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Caudell MA, Castillo C, Santos LF, Grajeda L, Romero JC, Lopez MR, Omulo S, Ning MF, Palmer GH, Call DR, Cordon-Rosales C, Smith RM, Herzig CT, Styczynski A, Ramay BM. Risk factors for colonization with extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales among hospitalized patients in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) study. IJID Reg 2024; 11:100361. [PMID: 38634070 PMCID: PMC11021947 DOI: 10.1016/j.ijregi.2024.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
Objectives The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) has resulted in increased morbidity, mortality, and health care costs worldwide. To identify the factors associated with ESCrE and CRE colonization within hospitals, we enrolled hospitalized patients at a regional hospital located in Guatemala. Methods Stool samples were collected from randomly selected patients using a cross-sectional study design (March-September, 2021), and samples were tested for the presence of ESCrE and CRE. Hospital-based and household variables were examined for associations with ESCrE and CRE colonization using lasso regression models, clustered by ward (n = 21). Results A total of 641 patients were enrolled, of whom complete data sets were available for 593. Colonization with ESCrE (72.3%, n = 429/593) was negatively associated with carbapenem administration (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) and positively associated with ceftriaxone administration (OR 1.61, 95% CI 1.02-2.53), as was reported hospital admission within 30 days of the current hospitalization (OR 2.84, 95% CI 1.19-6.80). Colonization with CRE (34.6%, n = 205 of 593) was associated with carbapenem administration (OR 2.62, 95% CI 1.39-4.97), reported previous hospital admission within 30 days of current hospitalization (OR 2.58, 95% CI 1.17-5.72), hospitalization in wards with more patients (OR 1.05, 95% CI 1.02-1.08), hospitalization for ≥4 days (OR 3.07, 95% CI 1.72-5.46), and intubation (OR 2.51, 95% CI 1.13-5.59). No household-based variables were associated with ESCrE or CRE colonization in hospitalized patients. Conclusion The hospital-based risk factors identified in this study are similar to what has been reported for risk of health care-associated infections, consistent with colonization being driven by hospital settings rather than community factors. This also suggests that colonization with ESCrE and CRE could be a useful metric to evaluate the efficacy of infection and prevention control programs in clinics and hospitals.
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Affiliation(s)
- Mark A. Caudell
- Washington State University, Paul G. Allen School for Global Health, Pullman, USA
| | - Carmen Castillo
- Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala
| | - Lucas F. Santos
- Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala
| | - Laura Grajeda
- Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala
| | - Juan Carlos Romero
- Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala
| | - Maria Renee Lopez
- Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala
| | - Sylvia Omulo
- Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala
- Washington State University, Global Health-Kenya, Nairobi, Kenya
| | - Mariangeli Freitas Ning
- U.S. Centers for Disease Control and Prevention, Guatemala City, Central America Regional Office, Guatemala
| | - Guy H. Palmer
- Washington State University, Paul G. Allen School for Global Health, Pullman, USA
| | - Douglas R. Call
- Washington State University, Paul G. Allen School for Global Health, Pullman, USA
| | - Celia Cordon-Rosales
- Washington State University, Paul G. Allen School for Global Health, Pullman, USA
- Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala
| | - Rachel M. Smith
- U.S. Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, USA
| | - Carolyn T.A. Herzig
- U.S. Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, USA
| | - Ashley Styczynski
- U.S. Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, USA
| | - Brooke M. Ramay
- Washington State University, Paul G. Allen School for Global Health, Pullman, USA
- Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala
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Omulo S, Ita T, Mugoh R, Ayodo C, Luvsansharav U, Bollinger S, Styczynski A, Ramay BM, Caudell MA, Palmer GH, Kariuki S, Call DR, Smith RM. Risk Factors for Colonization With Extended-Spectrum Cephalosporin-Resistant and Carbapenem-Resistant Enterobacterales Among Hospitalized Patients in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study. Clin Infect Dis 2023; 77:S97-S103. [PMID: 37406042 DOI: 10.1093/cid/ciad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) represents a significant global public health threat. We identified putative risk factors for ESCrE and CRE colonization among patients in 1 urban and 3 rural hospitals in Kenya. METHODS During a January 2019 and March 2020 cross-sectional study, stool samples were collected from randomized inpatients and tested for ESCrE and CRE. The Vitek2 instrument was used for isolate confirmation and antibiotic susceptibility testing, and least absolute shrinkage and selection operator (LASSO) regression models were used to identify colonization risk factors while varying antibiotic use measures. RESULTS Most (76%) of the 840 enrolled participants received ≥1 antibiotic in the 14 days preceding their enrollment, primarily ceftriaxone (46%), metronidazole (28%), or benzylpenicillin-gentamycin (23%). For LASSO models that included ceftriaxone administration, ESCrE colonization odds were higher among patients hospitalized for ≥3 days (odds ratio, 2.32 [95% confidence interval, 1.6-3.37]; P < .001), intubated patients (1.73 [1.03-2.91]; P = .009), and persons living with human immunodeficiency virus (1.70 [1.03-2.8]; P = .029). CRE colonization odds were higher among patients receiving ceftriaxone (odds ratio, 2.23 [95% confidence interval, 1.14-4.38]; P = .025) and for every additional day of antibiotic use (1.08 [1.03-1.13]; P = .002). CONCLUSIONS While CRE colonization was strongly associated with ceftriaxone use and duration of antibiotic use, the odds of ESCrE colonization increased with exposure to the hospital setting and invasive medical devices, which may reflect nosocomial transmission. These data suggest several areas where hospitals can intervene to prevent colonization among hospitalized patients, both through robust infection prevention and control practices and antibiotic stewardship programs.
