IDEAS home Printed from https://ideas.repec.org/a/nat/natcom/v16y2025i1d10.1038_s41467-025-64137-z.html
   My bibliography  Save this article

Antimicrobial resistance, equity and justice in low- and middle-income countries: an intersectional critical interpretive synthesis

Author

Listed:
  • Katy Davis

    (Liverpool School of Tropical Medicine)

  • Ralalicia Limato

    (Liverpool School of Tropical Medicine)

  • Meenakshi Monga

    (Liverpool School of Tropical Medicine)

  • Beatrice Egid

    (Liverpool School of Tropical Medicine)

  • Sneha Paul

    (BRAC University)

  • Susan Okioma

    (LVCT Health)

  • Owen Nyamwanza

    (Centre for Sexual Health & HIV/AIDS Research (CeSHHAR))

  • Abriti Arjyal

    (Bhaisepati)

  • Syeda Tahmina Ahmed

    (BRAC University)

  • Ayuska Parajuli

    (Bhaisepati)

  • Mavis Pearl Kwabla

    (University of Health and Allied Sciences)

  • Bachera Aktar

    (BRAC University)

  • Anne S. W. Ngunjiri

    (LVCT Health)

  • Kate Hawkins

    (Pamoja communications)

  • Russell Dacombe

    (Liverpool School of Tropical Medicine)

  • Syed Masud Ahmed

    (BRAC University)

  • Mustapha Immurana

    (University of Health and Allied Sciences)

  • Jane Thiomi

    (LVCT Health)

  • Fidelis EY Anumu

    (University of Health and Allied Sciences)

  • Webster Mavhu

    (Centre for Sexual Health & HIV/AIDS Research (CeSHHAR))

  • Lilian Otiso

    (LVCT Health)

  • Sabina Faiz Rashid

    (BRAC University)

  • Sushil Baral

    (Bhaisepati)

  • Margaret Gyapong

    (University of Health and Allied Sciences)

  • Sally Theobald

    (Liverpool School of Tropical Medicine)

  • Rosie Steege

    (Liverpool School of Tropical Medicine)

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.

Suggested Citation

  • Katy Davis & Ralalicia Limato & Meenakshi Monga & Beatrice Egid & Sneha Paul & Susan Okioma & Owen Nyamwanza & Abriti Arjyal & Syeda Tahmina Ahmed & Ayuska Parajuli & Mavis Pearl Kwabla & Bachera Akta, 2025. "Antimicrobial resistance, equity and justice in low- and middle-income countries: an intersectional critical interpretive synthesis," Nature Communications, Nature, vol. 16(1), pages 1-15, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-64137-z
    DOI: 10.1038/s41467-025-64137-z
    as

