Understanding the home as a source of infection of AMR bacteria carried by dust by exploring hygiene practices in different home environments in Ghana

Lead Research Organisation: Lancaster University
Department Name: Lancaster Inst for the Contemporary Arts

Abstract

The Dust Bunny project will apply design methods coupled with microbiological analyses to address issues of home-based infections in Ghana, particularly those carrying antimicrobial resistance, resulting in a reduction of infection and in positive increase of health outcomes.

Bacteria found in the natural and built environment (e.g. homes, schools, hospitals, etc.) are building up a resistance to drugs -changing to protect themselves against antibiotics. What this means is that in the not-too-distant future, something as simple as a minor cut infection could become life-threatening. This is such a concern that antimicrobial resistance (AMR) is now considered a global health crisis, far surpassing outbreaks of diseases such as Ebola and as real as climate change. This is even more evident and critical in developing countries in Africa, such as in Ghana, where there are a great number of deaths from infectious diseases.

Bacteria are made up of pathogens (bad germs) and non-pathogens (good germs) and are generally scattered across the home. Most surfaces in the home are covered to a certain degree with bacteria, but unlike fixed surfaces such as kitchen work surfaces and furniture, dust can move more easily around different parts of the home and therefore presents a major route for human exposure to bacterial infections.
Despite being clear evidence for microbial exposure and infection transmission within the home, there has been less research effort invested in understanding the home environment, due to difficulty of conducting detailed studies. Although the transmission routes by dust in the home environment are well known, what has not been studied is how to prevent bacterial infection at home and thereby reduce resistance.

Particularly in developing countries, such as Ghana, social inequalities mean a range of different quality and types of homes; this combined with often poor levels of domestic hygiene that is influenced by a number of economic, educational and religion factors, contributes to the spread of infectious diseases.

Although there are hygiene guidelines available for preventing infection in the home environment, these are targeted at hygiene professionals and do not reach the everyday household in Ghana. There is therefore a much-required and unmet need to identify, understand and develop domestic hygiene practices that are relevant to different home environments, educational and cultural backgrounds in developing countries, such as in Ghana, in order to reduce exposure to bacteria pathogens and thereby exposure to resistance forms.

Within this context, the Dust Bunny project aims at developing an understanding of the home as a source of infection of bacteria, resistant to antibiotics, found and carried by dust. This will be done by exploring hygiene practices across different home environments in Ghana, with the ultimate aim to reduce bacterial infection in the home environment thereby reducing AMR.

Understanding the hygiene practices in the household and interactions with airborne AMR bacteria will serve as a first step to designing appropriate education/information dissemination materials for various sections of the Ghanaian population as well as other low- and middle-income countries in Africa.

Dust Bunny, uniquely combines design research and microbiology to provide an informed assessment of societal practices in domestic cleanliness and novel solution to reduce infections in the home. The project team includes Imagination@Lancaster -an internationally leading research institution in design research- and the Noguchi Memorial Institute for Medical Research -a research centre of excellence and the prime biomedical research institution in Ghana, involved with the Ghana Health Service and Ministry of Health in providing the evidence to effect policy changes.

Planned Impact

Building on the 4 identified impacts in our Pathways to Impact document, here we expand on who we envisage benefiting from this research and develop further how they would benefit:

[IO1] Disseminating the findings: to academic and non-academic audiences in the UK and Ghana. Mechanisms, such as the project website, social media, regular dissemination trough the AHRC, ESRC AMR Champions and NERC AMR Programme Leader, academic (conference & journal papers) and non-academic publications (press releases/media briefings & newsletters via our partners, the Design Council, EPN/ReAct Africa, Zoomlion, Global Hygiene Council) will help in achieving this.

[IO2] Raising the profile: to engage appropriate stakeholders thereby bringing the research to the attention of a wider audience and solicit feedback as research insights emerge. Through our collaborators we will engage government and health policy makers who are actively involved in healthcare and AMR reduction such as the Ghanaian government, World health Organisation and United Nations Development programme. By engaging our governmental and non-governmental partners, the outcomes of this study will help to further inform Ghana's national antimicrobial resistance policy; and will further help inform future policy interventions to change the daily routine of hygiene practice to reduce bacterial pathogens and thereby exposure to antibiotic resistant forms which complicate and prevent effective treatment of diseases. Mechanisms for this include our advisory panel and project partners, co-design workshops with communities and expects in Ghana; a thought leaders workshop and development of personas of hygiene practices across different user groups.

[IO3] Engaging and co-developing: with the aim of ensuring shared ownership of the action plan, the research insights will be co-developed through engagement with key stakeholders and beneficiaries including discussions with key influencers at regional and national levels. We will engage wider society/community, usually via a relatively small group of change makers within communities, to inform and be informed by research, and so to co-design and implement the 'smart solutions' that are appropriate to the domestic environment on a range of social scales. To this end, the project will feed information and possible changes to Ghana's government-driven goal of reducing antimicrobial resistance, which uses the React toolbox incorporating into React Ghana's (one of our project partners) national AMR policy through its national AMR policy. Mechanisms for achieving this includes community engagement in Ghana through seminars, workshops, flyers in schools, churches, mosques and other relevant community access points; development of storyboards & other dis/nation material of co-designed hygiene practices; follow-on GCRF bid scoping workshop in Ghana.

[IO4] Capacity building and Knowledge Exchange: on hygiene practices, design-based and AMR based research in low and middle income countries in the African continent, such as in Ghana (for UK and Ghanaian researchers). Building capacity to deliver strategic development goals (3: Good health and well-being; 11: Sustainable cities and communities) from research in science & technology, which here encompasses microbiology and design, requires more than just research and training in those disciplines. It also demands research and training in the social and management sciences that maximises the capacity for translation to life influencing design in wider communities to shape the design, development and exploitation of this project. Our strategy is to build capacity and capability is fundamentally interdisciplinary. Mechanisms for this include our project partners (Design Council, EPN/ReAct Africa, Zoomlion, Global Hygiene Council), research exchange and training of the UK & Ghanaian researchers of the project and capacity building and knowledge exchange workshops to be held in the UK & Ghana.

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