Vijay K. Mahadik and Ashok J. Tamhankar contributed equally to this work.
The authors declare that they have no competing interests.
All authors were involved in the conceptualization and design of the study. CSL initiated as principal investigator the project and is the main responsible for the manuscript, VD is responsible for organization of data collection, AP drafted the first version of the manuscript, MRP is responsible for the molecular analyses and involved in the microbiological analyses, HS is responsible for the microbiological work, MS contributed in coordination, VJK and AJT are senior advisors to the project. All authors have given intellectual input in the development of data collection forms, the study design and have given their input to the development of this manuscript. All authors read and approved the final version of the manuscript.
CSL is professor and research group leader at Karolinska Institutet (KI). AP, MP, HS and AJT are professors at RDGMC, VD is assoc. professor and MS ass. prof at RDGMC. VD, AP, MP, MS and AJT are also affiliated to KI. AJT initiated in 2008 IIMAR – Indian Initiative for management of Antibiotic Resistance (http://save-antibiotics.blogspot.com) and is its national coordinator. The authors, whereof many have been working together for several years, represent a wide variation of competencies all important to this ‘One health’ project.
Antibiotic resistance has been referred to as ‘the greatest malice of the 21st century’ and a global action plan was adopted by the World Health Assembly in 2015. There is a wealth of independent studies regarding antibiotics and resistant bacteria in humans, animals and their environment, however, integrated studies are lacking, particularly ones that simultaneously also take into consideration the health related behaviour of participants and healthcare providers. Such, ‘One health’ studies are difficult to implement, because of the complex teamwork that they entail. This paper describes the protocol of a study that investigates ‘One health’ issues regarding antibiotic use and antibiotic resistance in children and their environment in Indian villages.
Both quantitative and qualitative studies are planned for a cohort of children, from 6 villages, and their surrounding environment. Repeated or continues data collection is planned over 2 years for quantitative studies. Qualitative studies will be conducted once. Studies include parents’ health seeking behavior for their children (1–3 years of age at the onset), prescribing pattern of formal and informal healthcare providers, analysis of phenotypic antibiotic resistance of Escherichia coli from samples of stool from children and village animals, household drinking water, village source water and waste water, and investigation on molecular mechanisms governing resistance. Analysis of interrelationship of these with each other will also be done as basis for future interventions. Ethics approval has been obtained from the Institutional Ethics Committee R.D. Gardi Medical College, Ujjain, India (No: 2013/07/17-311).
The findings of the study presented in this protocol will add to our knowledge about the multi-factorial nature of causes governing antibiotic use and antibiotic resistance from a ‘One health’ perspective. Our study will be the first of its kind addressing antibiotic use and resistance issues related to children in a One-health approach, particularly for rural India.