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Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance : a study of urinary tract infection patients in Kenya, Tanzania and Uganda
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dc.contributor.author | Sado, Keina | |
dc.contributor.author | Keenan, Katherine | |
dc.contributor.author | Manataki, Areti | |
dc.contributor.author | Kesby, Mike | |
dc.contributor.author | Mushi, Martha F. | |
dc.contributor.author | Mshana, Stephen E. | |
dc.contributor.author | Mwanga, Joseph R. | |
dc.contributor.author | Neema, Stella | |
dc.contributor.author | Asiimwe, Benon | |
dc.contributor.author | Bazira, Joel | |
dc.contributor.author | Kiiru, John | |
dc.contributor.author | Green, Dominique L. | |
dc.contributor.author | Ke, Xuejia | |
dc.contributor.author | Maldonado-Barragán, Antonio | |
dc.contributor.author | Abed Al Ahad, Mary | |
dc.contributor.author | Fredricks, Kathryn J. | |
dc.contributor.author | Gillespie, Stephen H. | |
dc.contributor.author | Sabiiti, Wilber | |
dc.contributor.author | Mmbaga, Blandina T. | |
dc.contributor.author | Kibiki, Gibson | |
dc.contributor.author | Aanensen, David | |
dc.contributor.author | Smith, V. Anne | |
dc.contributor.author | Sandeman, Alison | |
dc.contributor.author | Sloan, Derek J. | |
dc.contributor.author | Holden, Matthew T. G. | |
dc.contributor.author | Consortium, on behalf of HATUA | |
dc.date.accessioned | 2024-02-20T11:30:15Z | |
dc.date.available | 2024-02-20T11:30:15Z | |
dc.date.issued | 2024-02-16 | |
dc.identifier | 299422686 | |
dc.identifier | 9259cf45-9462-4e68-856f-ac089db0ef78 | |
dc.identifier | 85195791624 | |
dc.identifier.citation | Sado , K , Keenan , K , Manataki , A , Kesby , M , Mushi , M F , Mshana , S E , Mwanga , J R , Neema , S , Asiimwe , B , Bazira , J , Kiiru , J , Green , D L , Ke , X , Maldonado-Barragán , A , Abed Al Ahad , M , Fredricks , K J , Gillespie , S H , Sabiiti , W , Mmbaga , B T , Kibiki , G , Aanensen , D , Smith , V A , Sandeman , A , Sloan , D J , Holden , M T G & Consortium , O B O HATUA 2024 , ' Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance : a study of urinary tract infection patients in Kenya, Tanzania and Uganda ' , PLOS Global Public Health , vol. 4 , no. 2 , e0002709 . https://doi.org/10.1371/journal.pgph.0002709 | en |
dc.identifier.issn | 2767-3375 | |
dc.identifier.other | RIS: urn:05FA8D4543BEC4F0FCABB1E9210A1EF9 | |
dc.identifier.other | ORCID: /0009-0005-4229-8129/work/153976973 | |
dc.identifier.other | ORCID: /0000-0001-7789-870X/work/153977061 | |
dc.identifier.other | ORCID: /0000-0002-2529-6966/work/153977229 | |
dc.identifier.other | ORCID: /0000-0003-3698-8535/work/153977278 | |
dc.identifier.other | ORCID: /0000-0001-6537-7712/work/153977382 | |
dc.identifier.other | ORCID: /0000-0002-0487-2469/work/153977470 | |
dc.identifier.other | ORCID: /0000-0002-7888-5449/work/153977500 | |
dc.identifier.other | ORCID: /0000-0002-9670-1607/work/153977519 | |
dc.identifier.other | ORCID: /0000-0002-4742-2791/work/153977562 | |
dc.identifier.other | ORCID: /0000-0002-4958-2166/work/153977602 | |
dc.identifier.other | ORCID: /0000-0002-9006-730X/work/153977630 | |
dc.identifier.uri | https://hdl.handle.net/10023/29301 | |
dc.description | Funding: 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 (KK, MK, SEM, JM, SN, BA, JK, SM, WS, BTM, GK, DA, SHG, VAS, DJS, MTGH). 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)(BA). 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 (BA, AE), and a A Scottish Funding Council GCRF Consolidator Award (KK, WS, MK, DJS, MTGH). | en |
