Mapping the Research Growth and Citation Impact of Scholarly Works on Sickle Cell Disease in Tanzania: A Scientometric Study.

Antimicrobial resistance (AMR) refers to the ability of microbes to withstand drugs designed to inhibit or kill them. In this article, AMR refers primarily to antibacterial resistance. AMR is one of the most urgent public health crises of the 21st century, weakening modern medicine and imposing major global health and economic burdens. AMR undermines the treatment of common infections, heightens risks in surgeries, cancer care and childbirth, and could cause up to 10 million deaths annually by 2050 if unaddressed. The 2019 Global Resistance on Antimicrobial Resistance (GRAM) report estimated that AMR caused 1.27 million deaths and contributed to nearly 5 million globally, disproportionately impacting low- and middle-income countries (LMICs). In LMICs, weak health systems, limited diagnostic capacity and poor water, sanitation and hygiene (WASH) infrastructure contribute to a high infectious disease burden, often compensated for by excessive antimicrobial use, serving as structural ‘quick-fix’ patches for fragile health systems. Antimicrobial stewardship monitors antibiotic use across human, animal and environmental sectors, primarily targets supply-side factors. Nonetheless, these approaches often overlook demand-side dynamics such as communities’ treatment seeking behaviours, healthcare network and agricultural and animal husbandry practices, all of which are critical to effective One Health stewardship. Some LMICs have weak and fragmented primary healthcare systems, characterised by shortages of trained health workers, resources (eg, equipment, infrastructure), lack of health insurance, and poor referral pathways, all of which further constrain timely access to appropriate diagnosis and treatment. In these settings, antimicrobial use often compensates for deficiencies within the health systems and is therefore shaped by limited access to quality healthcare rather than by individual knowledge or preferences alone, underscoring the need to address structural health system barriers alongside behavioural interventions. Unregulated antimicrobial use in agriculture and aquaculture fuels environmental resistance that threatens both animals and humans. The socio-economic impacts are profound: prolonged illness, costly care and higher mortality deepen poverty and inequality. Consequently, AMR is not only a biomedical issue but also a social and developmental crisis that threatens progress in global health and exacerbates structural poverty and inequity in LMICs.