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

Katherine Lisa Keenan; Michail Papathomas; Stephen Mshana; Benon Asiimwe; John Kiiru; Andy Lynch; Mike Kesby; Stella Neema; Joseph R. Mwanga; Martha F. Mushi; Wei Jing; Dominique LaShari Green; Emmanuel Olawale Olamijuwon; Qingzhi Zhang; Rachel  Sippy; Kathryn Jean Fredricks; Stephen Henry Gillespie; Wilber Sabiiti; Joel Bazira; Derek James Sloan; HATUA Consortium; Gibson Kibiki; Blandina T. Mmbaga; David Aanensen; John Stelling; V.A. Smith; Alison  Sandeman; Matthew Holden

doi:10.1038/S41467-024-53253-X

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

Katherine Lisa Keenan^*, Michail Papathomas, Stephen Mshana, Benon Asiimwe, John Kiiru, Andy Lynch, Mike Kesby, Stella Neema, Joseph R. Mwanga, Martha F. Mushi, Wei Jing, Dominique LaShari Green, Emmanuel Olawale Olamijuwon, Qingzhi Zhang, Rachel Sippy, Kathryn Jean Fredricks, Stephen Henry Gillespie, Wilber Sabiiti, Joel Bazira, Derek James SloanHATUA Consortium, Gibson Kibiki, Blandina T. Mmbaga, David Aanensen, John Stelling, V.A. Smith, Alison Sandeman, Matthew Holden

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	9418
Number of pages	11
Journal	Nature Communications
Volume	15
DOIs	https://doi.org/10.1038/S41467-024-53253-X
Publication status	Published - 31 Oct 2024

Keywords

Urinary tract infections/drug therapy
Anti-bacterial agents/therapeutic use
Drug resistance, multiple, bacterial
Cross-sectional studies
Bayes theorem
Tanzania/epidemiology
Africa, Eastern/epidemiology
Kenya/epidemiology
Risk factors
Uganda/epidemiology
Socioeconomic factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1038/S41467-024-53253-XLicence: CC BY

Keenan_2024_NC_Intersecting-social-environmental-determinants_CC
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SFC GCRF 2020-21 Call: A health system analysis and modeling of methods to maximise uptake and utilization of advanced diagnostic and treatment technologies in LMICs - the case of COVID19
Sabiiti, W. (PI)
Scottish Funding Council
1/08/20 → 31/07/21
Project: Standard
SFC GCRF 2020-21 Call: Overcoming the COVID-19 dilemma in tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) research and care
Sabiiti, W. (PI)
1/08/20 → 31/07/21
Project: Standard
Katherine Keenan - SFC GCRF 19/20: Maximising analytical and translational capability for social science data on antimicrobial resistance (AMR) in East Africa
Keenan, K. L. (PI) & Kesby, M. (CoI)
Scottish Funding Council
1/12/19 → 31/12/20
Project: Standard

Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use (code)
Keenan, K. L. (Creator), GitHub, 2024
https://github.com/katykeenan1981/hatuaprofilepaper/tree/main
Dataset: Software

Cite this

Keenan, K. L., Papathomas, M., Mshana, S., Asiimwe, B., Kiiru, J., Lynch, A., Kesby, M., Neema, S., Mwanga, J. R., Mushi, M. F., Jing, W., Green, D. L., Olamijuwon, E. O., Zhang, Q., Sippy, R., Fredricks, K. J., Gillespie, S. H., Sabiiti, W., Bazira, J., ... Holden, M. (2024). Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use. Nature Communications, 15, Article 9418. https://doi.org/10.1038/S41467-024-53253-X

@article{9ebc71f36b044d878236434f8aa88908,

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

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.",

keywords = "Urinary tract infections/drug therapy, Anti-bacterial agents/therapeutic use, Drug resistance, multiple, bacterial, Cross-sectional studies, Bayes theorem, Tanzania/epidemiology, Africa, Eastern/epidemiology, Kenya/epidemiology, Risk factors, Uganda/epidemiology, Socioeconomic factors",

author = "Keenan, {Katherine Lisa} and Michail Papathomas and Stephen Mshana and Benon Asiimwe and John Kiiru and Andy Lynch and Mike Kesby and Stella Neema and Mwanga, {Joseph R.} and Mushi, {Martha F.} and Wei Jing and Green, {Dominique LaShari} and Olamijuwon, {Emmanuel Olawale} and Qingzhi Zhang and Rachel Sippy and Fredricks, {Kathryn Jean} and Gillespie, {Stephen Henry} and Wilber Sabiiti and Joel Bazira and Sloan, {Derek James} and {HATUA Consortium} and Gibson Kibiki and Mmbaga, {Blandina T.} and David Aanensen and John Stelling and V.A. Smith and Alison Sandeman and Matthew Holden",

