Risk perception and psychosocial factors influencing exposure to antimicrobial resistance through environmental pathways in Malawi

Chidziwisano, Kondwani and Cocker, Derek and Mwapasa Kumwenda, Taonga and Amos, Stevie and Feasey, Nicholas and Morse, Tracy (2024) Risk perception and psychosocial factors influencing exposure to antimicrobial resistance through environmental pathways in Malawi. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637 (In Press)

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Abstract

Antimicrobial resistant (AMR) bacteria are prevalent in household and environmental settings in low-income locations. However, there is limited data on individuals’ understanding of AMR exposure risks in these settings. A cross-sectional study was conducted to identify individual risk perception to AMR and its associated behavioral determinants at household level in urban, peri–urban and rural Malawi. We conducted interviews with 529 participants from 300 households (n=100 households/site). The Risk, Attitude, Norms, Ability and Self–regulation (RANAS) model was used to assess psychosocial factors underlying AMR exposure through animal feces, river and drain water. Analysis of variance was used to assess the difference between doers and non–doers of the three targeted behaviors: use and contact with river water, contact with drain water, and contact with animal feces. There was limited understanding regarding human-environmental interactions facilitating AMR transmission across all sites, as such perceived risk of contracting AMR was low (41%; p=0.189). Human contact with animal feces was seen as risky (64%) compared to contact with river and drain water (17%). Urban participants perceived they were at greater risk of AMR exposure than their rural counterparts (p=0.001). Perception of social norms were favorable for the targeted behaviors (p=0.001) as well as self–reported attitude and ability estimates (self–efficacy) (p=0.023). Thus, indicating the role of psychosocial factors influencing the human–environment interaction in AMR transmission. Our findings underscore the need for combined infrastructural improvements and behavior-centered AMR education to drive behavioral changes, benefitting both AMR mitigation and broader One-Health initiatives.

ORCID iDs

Chidziwisano, Kondwani, Cocker, Derek, Mwapasa Kumwenda, Taonga, Amos, Stevie, Feasey, Nicholas and Morse, Tracy ORCID logoORCID: https://orcid.org/0000-0003-4185-9471;
CORE (COnnecting REpositories)