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Affiliation(s)
- Sylvia Omulo
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Teresa Ita
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Robert Mugoh
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Charchil Ayodo
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Ulzii Luvsansharav
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Bollinger
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley Styczynski
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brooke M Ramay
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Mark A Caudell
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | | | - Douglas R Call
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Rachel M Smith
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Caudell MA, Ayodo C, Ita T, Smith RM, Luvsansharav UO, Styczynski AR, Ramay BM, Kariuki S, Palmer GH, Call DR, Omulo S. Risk Factors for Colonization With Multidrug-Resistant Bacteria in Urban and Rural Communities in Kenya: An Antimicrobial Resistance in Communities and Hospitals (ARCH) Study. Clin Infect Dis 2023; 77:S104-S110. [PMID: 37406050 DOI: 10.1093/cid/ciad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Colonization with antimicrobial-resistant bacteria increases the risk of drug-resistant infections. We identified risk factors potentially associated with human colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in low-income urban and rural communities in Kenya. METHODS Fecal specimens, demographic and socioeconomic data were collected cross-sectionally from clustered random samples of respondents in urban (Kibera, Nairobi County) and rural (Asembo, Siaya County) communities between January 2019 and March 2020. Presumptive ESCrE isolates were confirmed and tested for antibiotic susceptibility using the VITEK2 instrument. We used a path analytic model to identify potential risk factors for colonization with ESCrE. Only 1 participant was included per household to minimize household cluster effects. RESULTS Stool samples from 1148 adults (aged ≥18 years) and 268 children (aged <5 years) were analyzed. The likelihood of colonization increased by 12% with increasing visits to hospitals and clinics. Furthermore, individuals who kept poultry were 57% more likely to be colonized with ESCrE than those who did not. Respondents' sex, age, use of improved toilet facilities, and residence in a rural or urban community were associated with healthcare contact patterns and/or poultry keeping and may indirectly affect ESCrE colonization. Prior antibiotic use was not significantly associated with ESCrE colonization in our analysis. CONCLUSIONS The risk factors associated with ESCrE colonization in communities include healthcare- and community-related factors, indicating that efforts to control antimicrobial resistance in community settings must include community- and hospital-level interventions.
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Affiliation(s)
- Mark A Caudell
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Charchil Ayodo
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Teresa Ita
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Rachel M Smith
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ulzii-Orshikh Luvsansharav
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley R Styczynski
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brooke M Ramay
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Douglas R Call
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Sylvia Omulo
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
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Ross CT, Hooper PL, Smith JE, Jaeggi AV, Smith EA, Gavrilets S, Zohora FT, Ziker J, Xygalatas D, Wroblewski EE, Wood B, Winterhalder B, Willführ KP, Willard AK, Walker K, von Rueden C, Voland E, Valeggia C, Vaitla B, Urlacher S, Towner M, Sum CY, Sugiyama LS, Strier KB, Starkweather K, Major-Smith D, Shenk M, Sear R, Seabright E, Schacht R, Scelza B, Scaggs S, Salerno J, Revilla-Minaya C, Redhead D, Pusey A, Purzycki BG, Power EA, Pisor A, Pettay J, Perry S, Page AE, Pacheco-Cobos L, Oths K, Oh SY, Nolin D, Nettle D, Moya C, Migliano AB, Mertens KJ, McNamara RA, McElreath R, Mattison S, Massengill E, Marlowe F, Madimenos F, Macfarlan S, Lummaa V, Lizarralde R, Liu R, Liebert MA, Lew-Levy S, Leslie P, Lanning J, Kramer K, Koster J, Kaplan HS, Jamsranjav B, Hurtado AM, Hill K, Hewlett B, Helle S, Headland T, Headland J, Gurven M, Grimalda G, Greaves R, Golden CD, Godoy I, Gibson M, Mouden CE, Dyble M, Draper P, Downey S, DeMarco AL, Davis HE, Crabtree S, Cortez C, Colleran H, Cohen E, Clark G, Clark J, Caudell MA, Carminito CE, Bunce J, Boyette A, Bowles S, Blumenfield T, Beheim B, Beckerman S, Atkinson Q, Apicella C, Alam N, Mulder MB. Reproductive inequality in humans and other mammals. Proc Natl Acad Sci U S A 2023; 120:e2220124120. [PMID: 37216525 PMCID: PMC10235947 DOI: 10.1073/pnas.2220124120] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/16/2023] [Indexed: 05/24/2023] Open
Abstract
To address claims of human exceptionalism, we determine where humans fit within the greater mammalian distribution of reproductive inequality. We show that humans exhibit lower reproductive skew (i.e., inequality in the number of surviving offspring) among males and smaller sex differences in reproductive skew than most other mammals, while nevertheless falling within the mammalian range. Additionally, female reproductive skew is higher in polygynous human populations than in polygynous nonhumans mammals on average. This patterning of skew can be attributed in part to the prevalence of monogamy in humans compared to the predominance of polygyny in nonhuman mammals, to the limited degree of polygyny in the human societies that practice it, and to the importance of unequally held rival resources to women's fitness. The muted reproductive inequality observed in humans appears to be linked to several unusual characteristics of our species-including high levels of cooperation among males, high dependence on unequally held rival resources, complementarities between maternal and paternal investment, as well as social and legal institutions that enforce monogamous norms.
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Affiliation(s)
- Cody T. Ross
- Santa Fe Institute, Santa Fe, NM87501
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
| | - Paul L. Hooper
- Santa Fe Institute, Santa Fe, NM87501
- Department of Anthropology, University of New Mexico, Albuquerque, NM87131
| | | | - Adrian V. Jaeggi
- Institut für Anthropologie und Anthropologisches Museum, University of Zürich, Zürich8006, Switzerland
| | - Eric Alden Smith
- Department of Anthropology, University of Washington, Seattle, WA98195
| | - Sergey Gavrilets
- Departments of Ecology and Evolutionary Biology and Mathematics, University of Tennessee, Knoxville, TN37996
| | - Fatema tuz Zohora
- International Centre for Diarrheal Disease Research, Dhaka1000, Bangladesh
| | - John Ziker
- Department of Anthropology, Boise State University, Boise, ID83725
| | | | | | - Brian Wood
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
- Department of Anthropology, University of California, Los Angeles, CA90095
| | | | - Kai P. Willführ
- Institute for Social Science, University of Oldenburg, Oldenburg26129, Germany
| | - Aiyana K. Willard
- Centre for Culture and Evolution, Brunel University, LondonUB8 3PH, United Kingdom
| | - Kara Walker
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC27695
