Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya

Ayse Ercumen; Andrew N. Mertens; Zachary Butzin-Dozier; Da Kyung Jung; Shahjahan Ali; Beryl S. Achando; Gouthami Rao; Caitlin Hemlock; Amy J. Pickering; Christine P. Stewart; Sophia T. Tan; Jessica A. Grembi; Jade Benjamin-Chung; Marlene Wolfe; Gene G. Ho; Md Ziaur Rahman; Charles D. Arnold; Holly N. Dentz; Sammy M. Njenga; Theodora Meerkerk; Belinda Chen; Maya Nadimpalli; Mohammad Aminul Islam; Alan E. Hubbard; Clair Null; Leanne Unicomb; Mahbubur Rahman; John M. Colford; Stephen P. Luby; Benjamin F. Arnold; Audrie Lin

doi:10.1038/s41467-024-55801-x

Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya

Ayse Ercumen, Andrew N. Mertens, Zachary Butzin-Dozier, Da Kyung Jung, Shahjahan Ali, Beryl S. Achando, Gouthami Rao, Caitlin Hemlock, Amy J. Pickering, Christine P. Stewart, Sophia T. Tan, Jessica A. Grembi, Jade Benjamin-Chung, Marlene Wolfe, Gene G. Ho, Md Ziaur Rahman, Charles D. Arnold, Holly N. Dentz, Sammy M. Njenga, Theodora MeerkerkBelinda Chen, Maya Nadimpalli, Mohammad Aminul Islam, Alan E. Hubbard, Clair Null, Leanne Unicomb, Mahbubur Rahman, John M. Colford, Stephen P. Luby, Benjamin F. Arnold, Audrie Lin

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Abstract

Antibiotics can trigger antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and undernutrition can reduce infections and antibiotic use. We assess effects of water, sanitation, handwashing (WSH) and nutrition interventions on caregiver-reported antibiotic use in Bangladesh and Kenya, longitudinally measured at three timepoints among birth cohorts (ages 3–28 months) in a cluster-randomized trial. Over 50% of children used antibiotics at least once in the 90 days preceding data collection. In Bangladesh, the prevalence of antibiotic use was 10–14% lower in groups receiving WSH (prevalence ratio [PR] = 0.90 (0.82–0.99)), nutrition (PR = 0.86 (0.78–0.94)), and nutrition+WSH (PR = 0.86 (0.79–0.93)) interventions. The prevalence of using antibiotics multiple times was 26–35% lower in intervention arms. Reductions were largest when the birth cohort was younger. In Kenya, interventions did not affect antibiotic use. In this work, we show that improving WSH and nutrition can reduce antibiotic use. Studies should assess whether such reductions translate to reduced antimicrobial resistance.

Original language	English (US)
Article number	556
Journal	Nature communications
Volume	16
Issue number	1
DOIs	https://doi.org/10.1038/s41467-024-55801-x
State	Published - Dec 2025

All Science Journal Classification (ASJC) codes

General Chemistry
General Biochemistry, Genetics and Molecular Biology
General Physics and Astronomy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1038/s41467-024-55801-x

Cite this

Ercumen, A., Mertens, A. N., Butzin-Dozier, Z., Jung, D. K., Ali, S., Achando, B. S., Rao, G., Hemlock, C., Pickering, A. J., Stewart, C. P., Tan, S. T., Grembi, J. A., Benjamin-Chung, J., Wolfe, M., Ho, G. G., Rahman, M. Z., Arnold, C. D., Dentz, H. N., Njenga, S. M., ... Lin, A. (2025). Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya. Nature communications, 16(1), Article 556. https://doi.org/10.1038/s41467-024-55801-x

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title = "Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya",

abstract = "Antibiotics can trigger antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and undernutrition can reduce infections and antibiotic use. We assess effects of water, sanitation, handwashing (WSH) and nutrition interventions on caregiver-reported antibiotic use in Bangladesh and Kenya, longitudinally measured at three timepoints among birth cohorts (ages 3–28 months) in a cluster-randomized trial. Over 50% of children used antibiotics at least once in the 90 days preceding data collection. In Bangladesh, the prevalence of antibiotic use was 10–14% lower in groups receiving WSH (prevalence ratio [PR] = 0.90 (0.82–0.99)), nutrition (PR = 0.86 (0.78–0.94)), and nutrition+WSH (PR = 0.86 (0.79–0.93)) interventions. The prevalence of using antibiotics multiple times was 26–35% lower in intervention arms. Reductions were largest when the birth cohort was younger. In Kenya, interventions did not affect antibiotic use. In this work, we show that improving WSH and nutrition can reduce antibiotic use. Studies should assess whether such reductions translate to reduced antimicrobial resistance.",

