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Spatial and temporal variation in the community prevalence of antibiotic resistance in Bangladesh: an integrated surveillance study protocol
  1. Emily Rousham1,
  2. Leanne Unicomb2,
  3. Paul Wood3,
  4. Michael Smith4,
  5. Muhammad Asaduzzaman5,
  6. Mohammad Aminul Islam5
  1. 1 Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
  2. 2 Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
  3. 3 Department of Geography, School of Social, Political and Geographical Sciences, Loughborough University, Loughborough, UK
  4. 4 Water, Engineering and Development Centre, School of Architecture, Building and Civil Engineering, Loughborough University, Loughborough, UK
  5. 5 Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
  1. Correspondence to Dr Emily Rousham; e.k.rousham{at} and Dr Mohammad Aminul Islam; maislam{at}


Introduction Increasing antibiotic resistance (ABR) in low-income and middle-income countries such as Bangladesh presents a major health threat. However, assessing the scale of the health risk is problematic in the absence of reliable data on the community prevalence of antibiotic-resistant bacteria. We describe the protocol for a small-scale integrated surveillance programme that aims to quantify the prevalence of colonisation with antibiotic-resistant bacteria and concentrations of antibiotic-resistant genes from a ‘One Health’ perspective. The holistic assessment of ABR in humans, animals and within the environment in urban and rural Bangladesh will generate comprehensive data to inform human health risk.

Methods and analysis The study design focuses on three exposure-relevant sites where there is enhanced potential for transmission of ABR between humans, animals and the environment: (1) rural poultry-owning households, (2) commercial poultry farms and (3) urban live-bird markets. The comparison of ABR prevalence in human groups with high and low exposure to farming and poultry will enable us to test the hypothesis that ABR bacteria and genes from the environment and food-producing animals are potential sources of transmission to humans. Escherichia coli is used as an ABR indicator organism due to its widespread environmental presence and colonisation in both the human and animal gastrointestinal tract.

Ethics and dissemination The study has been approved by the Institutional Review Board of the International Centre for Diarrhoeal Disease Research, Bangladesh, and Loughborough University Ethics Committee. Data for the project will be stored on the open access repository of the Centre for Ecology and Hydrology, Natural Environment Research Council. The results of this study will be published in peer-reviewed journals and presented at national and international conferences.

  • public health
  • epidemiology
  • diagnostic microbiology

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors ER, MAI, LU, PW and MS all contributed to the design and development of the study protocol. MA contributed to the field methods, site selection and laboratory protocols. All authors contributed to writing the final protocol and manuscript.

  • Funding This work was supported by the Antimicrobial Resistance Cross Council Initiative supported by the seven research councils in partnership with the Department of Health and Department for Environment Food & Rural Affairs (NERC/BBSRC/MRC grant number: NE/N019555/1).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This research protocol was submitted to the Institutional Review Board of the International Centre for Diarrhoeal Disease Research, Bangladesh, where it received clearance from the Research Review Committee and Ethical Review Committee (protocol number PR-16071). Approval from the Human Participants Ethical Subcommittee was also obtained from Loughborough University (R17-P037).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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