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Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya

Article scientifique 2025 Anglais

Résumé

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.

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Ercümen, A., Mertens, A., Butzin-Dozier, Z., Jung, D., Ali, S., Achando, B., Rao, G., Hemlock, C., Pickering, A., Stewart, C., Tan, S., Grembi, J., Benjamin‐Chung, J., Wolfe, M., Ho, G., Rahman, M., Arnold, C., Dentz, H., Njenga, S., Meerkerk, T., Chen, B., Nadimpalli, M., Islam, M., Hubbard, A., Null, C., UNICOMB, L., Rahman, M., Colford, J., Luby, S., Arnold, B., Lin, A. (2025). Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya. https://doi.org/10.1038/s41467-024-55801-x

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Auteur(s)

Ayşe Ercümen Andrew 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 Anne Grembi Jade Benjamin‐Chung Marlene K. Wolfe Gene G. Ho Md Ziaur Rahman Charles D. Arnold Holly N. Dentz Sammy M. Njenga Theodora Meerkerk Belinda C. Chen Maya L. Nadimpalli Mohammad Aminul Islam Alan Hubbard Clair Null LEANNE E. UNICOMB Mahbubur Rahman John M. Colford Stephen P. Luby Benjamin F. Arnold Audrie Lin

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