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

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, Emmanuel Olamijuwon, Qing Zhang, Rachel Sippy, Kathryn J. Fredricks, Stephen H. Gillespie, Wilber Sabiiti, Joel Bazira, Derek J. Sloan, Blandina T. Mmbaga, Gibson Kibiki, David Aanensen, John Stelling, V. Anne Smith, Alison Sandeman and Matthew T. G. Holden
Additional contact information
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

Nature Communications, 2024, vol. 15, issue 1, 1-11

Abstract: 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.

Date: 2024
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DOI: 10.1038/s41467-024-53253-x

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