    Download full text from publisher

    File URL: https://www.nature.com/articles/s41467-025-64137-z
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1038/s41467-025-64137-z?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Connell, Raewyn, 2012. "Gender, health and theory: Conceptualizing the issue, in local and world perspective," Social Science & Medicine, Elsevier, vol. 74(11), pages 1675-1683.
    2. Samuel O. Abimbola & Melvine Anyango Otieno & Jennifer Cole, 2021. "Reducing the Use of Antimicrobials as a Solution to the Challenge of Antimicrobial Resistance (AMR): Approaching an Ethical Dilemma through the Lens of Planetary Health," Challenges, MDPI, vol. 12(2), pages 1-12, September.
    3. Felipe Lima dos Santos & Ludmilla Leidianne Limirio Souza & Alexandre Tadashi Inomata Bruce & Juliane de Almeida Crispim & Luiz Henrique Arroyo & Antônio Carlos Vieira Ramos & Thaís Zamboni Berra & Ya, 2021. "Patients’ perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study," PLOS ONE, Public Library of Science, vol. 16(4), pages 1-19, April.
    4. Blandhol,Christine & Sautmann,Anja, 2021. "Gender Differences in Children's Antibiotic Use and Adherence," Policy Research Working Paper Series 9542, The World Bank.
    5. Ljungqvist, Gunnar & van Kessel, Robin & Mossialos, Elias & Saint, Victoria & Schmidt, Jelena & Mafi, Alexander & Shutt, Alison & Chatterjee, Anuja & Charani, Esmita & Anderson, Michael, 2025. "Mapping socioeconomic factors driving antimicrobial resistance in humans: an umbrella review," LSE Research Online Documents on Economics 127395, London School of Economics and Political Science, LSE Library.
    6. Maya Ronse & Thuan Thi Nguyen & Xa Xuan Nguyen & Brecht Ingelbeen & Mira Leonie Schneiders & Duong Thanh Tran & Joan Muela Ribera & Charlotte Gryseels & Koen Peeters Grietens, 2024. "Use of antimicrobials and other medical products in an ethnic minority context of South-Central Vietnam: A qualitative study of vulnerability," PLOS Global Public Health, Public Library of Science, vol. 4(4), pages 1-21, April.
    7. Laura Dean & Sally Theobald & Gartee Nallo & Anthony Bettee & Karsor Kollie & Rachel Tolhurst, 2022. "A syndemic born of war: Combining intersectionality and structural violence to explore the biosocial interactions of neglected tropical diseases, disability and mental distress in Liberia," PLOS Global Public Health, Public Library of Science, vol. 2(6), pages 1-25, June.
    8. Chee Tao Chang & Ming Lee & Jason Choong Yin Lee & Nicholas Chor Teng Lee & Tsu Yin Ng & Asrul Akmal Shafie & Kah Shuen Thong, 2021. "Public KAP towards COVID-19 and Antibiotics Resistance: A Malaysian Survey of Knowledge and Awareness," IJERPH, MDPI, vol. 18(8), pages 1-20, April.
    9. Rachel Pain & Caitlin Cahill, 2022. "Critical political geographies of slow violence and resistance," Environment and Planning C, , vol. 40(2), pages 359-372, March.
    10. Aurélie Koho Pungu Shembo & Patou Masika Musumari & Kriengkrai Srithanaviboonchai & Arunrat Tangmunkongvorakul & Olivia Dalleur, 2022. "A qualitative study on community use of antibiotics in Kinshasa, Democratic Republic of Congo," PLOS ONE, Public Library of Science, vol. 17(4), pages 1-14, April.
    11. Naghavi, Mohsen & Vollset, Stein Emil & Ikuta, Kevin S & Swetschinski, Lucien R & Gray, Authia P & Wool, Eve E & Robles Aguilar, Gisela & Mestrovic, Tomislav & Smith, Georgia & Han, Chieh & Hsu, Rebec, 2024. "Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050," Open Access Publications from Kiel Institute for the World Economy 306603, Kiel Institute for the World Economy (IfW Kiel).
    12. Wesam Mansour & Sally Theobald & Fouad M. Fouad & Kyu Kyu Than & Amuda Baba & Joanna Raven, 2025. "The Urgent Struggle for Health Justice in Gaza: A Crisis of Human Rights and Inequity," International Journal of Health Planning and Management, Wiley Blackwell, vol. 40(2), pages 297-299, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Raquel Sánchez-Recio & Cristina García-Ael & Gabriela Topa, 2021. "Influence of Gender Determinants on Informal Care and Health Service Utilization in Spain: Ten Years after the Approval of the Equality Law," Administrative Sciences, MDPI, vol. 11(2), pages 1-21, April.
    2. Michael A. Stawnychy & Ercole Vellone & Valentina Zeffiro & Anne M. Teitelman & Maddalena De Maria & Barbara Riegel, 2023. "Dyad Gender and Relationship Quality Influence Heart Failure Self-Care," Clinical Nursing Research, , vol. 32(1), pages 29-39, January.
    3. Caroline Olsson & Helena Tinnerholm Ljungberg & Elisabeth Björk Brämberg & Lotta Nybergh & Irene Jensen, 2023. "A gender perspective on perceived causes of sick leave due to common mental disorders among young Swedish employees: A qualitative interview study," PLOS ONE, Public Library of Science, vol. 18(9), pages 1-20, September.
