P0267 - Operationalising a One Health approach to reduce the burden of infection and antimicrobial resistance in under-5 urban slum dwellers: The Childhood Infections and Pollution Consortium (CHIP)

Infections are the leading cause of mortality in children worldwide. Amongst those, respiratory infections and gastrointestinal diseases are the most prevalent. The health effects of these infections are exacerbated by increasing levels of antimicrobial resistance (AMR) due to poor antibiotic governance, particularly in developing nations, where rates of antibiotic consumption and resistance are highest. The aim of Childhood Infections and Pollution Consortium (CHIP) is to reduce the burden of childhood infections and AMR through the co-production of integrated, low-cost behavioural and slum-upgrading interventions using a One Health and technology-enabled Citizen Science approach.

As a multisectoral endeavour, CHIP brings together academics, local residents, community champions, non-governmental organisations, current and former policymakers, engineers and architects, healthcare professionals and veterinarians. Ignited by the lack of evidence-based holistic AMR interventions that integrate both health and environmental issues in slums, CHIP also targets the Sustainable Development Goals (SDGs). We aim to build on current efforts to implement the 2030 agenda for sustainable development by directly capturing SDGs 2, 3, 4, 5, 6, 7, 9, 13 and 16.

Our work involves undertaking a range of methodological approaches to enable us to identify One Health factors leading to infectious diseases in children U5 in partnership with and within our selected communities. Between September-December 2019, we undertook transect walks, social mapping and 1:1 interview with mothers and key informants in Jaipur, Jakarta and Antofagasta. We utilised a geo-tagged action camera in transect walks to observe potential infection pathways. Social mapping with slum-dwellers then produced detailed map of slum-level variables, including demographic and geographic aspects of households, access to general resources and One Health infection determinants. Lastly, 1:1 interview explored community residents’ understanding of infections and pathways, to engage and mobilise the community and understand its social-cultural context, and to discover the feasibility of collecting biological and non-biological samples. With safeguards, high acceptability of data collection was observed.

A conceptual map of One Health factors associated with infections and AMR in U5s living in urban slums was created from the collected data (Fig 1). It summarises the complex relationships we are investigating and serves as a roadmap to identifying specific research questions and designing effective SDGs-focused interventions. The infection pathways involve a complex network of multiple One Health factors and AMR. Recognising community engagement may be sporadic due to financial hardship as some of the slum dwellers have limited free time outside of their labour hours, we concurrently undertook preparatory work for utilising technology-enabled Citizen Science methods to digitise mapping information. This fieldwork allowed us to observe environmental and living conditions, potential human-livestock interactions, potential pathways to infections for children and to explore the feasibility of sampling procedures that would be acceptable to the individual communities.