar contexts (Afari-Asiedu et al., 2018; Torres et al., 2019; Yevutsey et al., 2017).”
Self-citationParajulee, P., Gunarathna, S. P., Burnett, A., Hwang, J. H., Lee, J.-S., El‐Jardali, F., & Sarkar, S. (2026) · Antibiotics · doi:10.3390/antibiotics15030255 · Cited by 1
“In Ghana, examples include pressure for inappropriate antibiotic use, weak regulatory enforcement, inconsistent protocol adherence, supply chain barriers, and limited legal mandates [32,33].”
Baolenwo, A. B., Efua, S.-D. V., & Vida, A. (2025) · BMC Primary Care · doi:10.1186/s12875-025-03072-w · Cited by 1
“Both underdosing and overdosing pose significant risks, including treatment failure, drug toxicity and the emergence of drug-resistant strains especially for antibiotics and antimalarial [38–40].”
Abruquah, N. A., Amponsah, O., Nair, D., Opoku, D. A., Konadu, E., Prajitha, K. C., Osafo, A. B., Buabeng, K., & Ayisi-Boateng, N. (2025) · Tropical Medicine and Infectious Disease · doi:10.3390/tropicalmed10100282 · Cited by 1
“Healthcare services in the country are delivered through private and public facilities [11].”
InfluentialSelf-citationNzayini, Z., Dlungele, A. P., & Mathibe, L. (2025) · Antimicrobial Stewardship and Healthcare Epidemiology · doi:10.1017/ash.2025.178 · Cited by 1
“14,15 Recently, Anstey Watkins and colleagues reported successfully initiating treatment for various conditions including antimicrobial therapy.”
Akoto, F., Nyarko, E., Nortey, P., & Doku-Amponsah, K. (2025) · Discover Public Health · doi:10.1186/s12982-025-00942-7 · Cited by 1
“Recent studies have focused on AMR in Ghana [24–26], but they lack quantification of the drivers of antimicrobial resistance and strategies for controlling it.”
InfluentialAntwi‐Boasiako, M. N., Ayensu, F., Awuah, A., Mutala, A., Boampong, K., & Badu, K. (2025) · MicrobiologyOpen · doi:10.1002/mbo3.70028 · Cited by 1
“Ghana has developed a national policy and action plan aligned with the World Health Organization's Global Action Plan on AMR, recognizing AMR as a critical public health threat (Yevutsey et al. 2017).”
Ibrahim, R., Duwiejuah, A. B., & Osei, K. (2025) · Journal of Health, Population and Nutrition · doi:10.1186/s41043-025-00853-y · Cited by 1
“However, indiscriminate use and uncontrolled access are causing microorganisms to become resistant to treatment [47].”
Ofori, S. K., Akowuah, E., Babatunde, D., Amankwa, C., & Baiden, F. (2021) · medRxiv · doi:10.1101/2021.10.31.21265726 · Cited by 1
“However, the prescription and 90 dispensing by ineligible individuals promote the inappropriate use of antibiotics for self91 medication, especially among vulnerable groups [13].”
BackgroundOutpatient prescription audit in a tertiary care hospital at Puducherry
N., B. L., B, M., A, L., P, P., P, M., & G., S. (2019) · International Journal of Basic & Clinical Pharmacology · doi:10.18203/2319-2003.ijbcp20195274 · Cited by 1
Sane, I., Gupte, J., & Karandikar, Y. (2026) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20263689
Viral diarrhea in Ghana: a scoping review of disease burden, epidemiology, and control strategies
-, A. A. K., Arthur, S. E., Yeboah-Manu, M., Jones, M. B., & Kyei, G. B. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1840821
“This often leads to inappropriate antibiotic prescribing, increasing antimicrobial resistance (AMR) in the country (85).”
Donkor, B., Badu, K., Boampong, K., Boamah, V., & Assor, V. E. (2026) · BMC Public Health · doi:10.1186/s12889-026-28725-y
“Common pathogens including streptococci, Salmonella, and E. coli have exhibited multiple drug resistance at rates as high as 78.7% across teaching, regional, and district hospitals in Ghana [5].”
InfluentialTettey, R., Tettey, P., Amprako, D. N., Egyir, B., Arko‐Mensah, J., Adzakpah, G., Addo, S. O., Oppong‐Kyekyeku, J., & Fobil, J. N. (2026) · Journal of Water and Health · doi:10.2166/wh.2026.272
Metadata
- Authors
- Yevutsey, S. K., Buabeng, K. O., Aikins, M., Anto, B. P., Biritwum, R. B., Frimodt-Møller, N., & Gyansa-Lutterodt, M.
- Affiliations
- Kwame Nkrumah University of Science and Technology (GH)
- University of Ghana (GH)
- Corresponding author
- Yevutsey, Saviour Kwame
- Venue
- BMC Public Health
- Published
- 2017-11-23
- Volume
- 17
- Issue
- 1
- Pages
- 896-896
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC5701378
- OpenAlex
- W2768228521
- Cited by
- 126
- References
- 44
- Citations by year
- 2026: 11 · 2025: 20 · 2024: 13 · 2023: 19 · 2022: 23 · 2021: 14 · 2020: 13 · 2019: 10 · 2018: 3
- FWCI
- 0.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Udenrigsministeriet
- University of Ghana
- Kwame Nkrumah University of Science and Technology
- Statens Serum Institut
- Danish International Development Agency
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- antibiotic use, antimicrobial resistance, antimicrobial policy, antimicrobial regulation, Ghana, antimicrobial prescribing guidelines, veterinary antibiotics, antimicrobial surveillance
- MeSH terms
- Animals, Anti-Bacterial Agents, Drug Resistance, Microbial, Ghana, Health Policy, Humans, Legislation, Drug
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