Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya
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...
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2025-01-01
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| Online Access: | https://doi.org/10.1038/s41467-024-55801-x |
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| author | 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 |
| author_facet | 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 |
| author_sort | Ayse Ercumen |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-3443618f92024fd38ee5d7fcd235e2a5 |
| institution | Kabale University |
| issn | 2041-1723 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Nature Communications |
| spelling | doaj-art-3443618f92024fd38ee5d7fcd235e2a52025-01-12T12:29:58ZengNature PortfolioNature Communications2041-17232025-01-0116111110.1038/s41467-024-55801-xWater, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and KenyaAyse Ercumen0Andrew N. Mertens1Zachary Butzin-Dozier2Da Kyung Jung3Shahjahan Ali4Beryl S. Achando5Gouthami Rao6Caitlin Hemlock7Amy J. Pickering8Christine P. Stewart9Sophia T. Tan10Jessica A. Grembi11Jade Benjamin-Chung12Marlene Wolfe13Gene G. Ho14Md. Ziaur Rahman15Charles D. Arnold16Holly N. Dentz17Sammy M. Njenga18Theodora Meerkerk19Belinda Chen20Maya Nadimpalli21Mohammad Aminul Islam22Alan E. Hubbard23Clair Null24Leanne Unicomb25Mahbubur Rahman26John M. Colford27Stephen P. Luby28Benjamin F. Arnold29Audrie Lin30Department of Forestry and Environmental Resources, North Carolina State UniversityDivision of Epidemiology and Biostatistics, School of Public Health, University of California, BerkeleyDivision of Epidemiology and Biostatistics, School of Public Health, University of California, BerkeleyDivision of Epidemiology and Biostatistics, School of Public Health, University of California, BerkeleyEnvironmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, BangladeshInnovations for Poverty ActionDepartment of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel HillDivision of Epidemiology and Biostatistics, School of Public Health, University of California, BerkeleyDepartment of Civil and Environmental Engineering, Blum Center for Developing Economies, University of California, BerkeleyInstitute for Global Nutrition, University of California, DavisDivision of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford UniversityDivision of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford UniversityChan Zuckerberg BiohubRollins School of Public Health, Emory UniversityDivision of Epidemiology and Biostatistics, School of Public Health, University of California, BerkeleyEnvironmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, BangladeshInstitute for Global Nutrition, University of California, DavisInstitute for Global Nutrition, University of California, DavisKenya Medical Research InstituteInnovations for Poverty ActionDivision of Epidemiology and Biostatistics, School of Public Health, University of California, BerkeleyRollins School of Public Health, Emory UniversityPaul G. Allen School for Global Health, Washington State UniversityDivision of Epidemiology and Biostatistics, School of Public Health, University of California, BerkeleyMathematica Policy ResearchEnvironmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, BangladeshEnvironmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, BangladeshDivision of Epidemiology and Biostatistics, School of Public Health, University of California, BerkeleyDivision of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford UniversityFrancis I. Proctor Foundation and Department of Ophthalmology, University of California, San FranciscoUniversity of California, Santa CruzAbstract 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.https://doi.org/10.1038/s41467-024-55801-x |
| spellingShingle | 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 Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya Nature Communications |
| title | Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya |
| title_full | Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya |
| title_fullStr | Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya |
| title_full_unstemmed | Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya |
| title_short | Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya |
| title_sort | water sanitation handwashing and nutritional interventions can reduce child antibiotic use evidence from bangladesh and kenya |
| url | https://doi.org/10.1038/s41467-024-55801-x |
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