dc.description.abstract | Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviour, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Using data from 6,388 patients, we analysed patterns of self-reported treatment seeking behaviours (‘patient pathways’) using process mining and single-channel sequence analysis. Among those with microbiologically confirmed UTI (n = 1,946), we used logistic regression to assess the relationship between treatment seeking behaviour, AB use, and the likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathway for UTI-like symptoms in this sample involved attending health facilities, rather than other providers like drug sellers. Patients from sites in Tanzania and Uganda, where over 50% of patients had an MDR UTI, were more likely to report treatment failures, and have repeat visits to providers than those from Kenyan sites, where MDR UTI proportions were lower (33%). There was no strong or consistent relationship between individual AB use and likelihood of MDR UTI, after accounting for country context. The results highlight the hurdles East African patients face in accessing effective UTI care. These challenges are exacerbated by high rates of MDR UTI, suggesting a vicious cycle of failed treatment attempts and sustained selection for drug resistance. Whilst individual AB use may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of variations in ABR. | |
dc.format.extent | 20 | |
dc.format.extent | 2366768 | |
dc.language.iso | eng | |
dc.relation.ispartof | PLOS Global Public Health | en |
dc.subject | QR Microbiology | en |
dc.subject | Critical Care and Intensive Care Medicine | en |
dc.subject | Public Health, Environmental and Occupational Health | en |
dc.subject | DAS | en |
dc.subject | SDG 3 - Good Health and Well-being | en |
dc.subject | MCC | en |
dc.subject.lcc | QR | en |
dc.title | Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance : a study of urinary tract infection patients in Kenya, Tanzania and Uganda | en |
dc.type | Journal article | en |
dc.contributor.sponsor | Medical Research Council | en |
dc.contributor.sponsor | Scottish Funding Council | en |
dc.contributor.institution | University of St Andrews. School of Geography & Sustainable Development | en |
dc.contributor.institution | University of St Andrews. School of Computer Science | en |
dc.contributor.institution | University of St Andrews. Geographies of Sustainability, Society, Inequalities and Possibilities | en |
dc.contributor.institution | University of St Andrews. School of Biology | en |
dc.contributor.institution | University of St Andrews. School of Medicine | en |
dc.contributor.institution | University of St Andrews. Population and Health Research | en |
dc.contributor.institution | University of St Andrews. Sir James Mackenzie Institute for Early Diagnosis | en |
dc.contributor.institution | University of St Andrews. Centre for Biophotonics | en |
dc.contributor.institution | University of St Andrews. Biomedical Sciences Research Complex | en |
dc.contributor.institution | University of St Andrews. Infection and Global Health Division | en |
dc.contributor.institution | University of St Andrews. Global Health Implementation Group | en |
dc.contributor.institution | University of St Andrews. St Andrews Centre for Exoplanet Science | en |
dc.contributor.institution | University of St Andrews. Centre for Biological Diversity | en |
dc.contributor.institution | University of St Andrews. Centre for Higher Education Research | en |
dc.contributor.institution | University of St Andrews. Institute of Behavioural and Neural Sciences | en |
dc.contributor.institution | University of St Andrews. St Andrews Bioinformatics Unit | en |
dc.contributor.institution | University of St Andrews. Office of the Principal | en |
dc.identifier.doi | 10.1371/journal.pgph.0002709 | |
dc.description.status | Peer reviewed | en |
dc.identifier.grantnumber | MR/S004785/1 | en |
dc.identifier.grantnumber | en |
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