The challenge

Antimicrobial resistance (AMR) is a global public health threat and has a disproportionate impact in low and middle-income countries due to their higher burden of infections. Although water sanitation & hygiene (WASH) behaviours are key strategies for reducing the incidence of infections in the AMR Global Action Plan, their application at community level is overlooked by most policies. Also, WASH strategies primarily focus on interrupting faecal-oral transmission and controlling intestinal infectious diseases.

During the COVID-19 period, numerous sanitation and hygiene policies were introduced at community level by authorities across the world. This highlights WASH’s new role in controlling respiratory tract infections and suggests its implementation for AMR, as improved WASH should reduce transmission of infections and thereby reduce antibiotic use. At the same time, extensive use of chemical measures may have other adverse consequences for health and environment, including development of AMR.

What we're doing

We are conducting a scoping review of policy and literature focusing on China and India. Both countries experienced massive changes in infection control (e.g. use of chemical measures and encouraging hygiene behaviours) due to the pandemic.

We want to understand how sanitation and hygiene policies and practices have evolved and challenges to good sanitation and hygiene from social sciences and environmental/engineering perspectives. Additionally, we aim to find evidence on influences of new sanitation and hygiene on AMR.

How it helps

This project will help us understand how good sanitation and hygiene policy and practices, at the community level, can have implications for antimicrobial resistance.

Investigators

• Dr Tingting Zhang, Bristol Medical School
• Dr Christie Cabral, Bristol Medical School
• Professor Helen Lambert, Bristol Medical School
• Dr Anisha Nijhawan, School of Civil, Aerospace and Design Engineering