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

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.