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dc.contributor.authorHATUA Consortium
dc.contributor.authorKeenan, Katherine
dc.contributor.authorFredricks, Kathryn J
dc.contributor.authorAl Ahad, Mary Abed
dc.contributor.authorNeema, Stella
dc.contributor.authorMwanga, Joseph R
dc.contributor.authorKesby, Mike
dc.contributor.authorMushi, Martha F
dc.contributor.authorAduda, Annette
dc.contributor.authorGreen, Dominique L
dc.contributor.authorLynch, Andy G
dc.contributor.authorHuque, Sarah I
dc.contributor.authorMmbaga, Blandina T
dc.contributor.authorWorthington, Hannah
dc.contributor.authorKansiime, Catherine
dc.contributor.authorOlamijuwon, Emmanuel
dc.contributor.authorNtinginya, Nyanda E
dc.contributor.authorLoza, Olga
dc.contributor.authorBazira, Joel
dc.contributor.authorMaldonado-Barragán, Antonio
dc.contributor.authorSmith, VAnne
dc.contributor.authorDecano, Arun Gonzales
dc.contributor.authorNjeru, John Mwaniki
dc.contributor.authorSandeman, Alison
dc.contributor.authorStelling, John
dc.contributor.authorElliott, Alison
dc.contributor.authorAanensen, David
dc.contributor.authorGillespie, Stephen H
dc.contributor.authorKibiki, Gibson
dc.contributor.authorSabiiti, Wilber
dc.contributor.authorSloan, Derek J
dc.contributor.authorAsiimwe, Benon B
dc.contributor.authorKiiru, John
dc.contributor.authorMshana, Stephen E
dc.contributor.authorHolden, Matthew T G
dc.identifier.citationHATUA Consortium , Keenan , K , Fredricks , K J , Al Ahad , M A , Neema , S , Mwanga , J R , Kesby , M , Mushi , M F , Aduda , A , Green , D L , Lynch , A G , Huque , S I , Mmbaga , B T , Worthington , H , Kansiime , C , Olamijuwon , E , Ntinginya , N E , Loza , O , Bazira , J , Maldonado-Barragán , A , Smith , VA , Decano , A G , Njeru , J M , Sandeman , A , Stelling , J , Elliott , A , Aanensen , D , Gillespie , S H , Kibiki , G , Sabiiti , W , Sloan , D J , Asiimwe , B B , Kiiru , J , Mshana , S E & Holden , M T G 2023 , ' Unravelling patient pathways in the context of antibacterial resistance in East Africa ' , BMC Infectious Diseases , vol. 23 , no. 1 , 414 . ,
dc.identifier.otherPubMedCentral: PMC10278291
dc.identifier.otherORCID: /0000-0001-5452-3032/work/137914853
dc.identifier.otherORCID: /0000-0001-7789-870X/work/137914858
dc.identifier.otherORCID: /0000-0002-6109-8131/work/137914882
dc.identifier.otherORCID: /0000-0002-2529-6966/work/137915058
dc.identifier.otherORCID: /0000-0001-6537-7712/work/137915087
dc.identifier.otherORCID: /0000-0002-7876-7338/work/137915294
dc.identifier.otherORCID: /0000-0002-7888-5449/work/137915425
dc.identifier.otherORCID: /0000-0002-9670-1607/work/137915447
dc.identifier.otherORCID: /0000-0002-4958-2166/work/137915491
dc.identifier.otherORCID: /0000-0002-4742-2791/work/137915511
dc.identifier.otherORCID: /0000-0002-9006-730X/work/137915518
dc.identifier.otherORCID: /0009-0005-4229-8129/work/151190563
dc.descriptionFunding: The Holistic Approach to Unravel Antibacterial Resistance in East Africa is a Global Context Consortia Award (MR/S004785/1) funded by the National Institute for Health Research, Medical Research Council, and the Department of Health and Social Care. The award is also part of the EDCTP2 programme supported by the European Union. This work is supported in part by the Makerere University-Uganda Virus Research Institute Centre of Excellence for Infection and Immunity Research and Training (MUII). MUII is supported through the DELTAS Africa Initiative (grant number 107743). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences and Alliance for Accelerating Excellence in Science in Africa and is supported by the New Partnership for Africa’s Development Planning and Coordinating Agency with funding from the Wellcome Trust (grant number 107743) and the UK Government. This paper was funded in part by a grant from the National Institutes of Health (grant number U01CA207167), and a Scottish Funding Council GCRF Consolidator Award.en