    4. Richards, Esther & Theobald, Sally & George, Asha & Kim, Julia C. & Rudert, Christiane & Jehan, Kate & Tolhurst, Rachel, 2013. "Going beyond the surface: Gendered intra-household bargaining as a social determinant of child health and nutrition in low and middle income countries," Social Science & Medicine, Elsevier, vol. 95(C), pages 24-33.
    5. Phyllis Dako-Gyeke & Adolphina Addoley Addo-Lartey & Deda Ogum Alangea & Yandisa Sikweyiya & Esnat Dorothy Chirwa & Dorcas Coker-Appiah & Rachel Jewkes & Richard Mawuena Kofi Adanu, 2019. "'Small small quarrels bring about happiness or love in the relationships’: Exploring community perceptions and gendered norms contributing to male perpetrated intimate partner violence in the Central ," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-22, November.
    6. Emma Brulin & Sofie Bjärntoft & Gunnar Bergström & David M. Hallman, 2023. "Gendered Associations of Flexible Work Arrangement and Perceived Flexibility with Work–Life Interference: A Cross-Sectional Mediation Analysis on Office Workers in Sweden," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 167(1), pages 571-588, June.
    7. Perez-Brumer, Amaya & Valdez, Natali & Scheim, Ayden I., 2024. "The anti-gender threat: An ethical, democratic, and scientific imperative for NIH research/ers," Social Science & Medicine, Elsevier, vol. 351(S1).
    8. Reczek, Corinne, 2012. "The promotion of unhealthy habits in gay, lesbian, and straight intimate partnerships," Social Science & Medicine, Elsevier, vol. 75(6), pages 1114-1121.
    9. Homan, Patricia, 2024. "Health consequences of structural sexism: Conceptual foundations, empirical evidence and priorities for future research," Social Science & Medicine, Elsevier, vol. 351(S1).
    10. Syed Wajid Ali Shah & Mujaddad ur Rehman & Muhammad Tauseef & Ejazul Islam & Azam Hayat & Samina Iqbal & Muhammad Arslan & Muhammad Afzal, 2022. "Ciprofloxacin Removal from Aqueous Media Using Floating Treatment Wetlands Supported by Immobilized Bacteria," Sustainability, MDPI, vol. 14(21), pages 1-14, October.
    11. Miguel Roselló-Peñaloza & Lukas Julio & Izaskun Álvarez-Aguado & Maryam Farhang, 2024. "Abuse in Chilean Trans and Non-Binary Health Care: Results from a Nationwide Survey," Social Sciences, MDPI, vol. 13(4), pages 1-16, April.
    12. Katharine J McCarthy & Ruchi Mehta & Nicole A Haberland, 2018. "Gender, power, and violence: A systematic review of measures and their association with male perpetration of IPV," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-27, November.
    13. Sharifah Aminah Syed Anwar Aly & Rahana Abdul Rahman & Shalisah Sharip & Shamsul Azhar Shah & Zaleha Abdullah Mahdy & Aida Kalok, 2021. "Pregnancy and COVID-19 Pandemic Perception in Malaysia: A Cross-Sectional Study," IJERPH, MDPI, vol. 18(11), pages 1-11, May.
    14. Yamin, Alicia Ely & Bazile, Junior & Knight, Lucia & Molla, Mitike & Maistrellis, Emily & Leaning, Jennifer, 2015. "Tracing shadows: How gendered power relations shape the impacts of maternal death on living children in sub Saharan Africa," Social Science & Medicine, Elsevier, vol. 135(C), pages 143-150.
    15. García-Calvente, Mar & Marcos-Marcos, Jorge & del Río-Lozano, María & Hidalgo-Ruzzante, Natalia & Maroto-Navarro, Gracia, 2012. "Embedded gender and social changes underpinning inequalities in health: An ethnographic insight into a local Spanish context," Social Science & Medicine, Elsevier, vol. 75(12), pages 2225-2232.
    16. Arulsamy, Karen & McNamee, Paul & Mendolia, Silvia, 2025. "The gendered impact of Covid-19 on health behaviours and mental health: Evidence from the UK," Social Science & Medicine, Elsevier, vol. 365(C).
    17. Agénor, Madina & Krieger, Nancy & Austin, S. Bryn & Haneuse, Sebastien & Gottlieb, Barbara R., 2014. "At the intersection of sexual orientation, race/ethnicity, and cervical cancer screening: Assessing Pap test use disparities by sex of sexual partners among black, Latina, and white U.S. women," Social Science & Medicine, Elsevier, vol. 116(C), pages 110-118.
    18. Jennifer Cole & Adam Eskdale & Jonathan D. Paul, 2022. "Tackling AMR: A Call for a(n Even) More Integrated and Transdisciplinary Approach between Planetary Health and Earth Scientists," Challenges, MDPI, vol. 13(2), pages 1-11, December.
    19. Gavin George & Leena Maqsood & Courtenay Sprague, 2024. "Balancing risk and reward: exploring women’s transactional sexual relationships with Blessers in South Africa," Humanities and Social Sciences Communications, Palgrave Macmillan, vol. 11(1), pages 1-9, December.
    20. Katariina Pärnänen & Matti O. Ruuskanen & Guilhem Sommeria-Klein & Ville Laitinen & Pyry Kantanen & Guillaume Méric & Camila Gazolla Volpiano & Michael Inouye & Rob Knight & Veikko Salomaa & Aki S. Ha, 2025. "Variation and prognostic potential of the gut antibiotic resistome in the FINRISK 2002 cohort," Nature Communications, Nature, vol. 16(1), pages 1-13, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-64137-z. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.nature.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.