note = "Funding: The Holistic Approach to Unravel Antibacterial Resistance in East Africa is a Global Context Consortia Award (MR/S004785/1, K.K., S.E.M., B.A., J.K., A.G.L., M.K., S.N., J.R.M., S.H.G., W.S., D.J.S., G.K., D.A., J.S., V.A.S., and M.T.G.H.) funded by the National Institute for Health Research, Medical Research Council, and the Department of Health and Social Care. This paper was funded in part by a grant from the National Institutes of Health (grant number U01CA207167, J.S.), and a Scottish Funding Council GCRF Consolidator Award (K.K., W.S.).",

year = "2024",

month = oct,

day = "31",

doi = "10.1038/S41467-024-53253-X",

language = "English",

volume = "15",

journal = "Nature Communications",

issn = "2041-1723",

publisher = "Nature publishing group",

}

Keenan, KL , Papathomas, M, Mshana, S, Asiimwe, B, Kiiru, J, Lynch, A , Kesby, M, Neema, S, Mwanga, JR, Mushi, MF, Jing, W, Green, DL, Olamijuwon, EO, Zhang, Q, Sippy, R, Fredricks, KJ , Gillespie, SH , Sabiiti, W, Bazira, J, Sloan, DJ, HATUA Consortium, Kibiki, G, Mmbaga, BT, Aanensen, D, Stelling, J, Smith, VA , Sandeman, A & Holden, M 2024, 'Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use', Nature Communications, vol. 15, 9418. https://doi.org/10.1038/S41467-024-53253-X

TY - JOUR

T1 - Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use

AU - Keenan, Katherine Lisa

AU - Papathomas, Michail

AU - Mshana, Stephen

AU - Asiimwe, Benon

AU - Kiiru, John

AU - Lynch, Andy

AU - Kesby, Mike

AU - Neema, Stella

AU - Mwanga, Joseph R.

AU - Mushi, Martha F.

AU - Jing, Wei

AU - Green, Dominique LaShari

AU - Olamijuwon, Emmanuel Olawale

AU - Zhang, Qingzhi

AU - Sippy, Rachel

AU - Fredricks, Kathryn Jean

AU - Gillespie, Stephen Henry

AU - Sabiiti, Wilber

AU - Bazira, Joel

AU - Sloan, Derek James

AU - HATUA Consortium

AU - Kibiki, Gibson

AU - Mmbaga, Blandina T.

AU - Aanensen, David

AU - Stelling, John

AU - Smith, V.A.

AU - Sandeman, Alison

AU - Holden, Matthew

N1 - Funding: The Holistic Approach to Unravel Antibacterial Resistance in East Africa is a Global Context Consortia Award (MR/S004785/1, K.K., S.E.M., B.A., J.K., A.G.L., M.K., S.N., J.R.M., S.H.G., W.S., D.J.S., G.K., D.A., J.S., V.A.S., and M.T.G.H.) funded by the National Institute for Health Research, Medical Research Council, and the Department of Health and Social Care. This paper was funded in part by a grant from the National Institutes of Health (grant number U01CA207167, J.S.), and a Scottish Funding Council GCRF Consolidator Award (K.K., W.S.).

PY - 2024/10/31

Y1 - 2024/10/31

N2 - 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.

AB - 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.

KW - Urinary tract infections/drug therapy

KW - Anti-bacterial agents/therapeutic use

KW - Drug resistance, multiple, bacterial

KW - Cross-sectional studies

KW - Bayes theorem

KW - Tanzania/epidemiology

KW - Africa, Eastern/epidemiology

KW - Kenya/epidemiology

KW - Risk factors

KW - Uganda/epidemiology

KW - Socioeconomic factors

U2 - 10.1038/S41467-024-53253-X

DO - 10.1038/S41467-024-53253-X

M3 - Article

C2 - 39482320

SN - 2041-1723

VL - 15

JO - Nature Communications

JF - Nature Communications

M1 - 9418

ER -

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

Abstract

Keywords

UN SDGs

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Projects

SFC GCRF 2020-21 Call: A health system analysis and modeling of methods to maximise uptake and utilization of advanced diagnostic and treatment technologies in LMICs - the case of COVID19

SFC GCRF 2020-21 Call: Overcoming the COVID-19 dilemma in tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) research and care

Katherine Keenan - SFC GCRF 19/20: Maximising analytical and translational capability for social science data on antimicrobial resistance (AMR) in East Africa

Datasets

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

Cite this