Nature Communications (Jan 2025)
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,
- Audrie Lin
Affiliations
- Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University
- Andrew N. Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
- Zachary Butzin-Dozier
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
- Da Kyung Jung
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
- Shahjahan Ali
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh
- Beryl S. Achando
- Innovations for Poverty Action
- Gouthami Rao
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Caitlin Hemlock
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
- Amy J. Pickering
- Department of Civil and Environmental Engineering, Blum Center for Developing Economies, University of California, Berkeley
- Christine P. Stewart
- Institute for Global Nutrition, University of California, Davis
- Sophia T. Tan
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University
- Jessica A. Grembi
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University
- Jade Benjamin-Chung
- Chan Zuckerberg Biohub
- Marlene Wolfe
- Rollins School of Public Health, Emory University
- Gene G. Ho
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
- Md. Ziaur Rahman
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh
- Charles D. Arnold
- Institute for Global Nutrition, University of California, Davis
- Holly N. Dentz
- Institute for Global Nutrition, University of California, Davis
- Sammy M. Njenga
- Kenya Medical Research Institute
- Theodora Meerkerk
- Innovations for Poverty Action
- Belinda Chen
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
- Maya Nadimpalli
- Rollins School of Public Health, Emory University
- Mohammad Aminul Islam
- Paul G. Allen School for Global Health, Washington State University
- Alan E. Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
- Clair Null
- Mathematica Policy Research
- Leanne Unicomb
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh
- Mahbubur Rahman
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh
- John M. Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley
- Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University
- Benjamin F. Arnold
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco
- Audrie Lin
- University of California, Santa Cruz
- DOI
- https://doi.org/10.1038/s41467-024-55801-x
- Journal volume & issue
-
Vol. 16,
no. 1
pp. 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.
