Chidziwisano Kondwani, Cocker Derek, Mwapasa Kumwenda Taonga, Amos Steve, Feasey Nicholas, Morse Tracy
Centre for Water, Sanitation, Health and Appropriate Technology Development, Malawi University of Business and Applied Sciences, Chichiri, Malawi.
Department of Environmental Health, Malawi University of Business and Applied Sciences, Chichiri, Malawi.
Am J Trop Med Hyg. 2024 Dec 3;112(2):355-363. doi: 10.4269/ajtmh.24-0253. Print 2025 Feb 5.
Antimicrobial-resistant (AMR) bacteria are prevalent in household and environmental settings in low-income locations. However, there are limited data on individuals' understanding of AMR bacteria exposure risks in these settings. A cross-sectional study was conducted to identify individual risk perception of AMR bacteria and its associated behavioral determinants at the household level in urban, peri-urban, and rural Malawi. We conducted interviews with 529 participants from 300 households (n = 100 households/site). The risk, attitude, norms, ability, and self-regulation model was used to assess psychosocial factors underlying AMR bacteria exposure through animal feces, river water, and drain water. Analysis of variance was used to assess the difference between doers and non-doers of the three targeted behaviors: use and contact with river water, contact with drain water, and contact with animal feces. There was limited understanding regarding human-environmental interactions facilitating AMR bacteria transmission across all sites, and as such, the perceived risk of contracting AMR infection was low (41%; P = 0.189). Human contact with animal feces was seen as risky (64%) compared with contact with river and drain water (17%). Urban participants perceived that they were at greater risk of AMR bacteria exposure than their rural counterparts (P = 0.001). The perception of social norms was favorable for the targeted behaviors (P = 0.001), as well as self-reported attitude and ability estimates (self-efficacy; P = 0.023), thus indicating the role of psychosocial factors influencing the human-environment interaction in AMR bacteria transmission. Our findings underscore the need for combined infrastructural improvements and behavior-centered AMR bacteria education to drive behavioral changes, benefiting both AMR infection mitigation and broader One Health initiatives.
抗菌药物耐药（AMR）细菌在低收入地区的家庭和环境中普遍存在。然而，关于个人对这些环境中AMR细菌暴露风险的了解的数据有限。在马拉维的城市、城郊和农村地区，开展了一项横断面研究，以确定家庭层面个人对AMR细菌的风险认知及其相关行为决定因素。我们对来自300户家庭的529名参与者进行了访谈（每个地点100户家庭）。采用风险、态度、规范、能力和自我调节模型，评估通过动物粪便、河水和排水接触AMR细菌背后的社会心理因素。方差分析用于评估三种目标行为（使用和接触河水、接触排水和接触动物粪便）的实施者和未实施者之间的差异。在所有地点，人们对促进AMR细菌传播的人类与环境相互作用的了解有限，因此，感染AMR的感知风险较低（41%；P = 0.189）。与接触河水和排水（17%）相比，人类接触动物粪便被视为有风险（64%）。城市参与者认为他们比农村参与者面临AMR细菌暴露的风险更大（P = 0.001）。对社会规范的认知有利于目标行为（P = 0.001），以及自我报告的态度和能力评估（自我效能；P = 0.023），从而表明社会心理因素在AMR细菌传播中影响人类与环境相互作用的作用。我们的研究结果强调，需要结合基础设施改善和以行为为中心的AMR细菌教育来推动行为改变，这有利于减轻AMR感染和更广泛的“同一健康”倡议。
