May 30, 2024
OHT’s Ramanan Laxminarayan co-authored a qualitative, exploratory study exploring barriers to implementing environmental surveillance of antibiotic resistance in low- and middle-income countries (LMICs). Using a constructivist grounded theory approach, the team identified infrastructural barriers such as unreliable and disorganized resources and facilities which result in inadequate sample collection and analysis; institutional barriers including bureaucracy, conflicts between political and managerial priorities, and difficulties obtaining collaboration agreements and permissions; and sociocultural barriers such as working culture, corruption, social unrest, and language differences.
Key informants reported various pathways to mitigate or entirely circumvent these barriers, some of which raised concerns about research and knowledge gaps. Some interviewees noted that they would avoid an area, such as a region or country, due to the perceived inevitability of conflict, disagreement, or unavailability of resources. These areas are then unaccounted for in maps of antibiotic resistance, which are essential to developing effective resistance mitigation efforts. Other pathways to overcome barriers included simplifying methods, local collaboration, and additional funding for local adaption. Interviewees predominantly supported establishing strong local connections as the most effective way to navigate barriers; however, they often did not report trying to secure such connections and even reported actions that would undermine future collaborations, indicating a potential tension between informants’ perceived barriers and their efforts to mitigate them.
Experts in high-income countries could improve their capacity to establish and strengthen local collaborators and facilities to optimize environmental surveillance efforts in LMICs. Institutions and global actors can also take considerable steps to facilitate some of the suggested pathways to mitigate reported barriers and improve environmental antibiotic resistance surveillance in LMICs.
Read the full article, published in Global Health Action, here.
