Grant: Operating Grant

Infectious diseases remain a concern worldwide and are the main cause of morbidity and mortality in low and middle-income countries(LMICs). While most infectious diseases can be prevented by improving access to clean water, sanitation, nutrition and immunization, antimicrobials remain essential. The spread of antimicrobial resistance is now a major public health threat driven by many interconnected factors, in particular misuse of antimicrobials for human and veterinary use, cultural conceptions, diagnostic uncertainty, economic incentives, inadequate training of health staff, and advertising from the pharmaceutical industry. Little research has targeted LMICs,and little is known on the effectiveness of community-based interventions. We thus aim to ascertain whether and how applying an ecosystem approach, considered a milestone in Canadian public health research, with its principles of transdisciplinarity, equity, participation and sustainability, can improve antimicrobial use and reduce the prevalence of infectious disease. This proposal to improve knowledge, attitudes and practices both by practitioners and the community, brings together four initiatives: the "Do Bugs Need Drugs?" Canadian campaign; Ecuadorean partners in Latin America's ReAct (worldwide network to reduce antimicrobial resistance); a Canadian-Ecuadorean research program on food security; and a six-year CIDA-funded project (ending this year) entitled "Sustainably Managing Environmental Health Risks in Ecuador", which embraces an ecosystem approach. This project builds on a solid partnership with indigenous communities, and will contribute important information on effectiveness of community-based campaigns to promote antibiotic stewardship and reduce infectious disease transmission in LMICs, using a rigorous study design. The study will also add to world knowledge on how to design, implement and evaluate a community-based population health intervention using an ecosystem health approach.