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One Health WASH: an AMR-smart integrative approach to preventing and controlling infection in farming communities

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March 7, 2023

Chris E Pinto Jimenez, Sarai M Keestra, Pranav Tandon, Amy J Pickering, Arshnee Moodley, Oliver Cumming , Clare I R Chandler

BMJ Glob Health. 2023 Mar;8(3):e011263.
PMID: 36882219 | DOI: 10.1136/bmjgh-2022-011263


Prevention is a critical, yet neglected, cornerstone for the response to antimicrobial resistance (AMR).1 The importance of a multitude of preventative measures is recognised across the One Health spectrum, with attention drawn to the issue by multilateral institutions. The 2022 World Antimicrobial Awareness Week saw the World Health Organization, the Food and Agriculture Organization, the United Nations Environment Programme and the World Organisation for Animal Health focused their campaign on the theme ‘Preventing AMR together’ to improve awareness and understanding of AMR and encourage best practices.2 While a One Health framework is now promoted for conceptualising the complex problem of AMR, the evidence base of interventions designed within this rubric is thin. Outstanding questions remain, for example, about how best to prevent and control infection across humans, animals, and the environment.

In public health, measures such as hygiene practices, biosecurity, vaccinations and other means to strengthen immunity, are commonly used to prevent and control infections. Highlighting the potential contribution of such measures to reducing AMR, the World Bank3 introduced the terms ‘AMR-sensitive’ and ‘AMR-specific’ to describe interventions that indirectly or directly contribute to reducing AMR, respectively. For example, measures to reduce the burden of infections in human health, such as water, sanitation, and hygiene (WASH), are recognised as essential to support AMR strategies due to their potential to indirectly combat AMR and produce co-benefits.3 Thus, investments in these interventions would be ‘AMR-Smart.’

Currently, measures to prevent and control infections in human health are most obvious for infections acquired in healthcare settings. Infection Prevention and Control (IPC) in human health is considered fundamental for AMR, defined as measures ‘that prevent patients and health workers from being harmed by avoidable infections and as a result of AMR’.4 In animal health, the prevention and control of infections commonly focus on measures to reduce the risk of introduction and/or spread of diseases between animals on farms and from and to farm workers. While the acronym IPC most commonly refers to healthcare settings in the human health sector, the general principle of infection prevention and control has a wider resonance. The subtle but important differences in the terminology for prevention and control of infections between health sectors have the potential to create misunderstandings across the wider One Health sphere, with consequences for the design and assumptions embedded in AMR interventions and programmes.

Measures to prevent and control infections at a community level in animal agricultural settings where humans and animals live in close contact is an overlooked area ripe for a One Health approach, especially when a significant proportion of the global population is involved in small-scale, semi-intensive livestock farming. It has been estimated that around 1 billion people (about 12% of the global human population) rely on smallholder livestock production5 and about 60 million on aquaculture for their livelihoods.6 The livestock population slaughtered for meat consumption in 2018 was estimated to be as high as 82 billion animals (69 billion chickens, 1.5 billion pigs, 656 million turkeys, 574 million sheep, 479 million goats and 302 million cattle).7 These figures are especially significant for low-and middle-income countries (LMICs) where animal production systems contribute to nearly 40% of countries’ agricultural gross domestic product and 2–33% of household incomes.5

In this commentary, we propose an integrative approach to infection prevention and control by combining WASH and biosecurity interventions to tackle AMR in human and animal populations beyond healthcare facilities, such as in settings where people and animals interact closely.

Source: https://pubmed.ncbi.nlm.nih.gov/36882219/