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dc.contributor.authorSado, Keina
dc.contributor.authorKeenan, Katherine
dc.contributor.authorManataki, Areti
dc.contributor.authorKesby, Mike
dc.contributor.authorMushi, Martha F.
dc.contributor.authorMshana, Stephen E.
dc.contributor.authorMwanga, Joseph R.
dc.contributor.authorNeema, Stella
dc.contributor.authorAsiimwe, Benon
dc.contributor.authorBazira, Joel
dc.contributor.authorKiiru, John
dc.contributor.authorGreen, Dominique L.
dc.contributor.authorKe, Xuejia
dc.contributor.authoret al
dc.date.accessioned2024-02-20T09:53:03Z
dc.date.available2024-02-20T09:53:03Z
dc.date.issued2024
dc.identifier.citationSado, K., Keenan, K., Manataki, A., Kesby, M., Mushi, M. F., Mshana, S. E., ... & HATUA Consortium. (2024). Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda. PLOS Global Public Health, 4(2), e0002709.en_US
dc.identifier.urihttp://ir.must.ac.ug/xmlui/handle/123456789/3393
dc.description.abstractAntibacterial 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.en_US
dc.description.sponsorshipNational Institute for Health Researchen_US
dc.language.isoen_USen_US
dc.publisherPLOS Global Public Healthen_US
dc.subjectAntibacterial resistanceen_US
dc.subjectMulti-drug resistanceen_US
dc.subjectUrinary tract infectionen_US
dc.subjectPatientsen_US
dc.subjectLow and middle-income countriesen_US
dc.titleTreatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Ugandaen_US
dc.typeArticleen_US


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