AMR and unhealthy environment

Clarifying the environment’s role in AMR transmission

OHT’s Ramanan Laxminarayan and co-authors charge that previous literature has not demonstrated that antimicrobial resistance (AMR) endangers human and domestic animal health by rendering antimicrobials ineffective. Still, it is less obvious how or whether the ability to survive antimicrobial exposure (resistance) could affect the health of the environment. The main reason for taking the environment into account in AMR mitigation efforts is not based on worries about the environment itself, but rather because microorganisms and the genetic material they contain frequently move between people, animals, and the environment, increasing the chances of both transmission and the evolution of resistance. The authors advocate for an informed One Health strategy to address the environment’s role in AMR emergence and spread. [Nature Microbiology]

Human and animal antimicrobial consumption is a key driver of AMR rates globally

One Health Trust researchers collaborated using public data on global AMR rates in humans and food-producing animals to identify the key socioeconomic, anthropogenic, and environmental drivers of AMR worldwide. They found that there were significant associations between animal antimicrobial consumption and AMR in food-producing animals, and between human antimicrobial consumption and AMR among WHO-classified critical and high-priority pathogens in humans. The researchers also noted bidirectional relationships between animal antimicrobial consumption and human AMR and between human antimicrobial consumption and AMR in food-producing animals. Significant associations were identified between several socioeconomic factors, including increased mortality due to unsafe water, sanitation, and hygiene (WASH) conditions or to cardiovascular complications, and human AMR. [The Lancet Planetary Health]

Urban and rural height disparities have reversed in many countries since 1990

Researchers performed a literature review of 2,325 population-based studies to assess the height and body mass index (BMI) of children and adolescents aged five to 19 years old on the basis of rural and urban places of residence between 1990 and 2020. They found that in 1990, children and adolescents living in urban settings were taller than those living in rural areas in most countries, with the exception of some high-income countries. In contrast, in 2020, the urban height advantage among children in many countries – especially high- and middle-income countries – was largely reduced. However, in countries in sub-Saharan Africa, Oceania, and South Asia, there was a significant increase in height and BMI among boys living in cities. Policymakers and global health experts should pay close attention to the growth and development of children as a function of poverty and rural and urban infrastructure. [Nature]

Marginalized groups in high-income countries do not have equitable WASH access

Rights to water and sanitation are threatened by widespread racism and discrimination against historically marginalized communities in high-income countries (HICs), resulting in an increased disease burden among these individuals. These issues are largely invisible in the global water, sanitation, and hygiene (WASH) discourse due to the social exclusion of these communities. Despite advances in WASH provision worldwide, reports of unequal WASH access and limited data on the quality of services are often overlooked in aggregate statistics from HICs. New models and technologies are needed to provide more equitable low-cost WASH services in HICs. [The Lancet Global Health]

Data-sharing mandates exacerbate inequity for researchers in LMICs

A scoping literature review of the perspectives of national stakeholders from low- and middle-income countries (LMICs) on equitable practices regarding data sharing in global health research revealed that current data sharing mandates risk creating a neo-colonial relationship between HIC researchers who mine data in LMICs. The lack of established research capacity and infrastructure in LMICs exacerbates this relationship, as the richness of data in LMICs does not necessarily translate into rich rewards for researchers in these countries. The asymmetrical data-sharing system puts HICs at an advantage over LMICs, further perpetuating historical global disparities in data access.[BMJ Global Health]

The presence of another bacterial species can slow down resistance selection in E. coli

Researchers examined the role of interspecies interaction on the dynamics of nitrofurantoin (NIT) resistance selection in Escherichia coli (E. coli). Using two variants of E. coli (one susceptible to NIT and one resistant), they found that the presence of another bacterial species, Bacillus subtilis, significantly slowed down selection for the resistant E. coli mutation when NIT was present. This result was not due to resource competition between the two bacteria; rather, extracellular compounds released by B. subtilis, including a peptide called YydF, which decreased the selection for NIT resistance. [Communications Biology]

Epidemic modeling shows that TB has become endemic in Jiangsu, China

Researchers explored the effects of long-term ambient air pollution (PM10) on the transmission of tuberculosis (TB) in Jiangsu, China using a TB epidemic model to analyze TB case data from the Jiangsu province between 2015 and 2019. TB became endemic to the region with predictions of long-term persistence. The model was also used to identify short-term TB control measures, such as increasing close-contact distancing and wearing protective masks. [Infectious Disease Modeling]

Antibiotic-resistant Campylobacter highlights the need for a One Health approach

The rise in antibiotic-resistant Campylobacter, particularly in fluoroquinolones (FQs), cannot be attributed exclusively to antibiotic usage in humans. Transmission of FQ-resistant Campylobacter between species, expansion of FQ-resistant Campylobacter clones in animal production sites where FQ was never used, and evidence of genetic exchange between Campylobacter and Gram-positive bacteria in the natural environment, contribute to the growing threat of this pathogen as well. Future research on Campylobacter transmission dynamics should use a One Health approach to devise effective mitigation strategies. [One Health Advances]

Mandatory public health insurance increased insurance enrollment and healthcare utilization in Vietnam

Using biennial Vietnam Household Living Standard Surveys, researchers assessed the effects of a 2015 law in Vietnam, making public health insurance (PHI) compulsory, on healthcare utilization and out-of-pocket expenditures. Overall, enrollment in PHI increased among low- and middle-income groups by 7.2 and 7.7 percent respectively after the mandate was passed. Additionally, the number of visits for medical services increased among all income groups after the amendment. Factors associated with a higher likelihood of enrolling in PHI included being an ethnic minority, unemployed status, and higher education attainment of the head of household. Health expenditures did not decrease significantly after the amendment, indicating the challenges of balancing healthcare provision and financial protection in Vietnam. [BMC Public Health]

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