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1. Unravelling patient pathways in the context of antibacterial resistance in East Africa

Author

Keenan, Katherine, Fredricks, Kathryn J., Al Ahad, Mary Abed, Neema, Stella, Mwanga, Joseph R., Kesby, Mike, Mushi, Martha F., Aduda, Annette, Green, Dominique L., Lynch, Andy G., Huque, Sarah I., Mmbaga, Blandina T., Worthington, Hannah, Kansiime, Catherine, Olamijuwon, Emmanuel, Ntinginya, Nyanda E., Loza, Olga, Bazira, Joel, Maldonado-Barragán, Antonio, Smith, VAnne, Decano, Arun Gonzales, Njeru, John Mwaniki, Sandeman, Alison, Stelling, John, Elliott, Alison, Aanensen, David, Gillespie, Stephen H., Kibiki, Gibson, Sabiiti, Wilber, Sloan, Derek J., Asiimwe, Benon B., Kiiru, John, Mshana, Stephen E., and Holden, Matthew T. G.

Published
2023
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2. The role of multidimensional poverty in antibiotic misuse: a mixed-methods study of self-medication and non-adherence in Kenya, Tanzania, and Uganda

Author

Green, Dominique L, Keenan, Katherine, Fredricks, Kathryn J, Huque, Sarah I, Mushi, Martha F, Kansiime, Catherine, Asiimwe, Benon, Kiiru, John, Mshana, Stephen E, Neema, Stella, Mwanga, Joseph R, Kesby, Mike, Lynch, Andy G, Worthington, Hannah, Olamijuwon, Emmanuel, Abed Al Ahad, Mary, Aduda, Annette, Njeru, John Mwaniki, Mmbaga, Blandina T, Bazira, Joel, Sandeman, Alison, Stelling, John, Gillespie, Stephen H, Kibiki, Gibson, Sabiiti, Wilber, Sloan, Derek J, Holden, Matthew T G, Smith, V Anne, Decano, Arun Gonzales, Maldonado-Barragán, Antonio, Aanensen, David, Ntinginya, Nyanda E, Elliott, Alison, and Clarkson, Madeleine

Published
2023
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3. Evidencing the Intersection of Environmental, Socioeconomic, Behavioural and Demographic Drivers of Antibacterial Resistance in East Africa

Author

Keenan, Katherine, primary, Papathomas, Michail, additional, Mshana, Stephen E., additional, Asiimwe, Benon, additional, Kiiru, John, additional, Lynch, Andy G., additional, Kesby, Mike, additional, Neema, Stella, additional, Mwanga, Joseph R., additional, Mushi, Martha F., additional, Green, Dominique L., additional, Jing, Wei, additional, Olamijuwon, Emmanuel, additional, Zhang, Qing, additional, Sippy, Rachel, additional, Fredricks, Kathryn J., additional, Gillespie, Stephen Henry, additional, Sabiti, Wilber, additional, Bazira, Joel, additional, Sloan, Derek J., additional, Mmbaga, Blandina T., additional, Kibiki, Gibson, additional, Stelling, John, additional, Smith, V. Anne, additional, Sandeman, Alison, additional, Holden, Matthew T. G., additional, and Consortium, HATUA, additional

Published
2024
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4. Predominance of multidrug-resistant bacteria causing urinary tract infections among symptomatic patients in East Africa: a call for action

Author

Maldonado-Barragán, Antonio, primary, Mshana, Stephen E, additional, Keenan, Katherine, additional, Ke, Xuejia, additional, Gillespie, Stephen H, additional, Stelling, John, additional, Maina, John, additional, Bazira, Joel, additional, Muhwezi, Ivan, additional, Mushi, Martha F, additional, Green, Dominique L, additional, Kesby, Mike, additional, Lynch, Andy G, additional, Sabiiti, Wilber, additional, Sloan, Derek J, additional, Sandeman, Alison, additional, Kiiru, John, additional, Asiimwe, Benon, additional, and Holden, Matthew T G, additional

Published
2023
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5. Predominance of multidrug-resistant bacteria causing urinary tract infections among symptomatic patients in East Africa: a call for action.

Author

Maldonado-Barragán, Antonio, Mshana, Stephen E, Keenan, Katherine, Ke, Xuejia, Gillespie, Stephen H, Stelling, John, Maina, John, Bazira, Joel, Muhwezi, Ivan, Mushi, Martha F, Green, Dominique L, Kesby, Mike, Lynch, Andy G, Sabiiti, Wilber, Sloan, Derek J, Sandeman, Alison, Kiiru, John, Asiimwe, Benon, and Holden, Matthew T G

Published
2024
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6. Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda

