Beyond symbolic participation: youth-led organisations' voices and actions against antimicrobial resistance in Africa South of the Sahara.

BACKGROUND: Antimicrobial resistance (AMR) is a global health threat, disproportionately affecting Africa South of the Sahara, where young people have been identified as key stakeholders in AMR prevention and awareness; however, effective engagement beyond symbolic participation remains challenging, limiting the impact of youth-led initiatives in addressing AMR in the region. OBJECTIVES: To examine how youth-led actors in Africa South of the Sahara engage in AMR awareness, education and advocacy; the challenges they encounter; and the institutional conditions needed to move beyond symbolic participation. METHODS: A qualitative study design was employed, involving semi-structured interviews with young professionals engaged in AMR efforts across Africa South of the Sahara. Participants were recruited through convenience and snowball sampling. Online interviews were conducted between March and September 2023. Data were analysed using reflexive thematic analysis. RESULTS: Seventeen participants (age range 22-34) from 15 countries shared insights on AMR awareness, community engagement, and barriers in their work. Major findings included the perception of AMR as an invisible threat, generational and structural challenges in community outreach, and the need for financial and institutional support. Despite these obstacles, participants demonstrated innovative approaches, including adapting AMR outreach methods to specific social groups and a strong commitment to AMR education and policy advocacy. CONCLUSIONS: Findings underscore the essential role of youth in AMR efforts in Africa South of the Sahara and the need for greater institutional support and capacity-building. Enhancing youth involvement beyond symbolic roles is crucial to advancing AMR initiatives, particularly through tailored communication strategies and collaborative policymaking.