| | | | - Eckart Voland
- Institute for Philosophy, Justus-Liebig University, Giessen35390, Germany
| | | | - Bapu Vaitla
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA02115
| | - Samuel Urlacher
- Department of Anthropology, Baylor University, Waco, TX76706
- Canadian Institute for Advanced Research, Toronto, CAM5G 1M1
| | - Mary Towner
- Department of Integrative Biology, Oklahoma State University, Stillwater, OK74078
| | - Chun-Yi Sum
- College of General Studies, Boston University, Boston, MA02215
| | | | - Karen B. Strier
- Department of Zoology, University of Wisconsin, Madison, WI53706
| | | | - Daniel Major-Smith
- Department of Anthropology and Archaeology, University of Bristol, BristolBS8 1QU, United Kingdom
| | - Mary Shenk
- Department of Anthropology, Pennsylvania State University, University Park, PA16802
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, United Kingdom
| | - Edmond Seabright
- Department of Anthropology, University of New Mexico, Albuquerque, NM87131
| | - Ryan Schacht
- Department of Anthropology, East Carolina University, Greenville, NC27858
| | - Brooke Scelza
- Department of Anthropology, University of California, Los Angeles, CA90095
| | - Shane Scaggs
- Department of Anthropology, Ohio State University, Columbus, OH43210
| | - Jonathan Salerno
- Department of Human Dimensions of Natural Resources, Colorado State University, Fort Collins, CO80523
| | - Caissa Revilla-Minaya
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
| | - Daniel Redhead
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
| | - Anne Pusey
- Department of Evolutionary Anthropology, Duke University, Durham, NC27708
| | - Benjamin Grant Purzycki
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
- Department of the Study of Religion, Aarhus University, Aarhus8000, Denmark
| | - Eleanor A. Power
- Santa Fe Institute, Santa Fe, NM87501
- Department of Methodology, London School of Economics and Political Science, LondonWC2A 2AE, United Kingdom
| | - Anne Pisor
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
- Department of Anthropology, Washington State University, Pullman, WA99164
| | - Jenni Pettay
- Department of Biology, University of Turku, Turku20014, Finland
| | - Susan Perry
- Department of Anthropology, University of California, Los Angeles, CA90095
| | - Abigail E. Page
- Department of Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, United Kingdom
| | - Luis Pacheco-Cobos
- Facultad de Ciencias Biológicas y Agropecuarias, Universidad Veracruzana, Veracruz94294, Mexico
| | - Kathryn Oths
- Department of Anthropology, University of Alabama, Tuscaloosa, AL35487
| | - Seung-Yun Oh
- Korea Insurance Research Institute, Seoul150-606, Korea
| | - David Nolin
- Department of Sociology, University of Massachusetts, Amherst, MA01003
| | - Daniel Nettle
- Département d’Etudes Cognitives, Ecole Normale Supérieure, Université PSL, Paris75230, France
| | - Cristina Moya
- Department of Anthropology, University of California, Davis, CA95616
| | - Andrea Bamberg Migliano
- Institut für Anthropologie und Anthropologisches Museum, University of Zürich, Zürich8006, Switzerland
| | - Karl J. Mertens
- Department of Anthropology, Boise State University, Boise, ID83725
| | - Rita A. McNamara
- School of Psychology, Victoria University of Wellington, Wellington6012, New Zealand
| | - Richard McElreath
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
| | - Siobhan Mattison
- Department of Anthropology, University of New Mexico, Albuquerque, NM87131
| | - Eric Massengill
- Department of Anthropology, University of New Mexico, Albuquerque, NM87131
| | - Frank Marlowe
- Department of Biological Anthropology, University of Cambridge, CambridgeCB2 1TN, United Kingdom
| | - Felicia Madimenos
- Department of Anthropology, Queens College (CUNY), New York, NY11367
| | - Shane Macfarlan
- Department of Anthropology, University of Utah, Salt Lake City, UT84112
| | - Virpi Lummaa
- Department of Biology, University of Turku, Turku20014, Finland
| | - Roberto Lizarralde
- Facultad de Ciencias Económicas y Sociales, Universidad Central de Venezuela, Caracas1010A, Venezuela
| | - Ruizhe Liu
- Department of Anthropology, University of New Mexico, Albuquerque, NM87131
| | - Melissa A. Liebert
- Department of Anthropology, Northern Arizona University, Flagstaff, AZ86011
| | - Sheina Lew-Levy
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
- Department of Psychology, Durham University, DurhamDH1 3LE, United Kingdom
| | - Paul Leslie
- Department of Anthropology, University of North Carolina, Chapel Hill, NC27599
| | | | - Karen Kramer
- Department of Anthropology, University of Utah, Salt Lake City, UT84112
| | - Jeremy Koster
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
- Department of Biological Sciences, University of Cincinnati, Cincinnati, OH45221
| | | | | | - A. Magdalena Hurtado
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ85287
| | - Kim Hill
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ85287
| | - Barry Hewlett
- Department of Anthropology, Washington State University, Pullman, WA99164
| | - Samuli Helle
- Department of Biology, University of Turku, Turku20014, Finland
| | | | | | - Michael Gurven
- Department of Anthropology, University of California, Santa Barbara, CA93106
| | | | - Russell Greaves
- Department of Anthropology, University of Utah, Salt Lake City, UT84112
| | - Christopher D. Golden
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA02115
| | - Irene Godoy
- Department of Animal Behaviour, Bielefeld University, Bielefeld33615, Germany
| | - Mhairi Gibson
- Department of Anthropology and Archaeology, University of Bristol, BristolBS8 1QU, United Kingdom
| | - Claire El Mouden
- School of Anthropology and Museum Ethnography, University of Oxford, OxfordOX1 2JD, United Kingdom
| | - Mark Dyble
- Department of Anthropology, University College London, LondonWC1E 6BT, United Kingdom
| | - Patricia Draper
- School of Global Integrative Studies, University of Nebraska, Lincoln, NE68588
| | - Sean Downey
- Department of Anthropology, Ohio State University, Columbus, OH43210
| | | | | | - Stefani Crabtree
- Santa Fe Institute, Santa Fe, NM87501
- Department of Environment and Society, Utah State University, Logan, UT84322
| | - Carmen Cortez
- Department of Anthropology, University of California, Davis, CA95616
| | - Heidi Colleran
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
| | - Emma Cohen
- School of Anthropology and Museum Ethnography, University of Oxford, OxfordOX1 2JD, United Kingdom
| | - Gregory Clark
- Department of Economics, University of California, Davis, CA95616
| | | | - Mark A. Caudell
- Department of Anthropology, Washington State University, Pullman, WA99164
| | - Chelsea E. Carminito
- Department of Biological Sciences, University of Cincinnati, Cincinnati, OH45221
| | - John Bunce
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
| | - Adam Boyette
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
| | | | - Tami Blumenfield
- Department of Anthropology, University of New Mexico, Albuquerque, NM87131
- School of Ethnology and Sociology, Yunnan University, Yunnan650106, China
| | - Bret Beheim
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
| | - Stephen Beckerman
- Department of Anthropology, Pennsylvania State University, University Park, PA16802
| | - Quentin Atkinson
- School of Psychology, University of Auckland, Auckland1010, New Zealand
| | - Coren Apicella
- Department of Psychology, University of Pennsylvania, Philadelphia, PA19104
