# Hygiene measures and antimicrobial use practices in households of a rural community in South India: a cross-sectional study

## TL;DR

This study examines hygiene and antimicrobial use in rural Indian households, finding that good water and sanitation may reduce unnecessary antibiotic use.

## Contribution

The study links improved WASH practices to lower household antimicrobial use in a rural Indian setting.

## Key findings

- Sixteen percent of households used antimicrobials in the last 12 months, all with valid prescriptions.
- Fever was the most common reason for antimicrobial use, followed by upper respiratory infections and urinary tract infections.
- Households with larger sizes and children were more likely to use antimicrobials.

## Abstract

Inadequate water, sanitation and hygiene (WASH) practices in community settings is a driver for antimicrobial use and antimicrobial resistance (AMR). Understanding the WASH and antimicrobial use practices in communities, can potentially open opportunities to enhance AMR awareness and stimulate action.

A cross sectional study was conducted in 400 households the state of Kerala, India. Basic socio demographic details of the household, antimicrobial use practices of the household and data on WASH practices and provisions were collected, using a pilot-tested questionnaire.

Sixteen percent of the households reported use of antimicrobials at least once in the last 12 months and all obtained it using valid prescriptions. The commonest reason cited for the use of antimicrobials was fever (33.8%), upper respiratory infections (17.7%) and urinary tract infection (12.9%). Access to piped drinking water and improved sanitation was universal in the area. Solid waste management was a challenge with most households (384, 96%) practicing open dumping. Larger household size and presence of children in the household were factors influencing antimicrobial use.

The household level antimicrobial use was lower than other estimates from similar contexts and all the antimicrobials were obtained with valid prescriptions. This may be partially due to stricter implementation of regulations in the state. The optimal access to safe drinking water and improved sanitation facilities in the area may be responsible for the low use of antimicrobials in the households. Therefore, WASH should be an integral part of the action plans on AMR, especially those in sub-national settings.