A diagnostic gap is fueling Africa’s antimicrobial resistance

In a rural West African clinic, a mother in labor arrives with a high fever. Suspecting an infection, the attending health worker administers a broad-spectrum antibiotic — without confirming the pathogen. It’s not negligence; it’s the reality of practicing medicine in a setting with no diagnostic tools. What happens next is predictable and dangerous: The infection worsens, resistance increases, and another patient is added to the silent pandemic of antimicrobial resistance, or AMR. Africa’s AMR crisis is no longer a looming threat; it is a present danger that climate change is exacerbating. From cholera and typhoid outbreaks in flood-prone areas to the spread of drug-resistant malaria, climate-linked factors are reshaping the AMR landscape across the continent. Rising temperatures and erratic rainfall are altering disease ecologies. Floods and droughts strain sanitation systems and contaminate water sources. These environmental changes increase the incidence of infections and, with limited diagnostics, lead to the indiscriminate use of antibiotics. The core of the crisis is diagnostic insufficiency. In sub-Saharan Africa, more than 70% of antibiotics are prescribed without laboratory confirmation. In maternal health, empirical treatment of postpartum infections and neonatal sepsis without proper diagnostics is common and deadly. This contributes to inappropriate antibiotic use and escalating resistance. Despite global declarations, diagnostic capacity remains critically underfunded. Primary health care facilities lack point-of-care tests, microbial culture labs, and trained personnel. Where such systems exist, they are often paralyzed by power outages, disrupted supply chains, or climate-related disasters. The diagnostic divide is a blind spot in the AMR response, and as climate change intensifies, the consequences become graver. Rapid diagnosis is essential not just for effective treatment, but also for outbreak detection, antimicrobial stewardship, and resilience against climate-linked health shocks. There are promising models. Nigeria’s integration of rapid diagnostic tests, or RDTs, into malaria and neonatal sepsis care has shown impact. Kenya and South Africa have launched AMR surveillance networks supported by public-private partnerships. The Africa Centres for Disease Control and Prevention recognizes diagnostics as a critical pillar in its regional AMR framework. But these efforts are still fragmented and underfunded. We must shift from siloed diagnostics to systemic, climate-adaptive diagnostic stewardship. We need bold action across five priorities: 1. Prioritize diagnostics in AMR and climate-health funding streams. 2. Scale decentralized, solar-powered diagnostic labs in rural and climate-vulnerable regions. 3. Train and retain lab professionals focused on infectious and maternal health. 4. Embed diagnostics into national climate adaptation plans. 5. Strengthen regulatory frameworks and regional manufacturing for diagnostics in Africa. Failing to act means locking vulnerable communities in a cycle of unchecked infections, rising resistance, and repeated loss. AMR is no longer just a microbial issue; it is a matter of climate justice, gender equity, and global health security. We must bridge the diagnostic gap now before climate pressures push fragile health systems beyond their limits.