dc.description.abstractBACKGROUND A key factor driving the development and maintenance of antibacterial resistance (ABR) is individuals' use of antibiotics (ABs) to treat illness. To better understand motivations and context for antibiotic use we use the concept of a patient treatment-seeking pathway: a treatment journey encompassing where patients go when they are unwell, what motivates their choices, and how they obtain antibiotics. This paper investigates patterns and determinants of patient treatment-seeking pathways, and how they intersect with AB use in East Africa, a region where ABR-attributable deaths are exceptionally high. METHODS The Holistic Approach to Unravelling Antibacterial Resistance (HATUA) Consortium collected quantitative data from 6,827 adult outpatients presenting with urinary tract infection (UTI) symptoms in Kenya, Tanzania, and Uganda between February 2019- September 2020, and conducted qualitative in-depth patient interviews with a subset (n = 116). We described patterns of treatment-seeking visually using Sankey plots and explored explanations and motivations using mixed-methods. Using Bayesian hierarchical regression modelling, we investigated the associations between socio-demographic, economic, healthcare, and attitudinal factors and three factors related to ABR: self-treatment as a first step, having a multi-step treatment pathway, and consuming ABs. RESULTS Although most patients (86%) sought help from medical facilities in the first instance, many (56%) described multi-step, repetitive treatment-seeking pathways, which further increased the likelihood of consuming ABs. Higher socio-economic status patients were more likely to consume ABs and have multi-step pathways. Reasons for choosing providers (e.g., cost, location, time) were conditioned by wider structural factors such as hybrid healthcare systems and AB availability. CONCLUSION There is likely to be a reinforcing cycle between complex, repetitive treatment pathways, AB consumption and ABR. A focus on individual antibiotic use as the key intervention point in this cycle ignores the contextual challenges patients face when treatment seeking, which include inadequate access to diagnostics, perceived inefficient public healthcare and ease of purchasing antibiotics without prescription. Pluralistic healthcare landscapes may promote more complex treatment seeking and therefore inappropriate AB use. We recommend further attention to healthcare system factors, focussing on medical facilities (e.g., accessible diagnostics, patient-doctor interactions, information flows), and community AB access points (e.g., drug sellers).
dc.relation.ispartofBMC Infectious Diseasesen
dc.subjectQualitative Researchen
dc.subjectBayes Theoremen
dc.subjectDelivery of Health Careen
dc.subjectAnti-Bacterial Agents/pharmacologyen
dc.subjectRM Therapeutics. Pharmacologyen
dc.subjectGN Anthropologyen
dc.titleUnravelling patient pathways in the context of antibacterial resistance in East Africaen
dc.typeJournal articleen
dc.contributor.sponsorMedical Research Councilen
dc.contributor.sponsorScottish Funding Councilen
dc.contributor.institutionUniversity of St Andrews. School of Geography & Sustainable Developmenten
dc.contributor.institutionUniversity of St Andrews. Population and Health Researchen
dc.contributor.institutionUniversity of St Andrews. Geographies of Sustainability, Society, Inequalities and Possibilitiesen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.contributor.institutionUniversity of St Andrews. Statisticsen
dc.contributor.institutionUniversity of St Andrews. Sir James Mackenzie Institute for Early Diagnosisen
dc.contributor.institutionUniversity of St Andrews. St Andrews Bioinformatics Uniten
dc.contributor.institutionUniversity of St Andrews. Cellular Medicine Divisionen
dc.contributor.institutionUniversity of St Andrews. Centre for Research into Ecological & Environmental Modellingen
dc.contributor.institutionUniversity of St Andrews. Centre for Biophotonicsen
dc.contributor.institutionUniversity of St Andrews. Biomedical Sciences Research Complexen
dc.contributor.institutionUniversity of St Andrews. Infection and Global Health Divisionen
dc.contributor.institutionUniversity of St Andrews. Global Health Implementation Groupen
dc.description.statusPeer revieweden

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