Understanding W.A.S.H. practices

Exposures associated with water, sanitation, and hygiene (WASH) are integral to enteric bacteria and antibiotic resistance transmission. Our study will examine the links between environmental antibiotic resistance and WASH at a community level to inform the transmission model and future interventions.

WASH practices contribute to antibiotic resistance

Antibiotic resistance elements have been found in water, faeces, and wastewater in low-income countries. This is compounded by:

• A lack of faeces management (e.g. open defaecation, lack of access to faecal sludge management)
• Multiple uses of water (e.g. washing, irrigation, animal management, and drinking), and
• Poor hygiene practices (e.g. no effective hand washing at critical times, poor food hygiene practices).

These factors contribute to community borne antibiotic resistance transmission and must be considered across multiple exposure pathways both within households and the wider community within institutional and communal settings.

Exploring WASH drivers of antibiotic resistance at a community level

Using both qualitative and quantitative methods, our study will work hand in hand with microbiological surveillance to examine the potential pathways for faecal-oral transmission, including infrastructure, current WASH practices and the drivers of these practices. This study will be one of the first to examine the links between environmental antibiotic resistance presence and WASH at community level in these settings.

The findings of this work strand will support the development of the transmission model, and help to model behaviours which are amenable to change, thereby informing WASH based interventions that could mitigate antibiotic resistance transmission in low-income settings.