# Antibiotic overuse as a modifiable early-life risk factor for non-communicable diseases in sub-Saharan Africa

## TL;DR

Early-life antibiotic overuse in sub-Saharan Africa is linked to increased risk of non-communicable diseases and needs better policy integration.

## Contribution

This paper reframes early-life antibiotic exposure as a modifiable health determinant by bridging antimicrobial resistance and NCD prevention strategies.

## Key findings

- Early-life antibiotic use in sub-Saharan Africa is widespread and linked to rising non-communicable disease risks.
- Health systems can address both antimicrobial resistance and NCDs by integrating antibiotic tracking into child health platforms.

## Abstract

Early-life antibiotic overuse is a public health concern. In low- and middle-income countries, consumption has surged by 76% since 2000. This trend is particularly acute in sub-Saharan Africa (SSA), where antimicrobial resistance contributes to 255,000 deaths annually and infant antibiotic exposure is widespread in the first two years of life. While a substantial body of research associates antibiotic-induced microbiome disruption with metabolic and immune dysregulation, with large cohorts reporting ~20% higher odds of childhood obesity and asthma, these observational findings do not establish causality and derive largely from high-income settings. This potential pathway remains a policy blind spot within most non-communicable disease (NCD) prevention frameworks. By synthesising biological, epidemiological and implementation evidence, this paper considers early-life antibiotic exposure as a potentially modifiable determinant of lifelong health and outlines a pragmatic research and policy agenda to integrate antibiotic-aware prevention into NCD prevention efforts and routine child health platforms in resource-limited SSA settings.

Main findings: Pervasive early-life antibiotic use, driven by rising consumption in LMICs and limited stewardship in sub-Saharan Africa, represents a significant and underappreciated driver of non-communicable disease risk.

Added knowledge: This paper bridges the policy gap between strategies to contain antimicrobial resistance and strategies to prevent chronic non-infectious diseases, by synthesising mechanistic, epidemiological and implementation evidence to reframe early-life antibiotic exposure as a primary, modifiable determinant of lifelong health.

Global health impact for policy and action: Health systems can address the dual burden of antimicrobial resistance and chronic non-infectious diseases by integrating antibiotic-aware risk profiling into routine child health, using existing platforms to track exposure and deliver targeted preventive interventions in high-burden settings.