Spatial and temporal variation in the community prevalence of antibiotic resistance in Bangladesh: an integrated surveillance study protocol

Introduction: Increasing antibiotic resistance (ABR) in low and middle-income countries such as Bangladesh presents a major health threat. However, assessing the scale of the health risk is problematic in the absence of reliable data on the community prevalence of antibiotic-resistant bacteria. We describe the protocol for a small-scale integrated surveillance programme that aims to quantify the prevalence of colonisation with antibiotic resistant bacteria and concentrations of antibiotic resistant genes from a ‘One Health’ perspective. The holistic assessment of antibiotic resistance in humans, animals and within the environment in urban and rural Bangladesh will generate comprehensive data to inform human health risk. Methods and analysis: The study design focuses on three exposure-relevant sites where there is enhanced potential for transmission of ABR between humans, animals and the environment: i) rural poultry-owning households, ii) commercial poultry farms and iii) urban live-bird markets. The comparison of ABR prevalence in human groups with high and low exposure to farming and poultry will enable us to test the hypothesis that ABR bacteria and genes from the environment and foodproducing animals are potential sources of transmission to humans. Escherichia coli is used as an ABR indicator organism due to its widespread environmental presence and colonisation in both the human and animal gastrointestinal tract. Ethics and dissemination: The study has been approved by the Institutional Review Board of the International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b) and Loughborough University Ethics Committee. Data for the project will be stored on the open access repository of the Centre for Ecology and Hydrology, Natural Environment Research Council. The results of this study will be published in peer-reviewed journals and presented at national and international conferences. STRENGTHS AND LIMITATIONS OF THIS STUDY • We present a study protocol focused on integrated surveillance of ABR in urban and rural Bangladesh using a One Health approach • Assessment of the human, poultry and environmental prevalence of antibiotic resistant E. coli will identify potential hotspots for transmission in Bangladesh • Seasonal and spatial variation on the occurrence of antibiotic resistant bacteria in humans, poultry and the wider environment will be assessed • The two regions included in the study may not be typical of all regions within Banglades

Data_Sheet_1_International collaborative research, systems leadership and education: reflections from academic biomedical researchers in Africa.docx

ScopeAcademic biomedical researchers and educators in African countries navigate complex local, national, and international systems to conduct grant-funded research. To secure funding, collaboration with researchers from high-income countries is often necessary. Existing literature highlights that these global health initiatives are commonly fraught with unequal power dynamics and lead by the foreign partners. Despite these inequalities, African faculty can benefit from these collaborations, fostering the development of their labs and careers. This study delves into reflections on lived experiences from academic biomedical researchers in Africa to better understand the impact of foreign collaborations.MethodsWe designed a qualitative study using the Interpretative Phenomenological Analysis (IPA) method and used Self-determination and Complex Systems Leadership theories to frame this study. Ten academic biomedical researchers in Africa consented to join this study. The participants submitted a four-week series of reflective journals through an online data management platform. Subsequently, IPA methods were employed to analyze the collected journals.ResultsParticipants’ reflections yielded six thematic key findings, encompassing their experiences in international collaborative research. The findings included: foreign dominance within the international macrosystem; resource challenges in their local microsystems; mesosystem dependency from collaborations; scholarly identity within research relationships; collaborative leadership; and the impact of the foreign perspective. From these findings, three implications were drawn suggesting that participants were (1) motivated by scholarly identity found in collaborations; (2) depended on collaborations that were colonialist but beneficial; and (3) created change through leadership at the microsystem level.ImplicationsForeign collaborators and funders in global health education and research should critically consider how implications of this study relate to their collaborative work. Based on our analysis, recommendations for foreign collaborators and funders include prioritizing local leadership and perspectives in education initiatives and research grants; reviewing and leveraging collective leadership; engaging in bidirectional training, and mentoring opportunities; participating in power assessments; and removing publication barriers for researchers in Africa (and low-and middle-income countries). Insights from this study could impact global health research and education in multiple ways including new initiatives in mentorship and training in international collaborations along with increased awareness and correction of colonialism within these collaborations.</p

Spatial and temporal variation in the community prevalence of antibiotic resistance in Bangladesh: an integrated surveillance study protocol

Introduction: Increasing antibiotic resistance (ABR) in low and middle-income countries such as Bangladesh presents a major health threat. However, assessing the scale of the health risk is problematic in the absence of reliable data on the community prevalence of antibiotic-resistant bacteria. We describe the protocol for a small-scale integrated surveillance programme that aims to quantify the prevalence of colonisation with antibiotic resistant bacteria and concentrations of antibiotic resistant genes from a ‘One Health’ perspective. The holistic assessment of antibiotic resistance in humans, animals and within the environment in urban and rural Bangladesh will generate comprehensive data to inform human health risk. Methods and analysis: The study design focuses on three exposure-relevant sites where there is enhanced potential for transmission of ABR between humans, animals and the environment: i) rural poultry-owning households, ii) commercial poultry farms and iii) urban live-bird markets. The comparison of ABR prevalence in human groups with high and low exposure to farming and poultry will enable us to test the hypothesis that ABR bacteria and genes from the environment and foodproducing animals are potential sources of transmission to humans. Escherichia coli is used as an ABR indicator organism due to its widespread environmental presence and colonisation in both the human and animal gastrointestinal tract. Ethics and dissemination: The study has been approved by the Institutional Review Board of the International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b) and Loughborough University Ethics Committee. Data for the project will be stored on the open access repository of the Centre for Ecology and Hydrology, Natural Environment Research Council. The results of this study will be published in peer-reviewed journals and presented at national and international conferences. STRENGTHS AND LIMITATIONS OF THIS STUDY • We present a study protocol focused on integrated surveillance of ABR in urban and rural Bangladesh using a One Health approach • Assessment of the human, poultry and environmental prevalence of antibiotic resistant E. coli will identify potential hotspots for transmission in Bangladesh • Seasonal and spatial variation on the occurrence of antibiotic resistant bacteria in humans, poultry and the wider environment will be assessed • The two regions included in the study may not be typical of all regions within Banglades

