Antimicrobial resistance (AMR) has caused at least one million deaths every year since 1990. Without further action, more than 39 million people could die from resistant bacterial infections between 2025 and 2050, with South Asia, Southeast Asia, and sub-Saharan Africa among the hardest-hit regions [1]. The same analysis linked the sharp fall in AMR deaths among young children partly to vaccination and improved access to water, sanitation, and hygiene, underscoring infection prevention as a powerful tool against resistance In December 2025, WHO concluded that monitoring AMR in wastewater and environmental waters is technically feasible and can complement clinical surveillance, but that methods still need standardization, validation, and integration with existing surveillance systems within a One Health approach
Environmental sampling in healthcare facilities in the Greater Kampala Metropolitan Area found Staphylococcus aureus to be the most prevalent organism (32.2% of samples), followed by E. coli (17.4%), Klebsiella pneumoniae (8.1%), and Pseudomonas aeruginosa (3.4%). None of the 48 S. aureus isolates tested was fully susceptible to the antibiotic panel, providing direct evidence for antimicrobial stewardship. In Ghana, ESBL-producing E. coli was detected in food and water pathways. Across the Consortium, partners have developed harmonized sampling protocols, laboratory quality assurance, and shared metadata standards, the same foundations WHO identifies as essential for reliable environmental surveillance.
Characterizing AMR, pharmaceuticals, and microplastics in fecal sludge and wastewater; understanding whether decentralized sanitation systems help these contaminants persist or break down; assessing implications for environmental and human health; and integrating wastewater surveillance as an early-warning tool.
A multi-country initiative advancing sanitation, hygiene, climate resilience, health security, digital decision systems, and healthy institutions in low- and middle-income countries
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