| | - Nurul Alam
- International Centre for Diarrheal Disease Research, Dhaka1000, Bangladesh
| | - Monique Borgerhoff Mulder
- Santa Fe Institute, Santa Fe, NM87501
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig04103, Germany
- Department of Anthropology, University of California, Davis, CA95616
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Caudell MA, Kiambi S, Afakye K, Koka E, Kabali E, Kimani T, Dorado-Garcia A. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlab193. [PMID: 35156026 PMCID: PMC8826779 DOI: 10.1093/jacamr/dlab193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/06/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- Mark A. Caudell
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
- Corresponding author. E-mail:
| | - Stella Kiambi
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Kofi Afakye
- Food and Agriculture Organization of the United Nations, Accra, Ghana
| | - Eric Koka
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
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Mangesho PE, Caudell MA, Mwakapeje ER, Ole-Neselle M, Kabali E, Obonyo M, Dorado-Garcia A, Valcarce A, Kimani T, Price C, Eckford S, Fasina FO. "We are doctors": Drivers of animal health practices among Maasai pastoralists and implications for antimicrobial use and antimicrobial resistance. Prev Vet Med 2021; 188:105266. [PMID: 33517159 DOI: 10.1016/j.prevetmed.2021.105266] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
Animal health service providers can play an important role in limiting drug resistance by promoting responsible and prudent use of veterinary drugs. Recognizing this potential, international agencies and governments have called for these providers to receive drug stewardship training, particularly providers in low- and middle-income countries where top-down regulations (e.g., national regulation of veterinary prescriptions) are largely unfeasible. The success of these stewardship trainings to promote responsible and prudent use will depend on many factors, including understanding how livestock-keeping communities currently interact with animal health service providers. Here, we use a mixed methods approach to identify and understand animal health seeking practices among Maasai pastoralists in Tanzania. Combining qualitative interviews (N = 31) and structured surveys (N = 195), we show the majority of Maasai respondents (≈80 %) do not frequently consult animal health service providers with most relying on advice from family and friends. Logistic regression models of health seeking practices find that increasing age, education, observance of treatment failure, and herd disease burdens are associated with greater odds of seeking out health services. Quantitative results were supported by data from focus group discussions and in-depth interviews that showed Maasai view animal health service providers as measures of last resort, whose input is largely sought after self-treatment with veterinary drugs fail. We argue patterns of animal health seeking among the Maasai are partially the consequence of their high confidence in their own abilities in livestock disease and treatment and generally low confidence in the skills of animal health service providers. We link this high sense of self-efficacy to the culturally engrained process by which Maasai develop mastery in animal health and how the roles and norms in Maasai culture surrounding animal health influence Maasai perceptions of animal health professionals. Our results highlight the need for more research to understand Maasai perceptions of animal health service providers as well as the knowledge, attitudes, and practices of these providers. Finally, our study emphasizes that the success of drug stewardship trainings will require efforts to first understand the cultural and historical contexts driving health seeking practices that impact perceptions of animal health service providers and animal health practices more generally.
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Affiliation(s)
- Peter E Mangesho
- National Institute for Medical Research, Amani Medical Research Centre, P.O Box 81, Muheza, Tanzania.
| | - Mark A Caudell
- Food and Agriculture Organization of the United Nations, United Nations Complex, PO Box 30470, Nairobi, Kenya
| | - Elibariki R Mwakapeje
- Food and Agriculture Organization of the United Nations, Ali Hassan Mwinyi Rd, P.O Box 2 Dar es Salaam, Tanzania
| | - Moses Ole-Neselle
- Food and Agriculture Organization of the United Nations, Ali Hassan Mwinyi Rd, P.O Box 2 Dar es Salaam, Tanzania
| | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, 00153, Rome, Italy
| | - Mark Obonyo
- Food and Agriculture Organization of the United Nations, Tendeseka Office Park, PO Box 3730, Harare, Zimbabwe
| | | | - Antonio Valcarce
- Food and Agriculture Organization of the United Nations, 00153, Rome, Italy
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, United Nations Complex, PO Box 30470, Nairobi, Kenya
| | - Cortney Price
- Food and Agriculture Organization of the United Nations, 00153, Rome, Italy
| | - Suzanne Eckford
- Veterinary Medicines Directorate, Woodham La, Addlestone, KT15 3LS, United Kingdom
| | - Folorunso O Fasina
- Food and Agriculture Organization of the United Nations, Ali Hassan Mwinyi Rd, P.O Box 2 Dar es Salaam, Tanzania
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7
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Mangesho PE, Caudell MA, Mwakapeje ER, Ole-Neselle M, Kimani T, Dorado-García A, Kabali E, Fasina FO. Knowing Is Not Enough: A Mixed-Methods Study of Antimicrobial Resistance Knowledge, Attitudes, and Practises Among Maasai Pastoralists. Front Vet Sci 2021; 8:645851. [PMID: 33834048 PMCID: PMC8023390 DOI: 10.3389/fvets.2021.645851] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/03/2021] [Indexed: 02/05/2023] Open
Abstract
Global, national, and local efforts to limit antimicrobial resistance (AMR) often stress the importance of raising awareness among users, sellers, and prescribers of antimicrobial drugs. This emphasis is founded upon two assumptions. First, awareness is limited, particularly concerning the links between antimicrobial use (AMU) and AMR. Second, "filling the awareness gaps" will motivate practises that will limit AMR. The first assumption is supported by knowledge, attitudes, and practises (KAP) surveys but these same studies provide mixed support for the second, with several studies finding that knowledge and attitudes are not correlated with related practises. This disconnect may arise as these surveys typically do not collect data on the cultural or historical contexts that pattern AMU. To explore how these contexts impact KAP related to AMU and AMR, we use a mixed-methods approach to examine veterinary practises among Maasai pastoralists in Tanzania. We combine a quantitative KAP survey (N = 195 households) with extensive qualitative data from focus group discussions (N = 55 participants). Results document limited awareness of AMR but also find that knowledge and attitudes are not correlated with practise. Thematic analysis of qualitative data pointed to three reasons behind this disconnect, including (1) Maasai self-perceptions as veterinary experts, (2) the central role of livestock in Maasai culture, and (3) the use of ethnoveterinary knowledge in animal health treatment. We argue that mixed-method approaches will be critical to developing the targeted awareness campaigns needed to limit the emergence and transmission of AMR.
