Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya

Ayse Ercumen (), Andrew N. Mertens, Zachary Butzin-Dozier, Da Kyung Jung, Shahjahan Ali, Beryl S. Achando, Gouthami Rao, Caitlin Hemlock, Amy J. Pickering, Christine P. Stewart, Sophia T. Tan, Jessica A. Grembi, Jade Benjamin-Chung, Marlene Wolfe, Gene G. Ho, Md. Ziaur Rahman, Charles D. Arnold, Holly N. Dentz, Sammy M. Njenga, Theodora Meerkerk, Belinda Chen, Maya Nadimpalli, Mohammad Aminul Islam, Alan E. Hubbard, Clair Null, Leanne Unicomb, Mahbubur Rahman, John M. Colford, Stephen P. Luby, Benjamin F. Arnold and Audrie Lin
Additional contact information
Ayse Ercumen: North Carolina State University
Andrew N. Mertens: Berkeley
Zachary Butzin-Dozier: Berkeley
Da Kyung Jung: Berkeley
Shahjahan Ali: Bangladesh
Beryl S. Achando: Innovations for Poverty Action
Gouthami Rao: University of North Carolina at Chapel Hill
Caitlin Hemlock: Berkeley
Amy J. Pickering: Berkeley
Christine P. Stewart: Davis
Sophia T. Tan: Stanford University
Jessica A. Grembi: Stanford University
Jade Benjamin-Chung: Chan Zuckerberg Biohub
Marlene Wolfe: Emory University
Gene G. Ho: Berkeley
Md. Ziaur Rahman: Bangladesh
Charles D. Arnold: Davis
Holly N. Dentz: Davis
Sammy M. Njenga: Kenya Medical Research Institute
Theodora Meerkerk: Innovations for Poverty Action
Belinda Chen: Berkeley
Maya Nadimpalli: Emory University
Mohammad Aminul Islam: Washington State University
Alan E. Hubbard: Berkeley
Clair Null: Mathematica Policy Research
Leanne Unicomb: Bangladesh
Mahbubur Rahman: Bangladesh
John M. Colford: Berkeley
Stephen P. Luby: Stanford University
Benjamin F. Arnold: San Francisco
Audrie Lin: Santa Cruz

Nature Communications, 2025, vol. 16, issue 1, 1-11

Abstract: Abstract Antibiotics can trigger antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and undernutrition can reduce infections and antibiotic use. We assess effects of water, sanitation, handwashing (WSH) and nutrition interventions on caregiver-reported antibiotic use in Bangladesh and Kenya, longitudinally measured at three timepoints among birth cohorts (ages 3–28 months) in a cluster-randomized trial. Over 50% of children used antibiotics at least once in the 90 days preceding data collection. In Bangladesh, the prevalence of antibiotic use was 10–14% lower in groups receiving WSH (prevalence ratio [PR] = 0.90 (0.82–0.99)), nutrition (PR = 0.86 (0.78–0.94)), and nutrition+WSH (PR = 0.86 (0.79–0.93)) interventions. The prevalence of using antibiotics multiple times was 26–35% lower in intervention arms. Reductions were largest when the birth cohort was younger. In Kenya, interventions did not affect antibiotic use. In this work, we show that improving WSH and nutrition can reduce antibiotic use. Studies should assess whether such reductions translate to reduced antimicrobial resistance.

Date: 2025
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DOI: 10.1038/s41467-024-55801-x

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