Browsing by Author "Matthews, Louise"

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Antimicrobial resistant enteric bacteria are widely distributed amongst people, animals and the environment in Tanzania
(Springer Nature Limited, 2020-01-13) Subbiah, Murugan; Caudell, Mark; Mair, Colette; Davis, Margaret; Matthews, Louise; Quinlan, Robert; Quinlan, Marsha; Lyimo, Beatus; Buza, Joram; Keyyu, Julius; Call, Douglas
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.
How public health crises expose systemic, day-to-day health inequalities in low- and-middle income countries: an example from East Africa
(Springer Nature, 2022-02-14) Davis, Alicia; Lembo, Tiziana; Laurie, Emma; Mutua, Edna; Loosli, Kathrin; Nthambi, Mary; Nimegeer, Amy; Mnzava, Kunda; Msoka, Elizabeth; Nasuwa, Fortunata; Melubo, Matayo; Shirima, Gabriel; Matthews, Louise; Hilton, Shona; Mshana, Stephen; Mmbaga, Blandina
Background: The current Coronavirus disease pandemic reveals political and structural inequities of the world’s poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental chal- lenges of health care in humans and animals in relation to AMR in Tanzania. Methods: We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences. Results: Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health out- comes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals. Conclusion: Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in ‘normal’ circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.