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Affiliation(s)
- Peter E. Mangesho
- Amani Medical Research Centre, National Institute for Medical Research, Muheza, Tanzania
- *Correspondence: Peter E. Mangesho
| | - Mark A. Caudell
- Food and Agriculture Organization of the United Nations, United Nations Complex, Nairobi, Kenya
| | | | - Moses Ole-Neselle
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, United Nations Complex, Nairobi, Kenya
| | | | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, Rome, Italy
- Woodham La, Addlestone, United Kingdom
| | - Folorunso O. Fasina
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania
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8
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Afakye K, Kiambi S, Koka E, Kabali E, Dorado-Garcia A, Amoah A, Kimani T, Adjei B, Caudell MA. The Impacts of Animal Health Service Providers on Antimicrobial Use Attitudes and Practices: An Examination of Poultry Layer Farmers in Ghana and Kenya. Antibiotics (Basel) 2020; 9:E554. [PMID: 32872381 PMCID: PMC7557566 DOI: 10.3390/antibiotics9090554] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
International organizations and governments have argued that animal health service providers can play a vital role in limiting antimicrobial resistance by promoting the prudent use of antimicrobials. However, there is little research on the impact of these service providers on prudent use at the farm level, especially in low- and middle-income countries where enforcement of prudent-use regulations is limited. Here, we use a mixed-methods approach to assess how animal health-seeking practices on layer farms in Ghana (n = 110) and Kenya (n = 76) impact self-reported antimicrobial usage, engagement in prudent administration and withdrawal practices and perceptions of antimicrobial resistance. In general, our results show that the frequency of health-seeking across a range of service providers (veterinarians, agrovets, and feed distributors) does not significantly correlate with prudent or non-prudent use practices or the levels of antimicrobials used. Instead, we find that patterns of antimicrobial use are linked to how much farmers invest in biosecurity (e.g., footbaths) and the following vaccination protocols. Our results emphasize that more research is required to understand the interactions between animal health service providers and farmers regarding antimicrobial use and antimicrobial resistance. Addressing these gaps will be crucial to inform antimicrobial stewardship training, curriculums and, guidelines whose ultimate purpose is to limit the selection and transmission of antimicrobial resistance.
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Affiliation(s)
- Kofi Afakye
- Food and Agriculture Organization of the United Nations, Accra 1628, Ghana; (K.A.); (A.A.); (B.A.)
| | - Stella Kiambi
- Food and Agriculture Organization of the United Nations, Nairobi 00100, Kenya; (S.K.); (T.K.)
| | - Eric Koka
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast 5007, Ghana;
| | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, 00153 Rome, Italy; (E.K.); (A.D.-G.)
| | - Alejandro Dorado-Garcia
- Food and Agriculture Organization of the United Nations, 00153 Rome, Italy; (E.K.); (A.D.-G.)
| | - Ann Amoah
- Food and Agriculture Organization of the United Nations, Accra 1628, Ghana; (K.A.); (A.A.); (B.A.)
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, Nairobi 00100, Kenya; (S.K.); (T.K.)
| | - Benjamin Adjei
- Food and Agriculture Organization of the United Nations, Accra 1628, Ghana; (K.A.); (A.A.); (B.A.)
| | - Mark A Caudell
- Food and Agriculture Organization of the United Nations, Nairobi 00100, Kenya; (S.K.); (T.K.)
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9
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Ramay BM, Caudell MA, Cordón-Rosales C, Archila LD, Palmer GH, Jarquin C, Moreno P, McCracken JP, Rosenkrantz L, Amram O, Omulo S, Call DR. Antibiotic use and hygiene interact to influence the distribution of antimicrobial-resistant bacteria in low-income communities in Guatemala. Sci Rep 2020; 10:13767. [PMID: 32792543 PMCID: PMC7426860 DOI: 10.1038/s41598-020-70741-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/30/2020] [Indexed: 11/09/2022] Open
Abstract
To examine the effects of poor sanitation and hygiene on the prevalence of antimicrobial-resistant bacteria, we surveyed households in two rural and two urban communities in Guatemala (N = 196 randomly selected households). One adult (≥ 18-years old) and, when available, one child (≤ 5 years-old) provided a stool sample. Up to 48 presumptive Escherichia coli isolates were collected from each stool sample (n = 21,256 total) and were subjected to breakpoint assays for ten antibiotics. Mixed-effects logistic models were used to identify potential factors influencing the likelihood of harboring antibiotic-resistant bacteria. For nine out of ten antibiotics, the odds of detecting resistant bacteria decreased by ~ 32% (odds ratios, OR 0.53-0.8, P < 0.001) for every unit of improvement of a hygiene scale. Hygiene differences between households had a greater impact on prevalence compared to antibiotic use differences. The likelihood of detecting resistant isolates was lower for five antibiotics among households that boiled raw milk before consumption (OR 0.31-0.69), and higher for nine antibiotics in urban households (OR > 1.89-9.6). Poor hygiene conditions likely obscure effects of individual antibiotic use, presumably due to enhanced microbial transmission. Consequently, efforts to improve antibiotic stewardship should be coupled with improving hygiene conditions.
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Affiliation(s)
- Brooke M Ramay
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
| | - Mark A Caudell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
- Food and Agriculture Organization of the United Nations, United Nations Complex, UN Avenue, Gigiri, PO Box: 30470, Nairobi, 00100, Kenya
| | - Celia Cordón-Rosales
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala.
| | - L Diego Archila
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
| | - Guy H Palmer
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
- Nelson Mandela African Institution of Science and Technology, P.O.BOX 447, Arusha, Tanzania
| | - Claudia Jarquin
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
| | - Purificación Moreno
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, 181 Avenida 11-95, Guatemala City, 01015, Guatemala
| | - Leah Rosenkrantz
- Department of Geography, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Ofer Amram
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, USA
| | - Sylvia Omulo
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
| | - Douglas R Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
- Nelson Mandela African Institution of Science and Technology, P.O.BOX 447, Arusha, Tanzania
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10
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Caudell MA, Dorado-Garcia A, Eckford S, Creese C, Byarugaba DK, Afakye K, Chansa-Kabali T, Fasina FO, Kabali E, Kiambi S, Kimani T, Mainda G, Mangesho PE, Chimpangu F, Dube K, Kikimoto BB, Koka E, Mugara T, Rubegwa B, Swiswa S. Towards a bottom-up understanding of antimicrobial use and resistance on the farm: A knowledge, attitudes, and practices survey across livestock systems in five African countries. PLoS One 2020; 15:e0220274. [PMID: 31978098 PMCID: PMC6980545 DOI: 10.1371/journal.pone.0220274] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/25/2019] [Indexed: 02/05/2023] Open
Abstract
The nutritional and economic potentials of livestock systems are compromised by the emergence and spread of antimicrobial resistance. A major driver of resistance is the misuse and abuse of antimicrobial drugs. The likelihood of misuse may be elevated in low- and middle-income countries where limited professional veterinary services and inadequately controlled access to drugs are assumed to promote non-prudent practices (e.g., self-administration of drugs). The extent of these practices, as well as the knowledge and attitudes motivating them, are largely unknown within most agricultural communities in low- and middle-income countries. The main objective of this study was to document dimensions of knowledge, attitudes and practices related to antimicrobial use and antimicrobial resistance in livestock systems and identify the livelihood factors associated with these dimensions. A mixed-methods ethnographic approach was used to survey households keeping layers in Ghana (N = 110) and Kenya (N = 76), pastoralists keeping cattle, sheep, and goats in Tanzania (N = 195), and broiler farmers in Zambia (N = 198), and Zimbabwe (N = 298). Across countries, we find that it is individuals who live or work at the farm who draw upon their knowledge and experiences to make decisions regarding antimicrobial use and related practices. Input from animal health professionals is rare and antimicrobials are sourced at local, privately owned agrovet drug shops. We also find that knowledge, attitudes, and particularly practices significantly varied across countries, with poultry farmers holding more knowledge, desirable attitudes, and prudent practices compared to pastoralist households. Multivariate models showed that variation in knowledge, attitudes and practices is related to several factors, including gender, disease dynamics on the farm, and source of animal health information. Study results emphasize that interventions to limit antimicrobial resistance should be founded upon a bottom-up understanding of antimicrobial use at the farm-level given limited input from animal health professionals and under-resourced regulatory capacities within most low- and middle-income countries. Establishing this bottom-up understanding across cultures and production systems will inform the development and implementation of the behavioral change interventions to combat antimicrobial resistance globally.