Predictors of Optimal Antenatal Care Service Utilization Among Adolescents and Adult Women in Bangladesh

Introduction: Utilization of recommended antenatal care (ANC) throughout the pregnancy period is a proven healthy behavior in reducing maternal mortalities and morbidities. The objective of this study is to identify the demand side factors that are associated with the recommended utilization of ANC services among adolescents and adult women in Bangladesh. Method: This study utilized cross-sectional data from latest Bangladesh Demographic and Health Survey 2014. Data of a total of 4626 adolescents and adult women were analyzed. Bivariate and multivariate analyses were performed for identifying the significant determining factors associated with the ANC services utilization. Results: Approximately, 32% adult and 30% adolescent women utilized the recommended ANC care. The higher educated adolescents and adult women were 8.08 times ( P < .001) and 2.98 times ( P < .001) more likely to receive 4 or more ANC, respectively, compared to uneducated women. The richest quintile showed higher tendency to utilize optimum ANC services and had 2.70 times ( P < .05) and 6.51 times ( P < .001) more likelihood to receive optimal ANC services for adolescent and adult groups, respectively, compared to poorest quintile. Conclusion: Other than education and income, several other factors including mass -media, place of residence, working status, and geographical variations were significantly associated with recommended ANC. These findings might help health-care programmers and policy makers for initiating appropriate policy and programs for ensuring optimal ANC coverage for all. Ensuring adequate ANC regardless of economic status and residence of pregnant women could guarantee universal maternal health-care coverage as devoted to a national strategic guideline

Human exposure to antimicrobial resistance from poultry production: assessing hygiene and waste-disposal practices in Bangladesh

The unregulated use of antibiotics is linked with intensive poultry farming in developing economies. In low-and middle-income countries, the dissemination of antimicrobial resistance (AMR) has also been attributed to contamination, poor public health infrastructure and inadequate waste disposal practices. There are limited data on hygiene and waste disposal practices in small-scale commercial and household poultry farming and market sales in Bangladesh. Our objective was to explore human exposures, hygiene and waste disposal practices in poultry raising and processing to identify probable pathways for transmission of AMR bacteria. We employed mixed methods approaches of in-depth interviews and structured observations to assess exposures, hygiene behaviours and waste-disposal practices relating to poultry production in Bangladesh. Interviews (n=18) were conducted with commercial poultry farmers, backyard poultry owners, and live poultry market workers. Structured observations were conducted for six-hours in five households, five commercial farms and five urban live bird markets to assess the frequency of transmission/ exposure events in these settings. Interviews highlighted existing practices that can contribute to transmission of antimicrobial resistant bacteria from poultry to humans. In households and farms, untreated poultry waste and carcasses were disposed of on agricultural fields and in water bodies which may contaminate surface water and soil with poultry faeces. Biosecurity precautions were not used, and hands were rarely washed with soap after handling poultry. In urban markets, live poultry slaughter and processing was done on site with bare hands which were subsequently rinsed in water stored in containers without soap. Solid waste from poultry processing was disposed into municipal waste disposal stations and liquid waste was discarded into open drains. Structured observations revealed that workers in live poultry markets had the highest direct contact with poultry and poultry waste, almost tenfold higher than those working in poultry farms or with domestic poultry (59 vs 544 observed direct poultry exposure events) placing them at particularly high risk of exposure to faecal bacteria. Biosecurity measures were limited; in some cases, workers in commercial farms and urban markets had gloves and masks but often did not use them. In 88% (606/689) of exposure events no handwashing took place. Eating and drinking after handling poultry and without washing hands was observed in all three settings. These data suggest effective intervention strategies to reduce environmental contamination and to decrease risks of transmission should be prioritized. Data on prevalence of risk behaviours and AMR transmission to humans along environmental pathways can inform policy and intervention strategies

Prevalence of MDR community-acquired UTI among patients according to different age and sex groups.

Prevalence of MDR community-acquired UTI among patients according to different age and sex groups.</p

Distribution of the prevalence of major pathogens causing CA-UTI among patients by age and sex.

Distribution of the prevalence of major pathogens causing CA-UTI among patients by age and sex.</p

Prevalence of major bacterial pathogens causing community-acquired UTI among patients from 2016 to 2018.

Prevalence of major bacterial pathogens causing community-acquired UTI among patients from 2016 to 2018.</p