Optimising community antibiotic use and environmental infection control with behavioural interventions in rural Burkina Faso and DR Congo
Emergence of antibiotic resistance (AMR) is a serious concern for Low and Middle Income Countries (LMICs). Unregulated use of antibiotics, a major AMR driver, is highly prevalent in LMICs, with medicine stores as key providers. Physical interactions between One Health compartments increase cross-domain transmission risks, although the relative importance of different reservoirs is uncertain, with community-level dynamics of AMR in LMICs largely unquantified. We will develop and evaluate a behavioural intervention bundle, targeting medicine stores and their communities, to optimise antibiotic use and improve hygiene, and hence reduce AMR prevalence and transmission. After a 6-month local co-development phase, the intervention will be implemented over 12 months in established health demographic surveillance sites in Burkina Faso and DR Congo with clinical microbiology facilities, and evaluated in a cluster RCT, comparing intervention and control villages. The primary outcome measure is the change in Watch antibiotic provision from medicine stores (where a formal prescription is not required), assessed via patient exit interviews and simulated client visits. Changes in hygiene practices and AMR pathogen and gene carriage will be assessed in repeated population surveys. Rodents, living in close proximity to humans in much of sub-Sahara Africa, provide a proxy estimate of environmental AMR pathogen and gene exposure. Using modelling and sequencing of selected human and rodent isolates, we will quantify how changes in antibiotic use and hygiene practices impact AMR transmission.
- Marianne van der Sande, Institute of Tropical Medicine, Belgium (Coordinator)
- Halidou Tinto, Institut de Recherche en Science de la Santé - Direction Régionale du Centre-Ouest, Burkina Faso (Partner)
- Delphin Phanzu Mavinga, Institut Médical Evangélique de Kimpese, Democratic Republic of the Congo (Partner)
- Edwin Wouters, University of Antwerp, Belgium (Partner)
- Tamara Giles-Vernick, Institut Pasteur, France (Partner)
- Stephen Baker, University of Cambridge, United Kingdom (Partner)
- Ben Cooper, University of Oxford, United Kingdom (Partner)
Incorrect use of antibiotics is a major cause of antibiotic resistance. In rural Africa, people often receive antibiotics without prescription from local pharmacy shops, increasing the risk of resistance . Substandard sanitation and hygiene practices result in frequent exchange of bacteria between humans’ guts, and their environment. How important these different sources are for the acquisition of antimicrobial resistant (AMR) bacteria in humans is still unclear, but contacts between humans and animals, in particular rodents, are frequent in much of Africa. We will develop and evaluate a behavioural intervention for community pharmacy staff and their communities, to improve antibiotic use and hygiene practices, to ultimately reduce AMR.The intervention will be implemented over 12 months in Burkina Faso and DR Congo . We’ll measure as primary result changes in the use of specific AMR-prone and clinically vital antibiotics at community pharmacies throughout the intervention period. We will compare antibiotic use in pharmacies and surrounding communities where the intervention was implemented, and where the intervention did not take place. Also, we will assess changes in hygiene practices by surveying members of the surrounding communities. Then, we will determine how frequent AMR bacteria are transmitted by repeatedly analysing stool samples of those populations, and of rodents living in the surroundings, for bacteria and specific AMR genes. Through mathematical modelling we will quantify how changes in antibiotic use and hygiene practices will impact AMR transmission.