Studying Antimicrobial Resistance in urban informal settlements through Community-based participatory research (CBPR)

 

Most AMR research has focused mainly on formal healthcare, overlooking the role of the environment. Yet, as cities expand, informal settlements grow, often facing environmental injustices (defined as an inequitable distribution of harms in the human and natural environment) that can worsen AMR. These urban informal settlements (slums) are described as ‘hotspots’ for antimicrobial resistance which is stigmatising. Rather, the marginalised communities face a higher risk of exposure to, and burden of, antimicrobial resistant microbes due to insecure tenure and land rights, poor access to affordable quality healthcare, a lack of formal governance and high exposure to waste, pollution and extreme weather events.

 Our research asks: can informal urban settlements become sites of positive change for AMR? Using community-based, participatory, and arts-driven approaches, we will challenge conventional strategies and explore new pathways across Bangladesh, Kenya, and Nepal. This study brings together diverse disciplines to co-create knowledge on antimicrobial resistance (AMR) within urban informal settlements. It moves beyond the usual framing of formal health systems as “solutions” and informal environments as “problems.”

We aim to:

• Understand community perspectives on the social, structural, and environmental drivers of AMR.
• Measure levels of resistance in informal urban environments.
• Make community priorities for environmental justice visible and actionable.
• Explore how locally generated data can guide ethical, sustainable interventions.

Key environmental justice principles - distributive justice (fair distribution of environmental benefits and burdens), procedural justice (fair and meaningful participation in decisionmaking), and recognition justice (acknowledging and respecting cultural differences and oppressions)- will guide this research, supporting rigorous engagement with the context and disparities in urban informal environments.

By centring community knowledge and agency, this programme will ensure AMR mitigation reflects local values, needs, and aspirations.

(from a forthcoming study proposal)