The role of gender in AMR: Preparations for field work by Nichola Jones

Nichola Jones is a 2^nd year PhD student at the University of Leeds using participatory video (PV) to explore the role of gender in antibiotic misuse in Nepal. Nichola joined the Leeds team last September following the work of the CARAN project; which used PV methodologies to look at antibiotic use/misuse in Nepal. She says “The combination of arts and health in this project speaks directly to my experience – I have an undergrad in performing arts and a masters in international health. This slightly unusual combination of educational backgrounds has put me at a small advantage in an increasingly interdisciplinary research environment!” We are going to be following Nichola’s journey through her data collection over the next few months, in this first blog she introduces us to her project and field work plans.  Keep up to date on twitter using the hashtag #AMR_gender

In partnership with the HERDi team based in Kathmandu (Nepal), the CARAN project ran two iterations of a PV study in both urban and semi-urban areas of the Kathmandu Valley. The aim of this project was to better understand behaviours around antibiotic use and how these could lead to antbiotic resitance.  The project yeilded a much greater understanding of antibiotic challenges within Nepal which are being used to influence governmental policy, however this project also produced a practical manual to guide future PV research. Part of my PhD is to review this manual with a focus on One Health, then to implement the study with gender at the centre of my analysis.  My suggested edits to the manual came from a number of literature searches conducted within the first year of my research. The first area of focus was to include an explicitly One Health lens to the language of the manual; One Health is an internationally generated approach to AMR reduction that places importance on the relationships between human, animal and environmental health relating to AMR. The second area of focus came in part from early results from the CARAN project, then was developed through literature review; how gender impacts AMR, particularly health seeking behaviours around antibiotic/antimicrobial use. From the CARAN project the researchers saw how health seeking behaviours were gendered in Nepal, especially in the acquirement of antibiotics – which prompted many conversations between our team members about the role gender has to play in all aspects of antibiotic use and AMR.

Upon researching the relationship between gender and AMR more thoroughly, it became clear that there is very little directly linking the two. Through searching online and discussions between staff members in the Leeds faculty, we found only 11 articles that addressed AMR topics and gender specifically. With such low numbers it would be difficult to draw any general conclusions about the relationship between AMR and gender, but it is fair to say that more attention is needed in this area. Each of the studies found trends in their own fields; some found women in China more likely to self-prescribe antibiotics than men, others found trends in types of antibiotics prescribed to each gender. A study in one hospital, worryingly, found that women were at higher risk of death through sepsis than men – a condition requiring emergency antibiotic treatment. While these studies begin to draw attention to the bigger picture, none can give reasoning for the trends they found and state a need for further research.  We know, as people working in public health, that gender plays a huge role in health at all levels from individual ability to access health to institutional biases (usually to the detriment of women and girls). The lack of AMR related research was quite a surprise – given that gender is shown to affect health outcomes globally. It is imperative that we focus high-quality, qualitative study into the possible drivers for antibiotics with the lens of gender: how does gender affect health seeking behaviours relating to antibiotic use? And perhaps most importantly – how can we use this information to influence behaviours and policy towards improved practises?

These questions drive the focus of my research, research I am very much looking forward to undertaking this March. I’ll be based between a Kathmandu office and the field site – located in the Kapilvastu District in the Terai (plains) region. I’m privileged to work alongside the HERDi team to implement a PV workshop based on the CARAN manual and see first-hand what it’s like to work in rural Nepal. I am excited to be part of such an interdisciplinary project, generating community-led solutions and informing policy makers on how best to address the issues of AMR in Nepal.