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Affiliation(s)
- Mark A. Caudell
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | | | - Suzanne Eckford
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Chris Creese
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | | | - Kofi Afakye
- Food and Agriculture Organization of the United Nations, Accra, Ghana
| | | | - Folorunso O. Fasina
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania
| | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, Harare, Zimbabwe
| | - Stella Kiambi
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Geoffrey Mainda
- Department of Veterinary Services, Ministry of Fisheries and Livestock, Lusaka, Zambia
| | - Peter E. Mangesho
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | - Francis Chimpangu
- Food and Agriculture Organization of the United Nations, Lusaka, Zambia
| | - Kululeko Dube
- Food and Agriculture Organization of the United Nations, Harare, Zimbabwe
| | | | - Eric Koka
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Tendai Mugara
- Food and Agriculture Organization of the United Nations, Harare, Zimbabwe
| | - Bachana Rubegwa
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania
| | - Samuel Swiswa
- Division of Veterinary Services, Department of Livestock and Veterinary Services, Harare, Zimbabwe
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11
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Subbiah M, Caudell MA, Mair C, Davis MA, Matthews L, Quinlan RJ, Quinlan MB, Lyimo B, Buza J, Keyyu J, Call DR. Antimicrobial resistant enteric bacteria are widely distributed amongst people, animals and the environment in Tanzania. Nat Commun 2020; 11:228. [PMID: 31932601 PMCID: PMC6957491 DOI: 10.1038/s41467-019-13995-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 12/07/2019] [Indexed: 11/09/2022] Open
Abstract
Antibiotic use and bacterial transmission are responsible for the emergence, spread and persistence of antimicrobial-resistant (AR) bacteria, but their relative contribution likely differs across varying socio-economic, cultural, and ecological contexts. To better understand this interaction in a multi-cultural and resource-limited context, we examine the distribution of antimicrobial-resistant enteric bacteria from three ethnic groups in Tanzania. Household-level data (n = 425) was collected and bacteria isolated from people, livestock, dogs, wildlife and water sources (n = 62,376 isolates). The relative prevalence of different resistance phenotypes is similar across all sources. Multi-locus tandem repeat analysis (n = 719) and whole-genome sequencing (n = 816) of Escherichia coli demonstrate no evidence for host-population subdivision. Multivariate models show no evidence that veterinary antibiotic use increased the odds of detecting AR bacteria, whereas there is a strong association with livelihood factors related to bacterial transmission, demonstrating that to be effective, interventions need to accommodate different cultural practices and resource limitations.
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Affiliation(s)
- Murugan Subbiah
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Mark A Caudell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya.
| | - Colette Mair
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Margaret A Davis
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Louise Matthews
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Robert J Quinlan
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
- Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Marsha B Quinlan
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
- Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Beatus Lyimo
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Joram Buza
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Julius Keyyu
- Tanzania Wildlife Research Institute, Arusha, Tanzania
| | - Douglas R Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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12
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Rosenkrantz L, Amram O, Caudell MA, Schuurman N, Call DR. Spatial relationships between small-holder farms coupled with livestock management practices are correlated with the distribution of antibiotic resistant bacteria in northern Tanzania. One Health 2019; 8:100097. [PMID: 31249856 PMCID: PMC6584765 DOI: 10.1016/j.onehlt.2019.100097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 05/21/2019] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
We examined the spatial distribution of antibiotic-resistant coliform bacteria amongst livestock from three distinct cultural groups, where group-level differences in practices (e.g., antibiotic use) may influence the magnitude of antibiotic resistance, while livestock interactions (e.g., mixing herds, shared markets) between these locations may reduce heterogeneity in the distribution of antibiotic resistant bacteria. Data was collected as part of a larger study of antibiotic-resistance in northern Tanzania. Simple regression and generalized linear regression were used to assess livestock management and care practices in relation to the prevalence of multidrug-resistant (MDR) coliform bacteria. Simple and multivariable logistic regression were then used to identify how different management practices affected the odds of households being found within MDR "hotspots." Households that had a higher median neighbourhood value within a 3000 m radius showed a significant positive correlation with livestock MDR prevalence (β = 4.33, 95% CI: 2.41-6.32). Households were more likely to be found within hotspots if they had taken measures to avoid disease (Adjusted Odds Ratio (AOR) 1.53, CI: 1.08-2.18), and if they reported traveling less than a day to reach the market (AOR 2.66, CI: 1.18-6.01). Hotspot membership was less likely when a greater number of livestock were kept at home (AOR 0.81, CI: 0.69-0.95), if livestock were vaccinated (AOR 0.32, CI: 0.21-0.51), or if distance to nearest village was greater (AOR 0.46, CI: 0.36-0.59). The probability of MDR increases when herds are mixed, consistent with evidence for passive transmission of resistant bacteria between animals. Reduced MDR with vaccination is consistent with many studies showing reduced antibiotic use with less disease burden. The neighbourhood effect has implications for design of intervention studies.