Author

Sado, Keina, primary, Keenan, Katherine, additional, Manataki, Areti, additional, Kesby, Mike, additional, Mushi, Martha, additional, Mshana, Stephen, additional, Mwanga, Joseph, additional, Neema, Stella, additional, Asiimwe, Benon, additional, Bazira, Joel, additional, Kiiru, John, additional, Green, Dominique L, additional, Maldonado-Barragán, Antonio, additional, Abed Al Ahad, Mary, additional, Fredricks, Kathryn, additional, Gillespie, Stephen H, additional, Sabiiti, Wilber, additional, Mmbaga, Blandina T, additional, Kibiki, Gibson, additional, Aanensen, David, additional, Smith, V Anne, additional, Sandeman, Alison, additional, Sloan, Derek J, additional, and Holden, Matthew TG, additional

Published
2023
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7. Unravelling patient pathways in the context of antibacterial resistance in East Africa

Author

Keenan, Katherine, primary, Fredricks, Kathryn J., additional, Ahad, Mary Abed Al, additional, Neema, Stella, additional, Mwanga, Joseph R., additional, Kesby, Mike, additional, Mushi, Martha F., additional, Aduda, Annette, additional, Green, Dominique L., additional, Lynch, Andy G., additional, Huque, Sarah I., additional, Mmbaga, Blandina T., additional, Worthington, Hannah, additional, Kansiime, Catherine, additional, Olamijuwon, Emmanuel, additional, Ntinginya, Nyanda E., additional, Loza, Olga, additional, Bazira, Joel, additional, Maldonado-Barragán, Antonio, additional, Smith, V Anne, additional, Decano, Arun Gonzales, additional, Mwaniki, John Njeru, additional, Sandeman, Alison, additional, Stelling, John, additional, Elliott, Alison, additional, Aanensen, David, additional, Gillespie, Stephen H., additional, Kibiki, Gibson, additional, Sabiiti, Wilber, additional, Sloan, Derek J., additional, Asiimwe, Benon B., additional, Kiiru, John, additional, Mshana, Stephen E., additional, Holden, Matthew T. G., additional, and Consortium, HATUA, additional

Published
2022
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8. The Role of Multidimensional Poverty in Antibiotic Misuse: A Study of Self-Medication and Non-Adherence in Kenya, Tanzania, and Uganda

Author

Green, Dominique L., primary, Keenan, Katherine, additional, Huque, Sarah I., additional, Kesby, Mike, additional, Mushi, Martha F., additional, Kansiime, Catherine, additional, Asiimwe, Benon, additional, Kiiru, John, additional, Mshana, Stephen E., additional, Neema, Stella, additional, Mwanga, Joseph R., additional, Fredricks, Kathryn J., additional, Lynch, Andy G., additional, Worthington, Hannah, additional, Olamijuwon, Emmanuel, additional, Ahad, Mary Abed Al, additional, Aduda, Annette, additional, Mmbaga, Blandina T., additional, Bazira, Joel, additional, Sandeman, Alison, additional, Stelling, John, additional, Gillespie, Stephen Henry, additional, Kibiki, Gibson, additional, Sabiti, Wilber, additional, Sloan, Derek J., additional, Holden, Matthew T. G., additional, and Consortium, HATUA, additional

Published
2021
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9. Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda.

Author

Sado K, Keenan K, Manataki A, Kesby M, Mushi MF, Mshana SE, Mwanga JR, Neema S, Asiimwe B, Bazira J, Kiiru J, Green DL, Ke X, Maldonado-Barragán A, Abed Al Ahad M, Fredricks KJ, Gillespie SH, Sabiiti W, Mmbaga BT, Kibiki G, Aanensen D, Smith VA, Sandeman A, Sloan DJ, and Holden MTG

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., 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.)

Published
2024
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10. Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda.

Author

Sado K, Keenan K, Manataki A, Kesby M, Mushi MF, Mshana SE, Mwanga J, Neema S, Asiimwe B, Bazira J, Kiiru J, Green DL, Ke X, Maldonado-Barragán A, Abed Al Ahad M, Fredricks K, Gillespie SH, Sabiiti W, Mmbaga BT, Kibiki G, Aanensen D, Smith VA, Sandeman A, Sloan DJ, and Holden MT

Abstract

Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviours, 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 6,827 adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Among 6,388 patients we analysed patterns of self-reported treatment seeking behaviours ('patient pathways') using process mining and single-channel sequence analysis. Of those with microbiologically confirmed UTI (n=1,946), we used logistic regression to assessed the relationship between treatment seeking behaviour, AB use, and likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathways for UTI-like symptoms included attending health facilities, rather than other providers (e.g. drug sellers). Patients from the sites sampled in Tanzania and Uganda, where prevalence of MDR UTI was over 50%, were more likely to report treatment failures, and have repeated visits to clinics/other providers, than those from Kenyan sites, where MDR UTI rates were lower (33%). There was no strong or consistent relationship between individual AB use and risk of MDR UTI, after accounting for country context. The results highlight challenges East African patients face in accessing effective UTI treatment. These challenges increase where rates of MDR UTI are higher, suggesting a reinforcing circle of failed treatment attempts and sustained selection for drug resistance. Whilst individual behaviours may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of ABR., Competing Interests: Conflict of Interest None

Published
2023
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