The harmattan had just begun; it was almost Christmas, Nneka found her way to Makoko, Lagos, where her sister lives. Her sister had been admitted to a local clinic due to a persistent cough, which Nneka believed to be infectious. She held onto the hope that antibiotics would end this ordeal. 

After a series of tests, the doctor called her and explained the concept of antimicrobial resistance and its significant role in her sister’s recurring cough. “Nneka,” he said, “these microbes are evolving. Antibiotics may not be the solution here.” This revelation underscored the complexity of her sister’s condition and the challenges that lay ahead.

News of Nneka's sister's condition spread subtly across Makoko, instilling a sense of fear among the residents as they began to comprehend the gravity of her situation. 

Antibiotics, once hailed as the panacea for all infections, are now witnessing a decline in their effectiveness. Over time, we risk seeing the loss of every antibiotic's potency.

Neglecting the slums in the battle against Antimicrobial Resistance (AMR) is akin to playing with fire. Can we afford to let the inhabitants of these slums shoulder the burden of this global health crisis? Can we risk their limited access to information and resources becoming the weak link that enables the proliferation of resistant microbes? If the slums are not safeguarded, then no one is truly safe. This stark reality underscores the urgency of addressing AMR in all communities, irrespective of socio-economic status.

AMR occurs when microbes like bacteria, fungi, and viruses develop resistance to drugs designed to kill them - antibiotics, antifungals, antivirals, etc. This is a major global concern, and prioritizing the most vulnerable people is crucial. 

The factors driving this silent pandemic are complicated. In the slums, the houses are overcrowded and poorly ventilated, creating a perfect breeding environment for various microbes. Poverty is a significant driver in the slums, and residents re-use and even borrow antimicrobials from neighbors without proper guidance. 

Professor Folasade Ogunsola, Vice Chancellor of the University of Lagos, aptly stated, "Slum health issues must be given special attention and should be a major focus in the battle against Antimicrobial resistance... a silent, deadly, and relentless pandemic that is sweeping across the world and threatens to undermine the gains we have made against infectious diseases since 1940 with the advent of penicillin."

In low—and middle-income countries, factors like the overuse of antibiotics in medicine and agriculture, alongside poor hygiene, contribute significantly to AMR. Unfortunately, these factors are also prevalent in many African slums, including Makoko, a Lagos community built on stilts in the lagoon.

Residents of Makoko face severe challenges, including flooding, poor sanitation, and a lack of clean water, healthcare, and proper sanitation facilities. The overcrowded living conditions further facilitate the spread of disease and contamination. Additionally, limited access to healthcare and awareness about AMR hamper residents' ability to manage the situation effectively.

Professor Ogunsola highlights the need for more AMR research in slums, stating, "Every action should start from the slums if we have a chance of winning this health war." This emphasizes the urgent need to understand the unique dynamics of slums and tailor interventions accordingly.

Combating AMR requires more than a grassroots effort. It requires a coherent and collaborative effort from governments, healthcare workers, and the citizens. Investing in clean water and ensuring adequate sanitation is critical. Strengthening healthcare systems with trained personnel and affordable diagnostics is vital for people living in the slums.

In Kibera slum, Nairobi, residents have formed health clubs to educate each other on proper hygiene and sanitation. Engagement plays a big role in convincing people of the risks attached to their activities. Such health clubs will go a long way in influencing health behaviors and reducing the chances of contamination and spread of infection within their community. 

In Kampala, Uganda, waste management has collaborated with the government and community to improve cleaning and prompt retrieval of wastes that could be breeding environments for microorganisms. A clean and hygienic environment is essential, and it is the first step in protecting residents from infectious diseases. 

The battle against Antimicrobial Resistance in African slums is about safeguarding the future. It's about ensuring that a situation like Nneka's does not repeat itself. We must ensure that antibiotics and other antimicrobial agents remain the shield against every infection.

If resistant microbes take hold in the slums, the battle is effectively lost. We must acknowledge this interconnectedness and prioritize vulnerable communities to achieve widespread victory. AMR is real, and the consequences of inaction are severe. Let's ensure everyone, including those in the slums, has a fighting chance against this silent threat. For the sake of the future we are building together, this fight is a must-win.