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Affiliation(s)
- Leah Rosenkrantz
- Department of Geography, Simon Fraser Univesity, Burnaby V5A 1S6, British Columbia, Canada
| | - Ofer Amram
- Elson S. Floyd College of Medicine, Washington State University, Spokane, PO Box 1495, WA, USA
| | - Mark A. Caudell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, 99164 Washington, USA
| | - Nadine Schuurman
- Department of Geography, Simon Fraser Univesity, Burnaby V5A 1S6, British Columbia, Canada
| | - Douglas R. Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, 99164 Washington, USA
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13
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Caudell MA, Mair C, Subbiah M, Matthews L, Quinlan RJ, Quinlan MB, Zadoks R, Keyyu J, Call DR. Identification of risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in Tanzania: a biological and socioeconomic analysis. Lancet Planet Health 2018; 2:e489-e497. [PMID: 30396440 PMCID: PMC6215761 DOI: 10.1016/s2542-5196(18)30225-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/10/2018] [Indexed: 05/07/2023]
Abstract
BACKGOUND Improved antimicrobial stewardship, sanitation, and hygiene are WHO-inspired priorities for restriction of the spread of antimicrobial resistance. Prioritisation among these objectives is essential, particularly in low-income and middle-income countries, but the factors contributing most to antimicrobial resistance are typically unknown and could vary substantially between and within countries. We aimed to identify the biological and socioeconomic risk factors associated with carriage of resistant Escherichia coli in three culturally diverse ethnic groups in northern Tanzania. METHODS We developed a survey containing more than 200 items and administered it in randomly selected households in 13 Chagga, Arusha, or Maasai villages chosen on the basis of ethnic composition and distance to urban centres. Human stool samples were collected from a subset of households, as were liquid milk samples and swabs of milk containers. Samples were processed and plated onto MacConkey agar plates, then presumptive E coli isolates were identified on the basis of colony morphology. Susceptibility of isolates was then tested against a panel of nine antimicrobials (ampicillin, ceftazidime, chloramphenicol, ciprofloxacin, kanamycin, streptomycin, sulfamethoxazole, tetracycline, and trimethoprim) via a breakpoint assay. Susceptibility findings were matched with data across a wide range of household characteristics, including education, hygiene practices, wealth, livestock husbandry, and antibiotic use. FINDINGS Between March 23, 2012, and July 30, 2015, we interviewed 391 households (118 Arusha, 100 Chagga, and 173 Maasai). Human stool samples were collected at 226 (58%) households across the 13 villages. 181 milk samples and 191 milk-container swabs were collected from 117 households across seven villages. 11 470 putative E coli samples were isolated from stool samples. Antimicrobial use in people and livestock was not associated with prevalence of resistance at the household level. Instead, the factors with the greatest predictive value involved exposure to bacteria, and were intimately connected with fundamental cultural differences across study groups. These factors included how different subsistence types (pastoralists vs farmers) access water sources and consumption of unboiled milk, reflecting increased exposure to resistant bacteria in milk. INTERPRETATION When cultural and ecological conditions favour bacterial transmission, there is a high likelihood that people will harbour antimicrobial-resistant bacteria irrespective of antimicrobial use practices. Public health interventions to limit antimicrobial resistance need to be tailored to local practices that affect bacterial transmission. FUNDING US National Science Foundation; Biotechnology and Biological Sciences Research Council, UK Medical Research Council; and the Allen School.
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Affiliation(s)
- Mark A Caudell
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Colette Mair
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Murugan Subbiah
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Louise Matthews
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Robert J Quinlan
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Marsha B Quinlan
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Ruth Zadoks
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Julius Keyyu
- Tanzania Wildlife Research Institute, Arusha, Tanzania
| | - Douglas R Call
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.
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14
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Roulette JW, Roulette CJ, Quinlan RJ, Call DR, Hewlett BS, Caudell MA, Quinlan MB. Children's Ethnobiological Notions of Contamination and Contagions among Maasai Agro-Pastoralists of Northern Tanzania. J ETHNOBIOL 2018. [DOI: 10.2993/0278-0771-38.2.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jennifer W. Roulette
- Department of Anthropology, Washington State University, Pullman, WA, 99164, USA
| | | | - Robert J. Quinlan
- Department of Anthropology, Washington State University, Pullman, WA, 99164, USA
- Paul G. Allen School for Global Animal Health, Washington State University
| | - Douglas R. Call
- Paul G. Allen School for Global Animal Health, Washington State University
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Barry S. Hewlett
- Department of Anthropology, Washington State University, Pullman, WA, 99164, USA
| | - Mark A. Caudell
- Department of Anthropology, Washington State University, Pullman, WA, 99164, USA
- Paul G. Allen School for Global Animal Health, Washington State University
| | - Marsha B. Quinlan
- Department of Anthropology, Washington State University, Pullman, WA, 99164, USA
- Paul G. Allen School for Global Animal Health, Washington State University
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Roulette CJ, Caudell MA, Roulette JW, Quinlan RJ, Quinlan MB, Subbiah M, Call DR. A two-month follow-up evaluation testing interventions to limit the emergence and spread of antimicrobial resistant bacteria among Maasai of northern Tanzania. BMC Infect Dis 2017; 17:770. [PMID: 29246196 PMCID: PMC5732506 DOI: 10.1186/s12879-017-2857-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/26/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, efforts to control antimicrobial resistance (AMR) are aggravated by unregulated drug sales and use, and high connectivity between human, livestock, and wildlife populations. Our previous research indicates that Maasai agropastoralists-who have high exposure to livestock and livestock products and self-administer veterinary antibiotics-harbor antibiotic resistant Escherichia coli (E. coli). Here, we report the results of a public health intervention project among Maasai aimed at reducing selection and transmission of E. coli bacteria. METHODS Research was conducted in two Maasai communities in Northern Tanzania. Participants were provided with health knowledge and technological innovations to facilitate: 1) the prudent use of veterinary antibiotics (tape measures and dosage charts to calculate livestock weight for more accurate dosage), and, 2) the pasteurization of milk (thermometers), the latter of which was motivated by findings of high levels of resistant E. coli in Maasai milk. To determine knowledge retention and intervention adoption, we conducted a two-month follow-up evaluation in the largest of the two communities. RESULTS Retention of antimicrobial knowledge was positively associated with retention of bacterial knowledge and, among men, retention of bacterial knowledge was associated with greater wealth. Bacterial and AMR knowledge were not, however, associated with self-reported use of the innovations. Among women, self-reported use of the thermometers was associated with having more children and greater retention of knowledge about the health benefits of the innovations. Whereas 70% of women used their innovations correctly, men performed only 18% of the weight-estimation steps correctly. Men's correct use was associated with schooling, such that high illiteracy rates remain an important obstacle to the dissemination and diffusion of weight-estimation materials. CONCLUSION Our results indicate that dietary preferences for unboiled milk, concerns over child health, and a desire to improve the health of livestock are important cultural values that need to be incorporated in future AMR-prevention interventions that target Maasai populations. More generally, these findings inform future community-health interventions to limit AMR.
