Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use
The global health crisis of antibacterial resistance (ABR) poses a particular threat in low-resource settings like East Africa. Interventions for ABR typically target antibiotic use, overlooking the wider set of factors which drive vulnerability and behaviours. In this cross-sectional study, we investigated the joint contribution of behavioural, environmental, socioeconomic, and demographic factors associated with higher risk of multi-drug resistant urinary tract infections (MDR UTIs) in Kenya, Tanzania, and Uganda. We sampled outpatients with UTI symptoms in healthcare facilities and linked their microbiology data with patient, household and community level data. Using bivariate statistics and Bayesian profile regression on a sample of 1610 individuals, we show that individuals with higher risk of MDR UTIs were more likely to have compound and interrelated social and environmental disadvantages: they were on average older, with lower education, had more chronic illness, lived in resource-deprived households, more likely to have contact with animals, and human or animal waste. This suggests that interventions to tackle ABR need to take account of intersectional socio-environmental disadvantage as a priority.
Authors
- Stephen H. Gillespie (ORCID: https://orcid.org/0000-0001-6537-7712)
- John N. Maina (ORCID: https://orcid.org/0000-0001-7549-2861)
- Andy G. Lynch (ORCID: https://orcid.org/0000-0002-7876-7338)
- Gibson Kibiki (ORCID: https://orcid.org/0000-0002-2826-8709)
- Annette Aduda
- Benon Asiimwe (ORCID: https://orcid.org/0000-0002-9458-4240)
- Katherine Lisa Keenan (ORCID: https://orcid.org/0000-0002-9670-1607)
- John M. Stelling (ORCID: https://orcid.org/0000-0001-5719-7754)
- Martha Fidelis Mushi (ORCID: https://orcid.org/0000-0003-3511-2523)
- Wilber Sabiiti (ORCID: https://orcid.org/0000-0002-4742-2791)
- Emmanuel Olamijuwon (ORCID: https://orcid.org/0000-0002-6109-8131)
- Catherine Kansiime (ORCID: https://orcid.org/0000-0002-2021-3252)
- Qing Zhang (ORCID: https://orcid.org/0000-0002-3990-1979)
- Stella Neema (ORCID: https://orcid.org/0000-0001-8687-1525)
- Matthew T. G. Holden (ORCID: https://orcid.org/0000-0002-4958-2166)
- Alison M. Elliott (ORCID: https://orcid.org/0000-0003-2818-9549)
- Mike Kesby (ORCID: https://orcid.org/0000-0001-7789-870X)
- Joel Bazira (ORCID: https://orcid.org/0000-0001-7600-7514)
- Rachel Sippy (ORCID: https://orcid.org/0000-0003-3617-2093)
- Derek J. Sloan (ORCID: https://orcid.org/0000-0002-7888-5449)
- V. Anne Smith (ORCID: https://orcid.org/0000-0002-0487-2469)
- Michail Papathomas (ORCID: https://orcid.org/0000-0002-5897-695X)
- Kathryn J. Fredricks (ORCID: https://orcid.org/0000-0002-2529-6966)
- David M. Aanensen (ORCID: https://orcid.org/0000-0001-6688-0854)
- Alison Sandeman (ORCID: https://orcid.org/0009-0005-4229-8129)
- Dominique L. Green (ORCID: https://orcid.org/0000-0002-9411-4281)
- Stephen Eliatosha Mshana (ORCID: https://orcid.org/0000-0002-7526-6271)
- Blandina Theophil Mmbaga (ORCID: https://orcid.org/0000-0002-5550-1916)
- Joseph R. Mwanga (ORCID: https://orcid.org/0000-0002-0277-227X)
- John Kiiru (ORCID: https://orcid.org/0000-0002-0571-5190)
- Wei Jing (ORCID: https://orcid.org/0000-0001-8054-0725)
Institutions
- Brigham and Women's Hospital (US)
- Mbarara University of Science and Technology (UG)
- University of St Andrews (GB)
- Catholic University of Health and Allied Sciences (TZ)
- Open Data Institute (GB)
- Kenya Medical Research Institute (KE)
- London School of Hygiene & Tropical Medicine (GB)
- Kilimanjaro Christian Medical Centre (TZ)
- Makerere University (UG)
- Uganda Virus Research Institute (UG)
Publication Details
- Journal
- Nature Communications
- Published
- 2024-10-31
- DOI
- https://doi.org/10.1038/s41467-024-53253-x
- Citations
- 11
- Primary Topic
- Urinary Tract Infections Management
- Type
- article
- Field-Weighted Citation Impact
- 4.25
Funders
- Foundation for the National Institutes of Health
- National Institute for Health and Care Research
- Department of Health and Social Care
- Scottish Funding Council
- National Institutes of Health
- Medical Research Council
- Economic and Social Research Council
- Medical Research Foundation