University of St Andrews, St Andrews, UK.
Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Nat Commun. 2024 Oct 31;15(1):9418. doi: 10.1038/s41467-024-53253-x.
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.
全球抗菌药物耐药性（ABR）危机对东非等资源匮乏地区构成了特别威胁。针对 ABR 的干预措施通常针对抗生素的使用，而忽略了驱动脆弱性和行为的更广泛因素。在这项横断面研究中，我们调查了与肯尼亚、坦桑尼亚和乌干达的多药耐药性尿路感染（MDR UTI）风险较高相关的行为、环境、社会经济和人口因素的综合贡献。我们在医疗机构中对有 UTI 症状的门诊患者进行了抽样，并将他们的微生物学数据与患者、家庭和社区层面的数据联系起来。在对 1610 人的样本进行了双变量统计和贝叶斯轮廓回归后，我们发现 MDR UTI 风险较高的个体更有可能面临复杂和相互关联的社会和环境劣势：他们的平均年龄较大，教育程度较低，患有更多的慢性疾病，生活在资源匮乏的家庭中，更有可能与动物、人类或动物粪便接触。这表明，应对 ABR 的干预措施需要优先考虑交叉的社会环境劣势。
