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Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use

Author

Listed:
  • Katherine Keenan

    (University of St Andrews)

  • Michail Papathomas

    (University of St Andrews)

  • Stephen E. Mshana

    (Catholic University of Health and Allied Sciences)

  • Benon Asiimwe

    (Makerere University)

  • John Kiiru

    (Kenya Medical Research Institute)

  • Andy G. Lynch

    (University of St Andrews)

  • Mike Kesby

    (University of St Andrews)

  • Stella Neema

    (Makerere University)

  • Joseph R. Mwanga

    (Catholic University of Health and Allied Sciences)

  • Martha F. Mushi

    (Catholic University of Health and Allied Sciences)

  • Wei Jing

    (University of St Andrews)

  • Dominique L. Green

    (University of St Andrews)

  • Emmanuel Olamijuwon

    (University of St Andrews)

  • Qing Zhang

    (University of St Andrews)

  • Rachel Sippy

    (University of St Andrews)

  • Kathryn J. Fredricks

    (University of St Andrews)

  • Stephen H. Gillespie

    (University of St Andrews)

  • Wilber Sabiiti

    (University of St Andrews)

  • Joel Bazira

    (Mbarara University of Science and Technology)

  • Derek J. Sloan

    (University of St Andrews)

  • Blandina T. Mmbaga

    (Tanzania; Kilimanjaro Christian Medical University College)

  • Gibson Kibiki

    (Africa Excellence Research Fund)

  • David Aanensen

    (Oxford Big Data Institute)

  • John Stelling

    (Brigham and Women’s Hospital)

  • V. Anne Smith

    (University of St Andrews)

  • Alison Sandeman

    (University of St Andrews)

  • Matthew T. G. Holden

    (University of St Andrews)

Abstract

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.

Suggested Citation

  • Katherine Keenan & Michail Papathomas & Stephen E. Mshana & Benon Asiimwe & John Kiiru & Andy G. Lynch & Mike Kesby & Stella Neema & Joseph R. Mwanga & Martha F. Mushi & Wei Jing & Dominique L. Green , 2024. "Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use," Nature Communications, Nature, vol. 15(1), pages 1-11, December.
    • Handle: RePEc:nat:natcom:v:15:y:2024:i:1:d:10.1038_s41467-024-53253-x
    DOI: 10.1038/s41467-024-53253-x
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    References listed on IDEAS

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    1. Hadley, Craig & Maxfield, Amanda & Hruschka, Daniel, 2019. "Different forms of household wealth are associated with opposing risks for HIV infection in East Africa," World Development, Elsevier, vol. 113(C), pages 344-351.
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