Antimicrobial resistance, equity and justice in low- and middle-income countries: an intersectional critical interpretive synthesis
Katy Davis, Ralalicia Limato, Meenakshi Monga, Beatrice Egid, Sneha Paul, S. N. M. Okioma, Owen Nyamwanza, Abriti Arjyal, Syeda Tahmina Ahmed, Ayuska Parajuli, Mavis Pearl Kwabla, Bachera Aktar, Anne Ngũnjiri, Kate Hawkins, Russell Dacombe, Syed Masud Ahmed, Mustapha Immurana, Jane Thiomi, Fidelis E. Y. Anumu, Webster Mavhu, Lilian Otiso, Sabina Faiz Rashid, Sushil Baral, Margaret Gyapong, Sally Theobald, Rosie Steege
Abstract
Global inequities in the burden of antimicrobial resistance (AMR), between and within populations, are heavily influenced by the social and structural determinants of health. Yet, AMR action has had limited attention to equity, and social approaches to AMR haven't routinely gone beyond an exploration of knowledge and awareness around ABU. This represents a missed opportunity to design equitable interventions and policy across One Health. We report the results of a critical interpretive synthesis of the social and structural drivers of AMR in Low- and Middle-Income Countries and present a conceptual framework of these drivers, linking to the Sustainable Development Goals (SDGs). We emphasise the limitations of a biomedical dominance in AMR research, highlighting the value of wider bodies of evidence for understanding the drivers of AMR to support equity and justice. We argue AMR interventions need action across the SDGs to target the root causes and address significant gaps in evidence.