Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda.

Autor:	Sado K; University of St Andrews, St Andrews, United Kingdom., Keenan K; University of St Andrews, St Andrews, United Kingdom., Manataki A; University of St Andrews, St Andrews, United Kingdom., Kesby M; University of St Andrews, St Andrews, United Kingdom., Mushi MF; Catholic University of Health and Allied Sciences, Mwanza, Tanzania., Mshana SE; Catholic University of Health and Allied Sciences, Mwanza, Tanzania., Mwanga JR; Catholic University of Health and Allied Sciences, Mwanza, Tanzania., Neema S; Makerere University, Kampala, Uganda., Asiimwe B; Makerere University, Kampala, Uganda., Bazira J; Mbarara University of Science and Technology, Mbarara, Uganda., Kiiru J; Kenya Medical Research Institute, Nairobi, Kenya., Green DL; University of St Andrews, St Andrews, United Kingdom., Ke X; University of St Andrews, St Andrews, United Kingdom., Maldonado-Barragán A; University of St Andrews, St Andrews, United Kingdom., Abed Al Ahad M; University of St Andrews, St Andrews, United Kingdom., Fredricks KJ; University of St Andrews, St Andrews, United Kingdom., Gillespie SH; University of St Andrews, St Andrews, United Kingdom., Sabiiti W; University of St Andrews, St Andrews, United Kingdom., Mmbaga BT; Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.; Kilimanjaro Christian Medical University College, Moshi, Tanzania., Kibiki G; Africa Excellence Research Fund, London, United Kingdom., Aanensen D; Oxford Big Data Institute, Oxford, United Kingdom., Smith VA; University of St Andrews, St Andrews, United Kingdom., Sandeman A; University of St Andrews, St Andrews, United Kingdom., Sloan DJ; University of St Andrews, St Andrews, United Kingdom., Holden MTG; University of St Andrews, St Andrews, United Kingdom.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Feb 16; Vol. 4 (2), pp. e0002709. Date of Electronic Publication: 2024 Feb 16 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0002709
Abstrakt:	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. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2024 Sado et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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