Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya
Antibiotics can trigger antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and undernutrition can reduce infections and antibiotic use. We assess effects of water, sanitation, handwashing (WSH) and nutrition interventions on caregiver-reported antibiotic use in Bangladesh and Kenya, longitudinally measured at three timepoints among birth cohorts (ages 3-28 months) in a cluster-randomized trial. Over 50% of children used antibiotics at least once in the 90 days preceding data collection. In Bangladesh, the prevalence of antibiotic use was 10-14% lower in groups receiving WSH (prevalence ratio [PR] = 0.90 (0.82-0.99)), nutrition (PR = 0.86 (0.78-0.94)), and nutrition+WSH (PR = 0.86 (0.79-0.93)) interventions. The prevalence of using antibiotics multiple times was 26-35% lower in intervention arms. Reductions were largest when the birth cohort was younger. In Kenya, interventions did not affect antibiotic use. In this work, we show that improving WSH and nutrition can reduce antibiotic use. Studies should assess whether such reductions translate to reduced antimicrobial resistance.
Authors
- Mohammad Aminul Islam (ORCID: https://orcid.org/0000-0001-5107-5289)
- Benjamin F. Arnold (ORCID: https://orcid.org/0000-0001-6105-7295)
- Ayşe Ercümen (ORCID: https://orcid.org/0000-0001-6002-1514)
- Theodora Meerkerk (ORCID: https://orcid.org/0000-0002-8267-3676)
- Caitlin Hemlock (ORCID: https://orcid.org/0000-0002-1714-1016)
- Andrew N. Mertens (ORCID: https://orcid.org/0000-0002-1050-6721)
- Alan Hubbard (ORCID: https://orcid.org/0000-0002-3769-0127)
- Jessica A. Grembi (ORCID: https://orcid.org/0000-0001-6142-4913)
- Md Ziaur Rahman (ORCID: https://orcid.org/0000-0002-8058-4602)
- Stephen P. Luby (ORCID: https://orcid.org/0000-0001-5385-899X)
- Sammy M. Njenga (ORCID: https://orcid.org/0000-0001-6309-476X)
- Leanne Unicomb (ORCID: https://orcid.org/0000-0002-7757-5641)
- Beryl S. Achando
- Belinda Chen (ORCID: https://orcid.org/0000-0002-8951-9866)
- John M. Colford (ORCID: https://orcid.org/0000-0002-3288-6956)
- Charles D. Arnold (ORCID: https://orcid.org/0000-0001-6510-3172)
- Audrie Lin (ORCID: https://orcid.org/0000-0002-3877-3469)
- Marlene K. Wolfe (ORCID: https://orcid.org/0000-0002-6476-0450)
- Amy J. Pickering (ORCID: https://orcid.org/0000-0001-6193-2221)
- Gouthami Rao (ORCID: https://orcid.org/0000-0002-0459-5852)
- Christine P. Stewart
- Holly N. Dentz
- Maya Nadimpalli (ORCID: https://orcid.org/0000-0002-6526-116X)
- Shahjahan Ali (ORCID: https://orcid.org/0000-0003-3883-1208)
- Jade Benjamin‐Chung (ORCID: https://orcid.org/0000-0003-3631-3132)
- Zachary Butzin-Dozier (ORCID: https://orcid.org/0000-0001-6419-0008)
- Da Kyung Jung (ORCID: https://orcid.org/0009-0009-8510-2033)
- Mahbubur Rahman (ORCID: https://orcid.org/0000-0003-0520-2683)
- Clair Null (ORCID: https://orcid.org/0000-0003-0819-536X)
- Sophia T. Tan (ORCID: https://orcid.org/0009-0000-5421-4627)
- Gene G. Ho
Institutions
- University of North Carolina at Chapel Hill (US)
- Uppsala University (SE)
- North Carolina State University (US)
- Emory University (US)
- University of California, San Francisco (US)
- University of California, Santa Cruz (US)
- International Centre for Diarrhoeal Disease Research (BD)
- San Francisco Foundation (US)
- Kenya Medical Research Institute (KE)
- Practical Action (KE)
- Chan Zuckerberg Initiative (United States) (US)
- Mathematica Policy Research (US)
- Washington State University (US)
- University of California, Davis (US)
- University of California, Berkeley (US)
- Stanford University (US)
Publication Details
- Journal
- Nature Communications
- Published
- 2025-01-09
- DOI
- https://doi.org/10.1038/s41467-024-55801-x
- Citations
- 7
- Primary Topic
- Child Nutrition and Water Access
- Type
- article
- Field-Weighted Citation Impact
- 7.84
Funders
- Bill and Melinda Gates Foundation