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Affiliation(s)
- Casey J. Roulette
- Department of Anthropology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182 USA
| | - Mark A. Caudell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, USA
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Jennifer W. Roulette
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Robert J. Quinlan
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, USA
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Marsha B. Quinlan
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, USA
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Murugan Subbiah
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, USA
| | - Douglas R. Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, USA
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Caudell MA, Quinlan MB, Subbiah M, Call DR, Roulette CJ, Roulette JW, Roth A, Matthews L, Quinlan RJ. Antimicrobial Use and Veterinary Care among Agro-Pastoralists in Northern Tanzania. PLoS One 2017; 12:e0170328. [PMID: 28125722 PMCID: PMC5268417 DOI: 10.1371/journal.pone.0170328] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/03/2017] [Indexed: 12/22/2022] Open
Abstract
Frequent and unregulated use of antimicrobials (AM) in livestock requires public health attention as a likely selection pressure for resistant bacteria. Studies among small-holders, who own a large percentage of the world's livestock, are vital for understanding how practices involving AM use might influence resistance. We present a cultural-ecological mixed-methods analysis to explore sectors of veterinary care, loosely regulated AM use, and human exposure to AMs through meat and milk consumption across three rural to peri-urban Tanzanian ethnic groups (N = 415 households). Reported use of self-administered AMs varied by ethnic group (Maasai: 74%, Arusha: 21%, Chagga: 1%) as did consultation with professional veterinarians (Maasai: 36%, Arusha: 45%, Chagga: 96%) and observation of withdrawal of meat and milk from consumption during and following AM treatment (Maasai: 7%, Arusha: 72%, Chagga: 96%). The antibiotic oxytetracycline was by far the most common AM in this sample. Within ethnic groups, herd composition differences, particularly size of small-stock and cattle herds, were most strongly associated with differences in lay AM use. Among the Arusha, proxies for urbanization, including owning transportation and reliance on "zero-grazing" herds had the strongest positive associations with veterinarian consultation, while distance to urban centers was negatively associated. For Maasai, consultation was negatively associated with use of traditional healers or veterinary drug-shops. Observation of withdrawal was most strongly associated with owning technology among Maasai while Arusha observance displayed seasonal differences. This "One-Health" analysis suggests that livelihood and cultural niche factors, through their association with practices in smallholder populations, provide insight into the selection pressures that may contribute to the evolution and dissemination of antimicrobial resistance.
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Affiliation(s)
- Mark A. Caudell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Department of Anthropology, Washington State University, Pullman, Washington, United States of America
| | - Marsha B. Quinlan
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Department of Anthropology, Washington State University, Pullman, Washington, United States of America
| | - Murugan Subbiah
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
| | - Douglas R. Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
| | - Casey J. Roulette
- Department of Anthropology, San Diego State University, San Diego, California, United States of America
| | - Jennifer W. Roulette
- Department of Anthropology, Washington State University, Pullman, Washington, United States of America
| | - Adam Roth
- Department of Sociology, Washington State University, Pullman, Washington, United States of America
| | - Louise Matthews
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Robert J. Quinlan
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Department of Anthropology, Washington State University, Pullman, Washington, United States of America
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17
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Caudell MA, Quinlan MB, Quinlan RJ, Call DR. Medical pluralism and livestock health: ethnomedical and biomedical veterinary knowledge among East African agropastoralists. J Ethnobiol Ethnomed 2017; 13:7. [PMID: 28109305 PMCID: PMC5251319 DOI: 10.1186/s13002-017-0135-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/06/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Human and animal health are deeply intertwined in livestock dependent areas. Livestock health contributes to food security and can influence human health through the transmission of zoonotic diseases. In low-income countries diagnosis and treatment of livestock diseases is often carried out by household members who draw upon both ethnoveterinary medicine (EVM) and contemporary veterinary biomedicine (VB). Expertise in these knowledge bases, along with their coexistence, informs treatment and thus ultimately impacts animal and human health. The aim of the current study was to determine how socio-cultural and ecological differences within and between two livestock-keeping populations, the Maasai of northern Tanzania and Koore of southwest Ethiopia, impact expertise in EVM and VB and coexistence of the two knowledge bases. METHODS An ethnoveterinary research project was conducted to examine dimensions of EVM and VB knowledge among the Maasai (N = 142 households) and the Koore (N = 100). Cultural consensus methods were used to quantify expertise and the level of agreement on EVM and VB knowledge. Ordinary least squares regression was used to model patterns of expertise and consensus across groups and to examine associations between knowledge and demographic/sociocultural attributes. RESULTS Maasai and Koore informants displayed high consensus on EVM but only the Koore displayed consensus on VB knowledge. EVM expertise in the Koore varied across gender, herd size, and level of VB expertise. EVM expertise was highest in the Maasai but was only associated with age. The only factor associated with VB expertise was EVM expertise in the Koore. CONCLUSIONS Variation in consensus and the correlates of expertise across the Maassi and the Koore are likely related to differences in the cultural transmission of EVM and VB knowledge. Transmission dynamics are established by the integration of livestock within the socioecological systems of the Maasai and Koore and culture historical experiences with livestock disease. Consideration of the nature and coexistence of EVM and VB provides insight into the capacity of groups to cope with disease outbreaks, pharmaceutical use patterns, and the development of community health interventions.
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Affiliation(s)
- Mark A. Caudell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA USA
- Department of Anthropology, Washington State University, Pullman, WA USA
| | - Marsha B. Quinlan
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA USA
- Department of Anthropology, Washington State University, Pullman, WA USA
| | - Robert J. Quinlan
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA USA
- Department of Anthropology, Washington State University, Pullman, WA USA
| | - Douglas R. Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA USA
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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Abstract
Humans exhibit considerable diversity in timing and rate of reproduction. Life-history theory (LHT) suggests that ecological cues of resource richness and survival probabilities shape human phenotypes across populations. Populations experiencing high extrinsic mortality due to uncertainty in resources should exhibit faster life histories. Here we use a path analytic (PA) approach informed by LHT to model the multiple pathways between resources, mortality rates, and reproductive behavior in 191 countries. Resources that account for the most variance in population mortality rates are predicted to explain the most variance in total fertility rates. Results indicate that resources (e.g., calories, sanitation, education, and health-care expenditures) influence fertility rates in paths through communicable and noncommnunicable diseases. Paths acting through communicable disease are more strongly associated with fertility than are paths through noncommunicable diseases. These results suggest that a PA approach may help disaggregate extrinsic and intrinsic mortality factors in cross-cultural analyses. Such knowledge may be useful in developing targeted policies to decrease teenage pregnancy, total fertility rates, and thus issues associated with overpopulation.
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Affiliation(s)
- Mark A Caudell
- Department of Anthropology, Washington State University, Pullman, WA 99164-4910, USA.
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