author = "Ayse Ercumen and Mertens, {Andrew N.} and Zachary Butzin-Dozier and Jung, {Da Kyung} and Shahjahan Ali and Achando, {Beryl S.} and Gouthami Rao and Caitlin Hemlock and Pickering, {Amy J.} and Stewart, {Christine P.} and Tan, {Sophia T.} and Grembi, {Jessica A.} and Jade Benjamin-Chung and Marlene Wolfe and Ho, {Gene G.} and Rahman, {Md Ziaur} and Arnold, {Charles D.} and Dentz, {Holly N.} and Njenga, {Sammy M.} and Theodora Meerkerk and Belinda Chen and Maya Nadimpalli and Islam, {Mohammad Aminul} and Hubbard, {Alan E.} and Clair Null and Leanne Unicomb and Mahbubur Rahman and Colford, {John M.} and Luby, {Stephen P.} and Arnold, {Benjamin F.} and Audrie Lin",

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Ercumen, A, Mertens, AN, Butzin-Dozier, Z, Jung, DK, Ali, S, Achando, BS, Rao, G, Hemlock, C, Pickering, AJ, Stewart, CP, Tan, ST, Grembi, JA, Benjamin-Chung, J, Wolfe, M, Ho, GG, Rahman, MZ, Arnold, CD, Dentz, HN, Njenga, SM, Meerkerk, T, Chen, B, Nadimpalli, M, Islam, MA, Hubbard, AE, Null, C, Unicomb, L, Rahman, M, Colford, JM, Luby, SP, Arnold, BF & Lin, A 2025, 'Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya', Nature communications, vol. 16, no. 1, 556. https://doi.org/10.1038/s41467-024-55801-x

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T1 - Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use

T2 - evidence from Bangladesh and Kenya

AU - Ercumen, Ayse

AU - Mertens, Andrew N.

AU - Butzin-Dozier, Zachary

AU - Jung, Da Kyung

AU - Ali, Shahjahan

AU - Achando, Beryl S.

AU - Rao, Gouthami

AU - Hemlock, Caitlin

AU - Pickering, Amy J.

AU - Stewart, Christine P.

AU - Tan, Sophia T.

AU - Grembi, Jessica A.

AU - Benjamin-Chung, Jade

AU - Wolfe, Marlene

AU - Ho, Gene G.

AU - Rahman, Md Ziaur

AU - Arnold, Charles D.

AU - Dentz, Holly N.

AU - Njenga, Sammy M.

AU - Meerkerk, Theodora

AU - Chen, Belinda

AU - Nadimpalli, Maya

AU - Islam, Mohammad Aminul

AU - Hubbard, Alan E.

AU - Null, Clair

AU - Unicomb, Leanne

AU - Rahman, Mahbubur

AU - Colford, John M.

AU - Luby, Stephen P.

AU - Arnold, Benjamin F.

AU - Lin, Audrie

PY - 2025/12

Y1 - 2025/12

N2 - Antibiotics can trigger antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and undernutrition can reduce infections and antibiotic use. We assess effects of water, sanitation, handwashing (WSH) and nutrition interventions on caregiver-reported antibiotic use in Bangladesh and Kenya, longitudinally measured at three timepoints among birth cohorts (ages 3–28 months) in a cluster-randomized trial. Over 50% of children used antibiotics at least once in the 90 days preceding data collection. In Bangladesh, the prevalence of antibiotic use was 10–14% lower in groups receiving WSH (prevalence ratio [PR] = 0.90 (0.82–0.99)), nutrition (PR = 0.86 (0.78–0.94)), and nutrition+WSH (PR = 0.86 (0.79–0.93)) interventions. The prevalence of using antibiotics multiple times was 26–35% lower in intervention arms. Reductions were largest when the birth cohort was younger. In Kenya, interventions did not affect antibiotic use. In this work, we show that improving WSH and nutrition can reduce antibiotic use. Studies should assess whether such reductions translate to reduced antimicrobial resistance.

AB - Antibiotics can trigger antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and undernutrition can reduce infections and antibiotic use. We assess effects of water, sanitation, handwashing (WSH) and nutrition interventions on caregiver-reported antibiotic use in Bangladesh and Kenya, longitudinally measured at three timepoints among birth cohorts (ages 3–28 months) in a cluster-randomized trial. Over 50% of children used antibiotics at least once in the 90 days preceding data collection. In Bangladesh, the prevalence of antibiotic use was 10–14% lower in groups receiving WSH (prevalence ratio [PR] = 0.90 (0.82–0.99)), nutrition (PR = 0.86 (0.78–0.94)), and nutrition+WSH (PR = 0.86 (0.79–0.93)) interventions. The prevalence of using antibiotics multiple times was 26–35% lower in intervention arms. Reductions were largest when the birth cohort was younger. In Kenya, interventions did not affect antibiotic use. In this work, we show that improving WSH and nutrition can reduce antibiotic use. Studies should assess whether such reductions translate to reduced antimicrobial resistance.

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Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya

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UN SDGs

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